Association of Biceps Tendon Lesions with Rotator CuffTears and a Meta-analysis for Timing of Rehabilitationafter Rotator Cuff Repair

• Main Authors: Ke-Vin Chang, 張凱閔
• Other Authors: 簡國龍
• Format: Others
• Language: en_US
• Published: 2015
• Online Access: http://ndltd.ncl.edu.tw/handle/87589998389605747675

博士 === 國立臺灣大學 === 流行病學與預防醫學研究所 === 103 === Background and objectives: Limited numbers of studies investigated the association between rotator cuff (RC) tears and the long head of biceps tendon (LHBT) pathology.There is no consensus about the best timing to initiate passive range of motion (PROM)exercise following RC repair. The dissertation aims to explore the relationships between RC tears and LHBT pathology and also to compare outcomes between early and delayed PROM exercise for patients receiving arthroscopic RC repair. Methods: We investigated reports of patients undergoing shoulder ultrasound examinations between January 2011 and January 2012. Biceps peritendinous effusion (BPE) was graded according to its measured thickness, as absent (<1 mm), mild (1–2 mm), moderate (2–3 mm), or severe (>3 mm). The associations between BPE and RC tears were examined using logistic regression. Regarding the morphological association between RC tears and LHBT morphology, cases with supraspinatus tendon full thickness tear (SSFT) and age-and- gender-matched controls were chosen. The width, thickness, flattening ratio, cross-sectional area, and echogenicity ratio of the LHBT were measured and analyzed by a linear regression model. The receiver operating characteristic curves of each parameter were constructed for SSFT discrimination. Regarding the rehabilitation protocol for patients following arthroscopic RC repair, we used a systematic review and meta-analysis to compare early and late PROM exercise. Results: In 907 shoulder pain patients, SSFT was significantly associated with the entire spectrum of BPE, while subscapularis tendon tear was significantly associated with moderate to severe BPE. Severe BPE was associated with articular-sided partial-thickness tear of the supraspinatus tendon. SSFT was associated with an increase in the thickness and cross-sectional area and a decrease in the flattening ratio of LHBT. The flattening ratio was the best discriminator for SSFT with an area under curve of 0.81 [95% confidence interval (CI), 0.76–0.86]. Regarding the meta-analysis, 6 RCTs were included, comprising 482 patients. Although the early ROM group demonstrated more ROM improvement than the delayed rehabilitation group, no difference in shoulder function was identified between both protocols. Early ROM exercise tended to cause a higher rate of recurrent tendon tear, and the effect became statistically significant (odds ratio, 1.93, 95% CI, 1.04-3.60) after excluding 2 trials that recruited only patients with small to medium-sized RC tears. Conclusions: The thesis indicated BPE was related to various shoulder abnormalities. SSFT was associated with the morphology changes of the extra-articular LHBT examined using ultrasound. Regarding patients following arthroscopic rotator cuff repairs, a proper choice of either rehabilitation protocol should be established based on an assessment of risks between recurrent tears and postoperative shoulder stiffness.