abductionbrace versus sling after arthroscopic cuff repair the effect on pain and function...
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Abductionbrace versus Sling after arthroscopic cuff repair
The effect on pain and functionRandomised controlled trial
Freek Hollman, Nienke Wolterbeek, Jacco Zijl, Sjoerd van Egeraat,
Tom Mooij, Ronald Wessel
Department of orthopaedic surgery
St. Antonius Hospital
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Disclosure
Össur: supply of the abduction braces
2 NVA Jaarcongres | F. Hollman | 4 april 2014
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3
Introduction and purpose
Antirotation sling: adduction and endorotation
increased tension SST/IST
Abduction brace: abduction and neutral rotation
less tension SST/IST
Hypothesis: there will be less tension on the repaired tendons and thereby less pain with the abduction brace compared to the antirotation sling.
Jerosch J, et al. 1993
Stiglitz Y, et al. 2011
NVA Jaarcongres | F. Hollman | 4 april 2014
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Material and methods (1)
• Randomized controlled trial.
• N=40 (P= 0.05 (α), power 80%, dropout of 10%).
• Consecutive patients.
• Traumatic or degenerative full-thickness SST and/or IST tear on MRI.
NVA Jaarcongres | F. Hollman | 4 april 20144
Inclusion criteria Exclusion criteria
Age 18-75 yrs Chronic pain disease (fibromyalgia)
Full thickness cuff tear BMI>35
Reparable cuff tear
+/- Subacromial decompression
+/- Bicepstenotomy/tenodesis
Labral repair/lesion
Lateral clavical resection
Partial repair
Subscapularis tendon repair
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Material and methods (2)
Preoperative
• MRI: fatty infiltration, atrophy, retraction, location
Peroperative
• Thomazeau (saggital/coronal); Bateman; tension
Follow-up
• 6 weeks immobilization
• Pain: patient diary 12 weeks
• Function: 6 weeks, 3 months, 6 months
Constant score, GH-ROM, WORC, QOL, level of satisfaction
• Ultrasound at 3 months5 NVA Jaarcongres | F. Hollman | 4 april 2014
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Results preliminary baseline
Variables Sling (n=11) Brace (n=13) P-value
Age (years ± SD) 61.5 ± 10.4 61.2 ± 7.4 ns
Gender (M:F) 4:7 8:5 ns
Traumatic:Degenerative 6:5 7:6 ns
Retraction SST (1:2:3:4) 6:5:0:0 6:2:4:1 ns
Fatty infiltration SST (1:2:3:4) 6:5:0:0 2:9:2:0 ns
Fatty infiltration IST (1:2:3:4) 4:7:0:0 2:8:2:1 ns
Tear size (Bateman (1:2:3:4)) 4:4:2:1 1:8:0:4 ns
Tension (0:1:2:3:4) 3:5:2:1:0 3:12:6:2:1 ns
Margin convergence (n) 2 4 ns
NVA Jaarcongres | F. Hollman | 4 april 20146
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ResultsPain
7 NVA Jaarcongres | F. Hollman | 4 april 2014
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ResultsFunction/QOL
WORC CMS abduction exorotation
Preop Sling 36.3 39.0 82.3 71.5
Brace 42.2 40.2 76.9 67.5
8
6 weeks Sling 44.2 27.2 61.8 38.9
Brace 56.2 35.3 61.5 44.2
NVA Jaarcongres | F. Hollman | 4 april 2014
3months
Sling 61.0 52.5 68.6 54.7
Brace 74.7 64.1 78.5 58.8
6 months
Sling 81.6 76.0 75.5 62.5
Brace 88.4 81.8 79.2 68.8
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Conclusion
• On the short term the level of pain, QOL and function was not significantly different between groups.
• No retears were observed.
• Study results might be significantly different when completed.
9 NVA Jaarcongres | F. Hollman | 4 april 2014
Discussion
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Complicatiebespreking | R.Huijbregts | 18 april 202310