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Objective: To investigate the Young's modulus value of infraspinatus tendons using shear wave elastography (SWE) technique in normal adults, and to analyze the influence of gender, postures, exercise, and dominant side on Young's modulus of infraspinatus tendons., Methods: This is a prospective cross-sectional study. From January 2019 to July 2020, 14 healthy subjects were identified, including seven males and seven females aged between 24 to 34, with a mean age of 27.67 ± 3.08 years. The Young's modulus of their infraspinatus tendons was measured by two operators using SWE in neutral and maximum external rotation positions of both sides before exercise and the dominant side after exercise. The Young's modulus values in different sexes, different postures, before vs after exercise, and dominant vs non-dominant side were statistically analyzed., Results: All 14 subjects completed the data collection process. The mean Young's modulus values of infraspinatus tendon for dominant sides in neutral position were 33.04 ± 3.01 kPa for males and 28.76 ± 3.09 kPa for females. And for non-dominant sides in the neutral position, the values were 33.02 ± 2.38 kPa for males and 28.86 ± 2.47 kPa for females. In the maximum external rotation position, the values for dominant sides were 50.19 ± 4.86 kPa for males and 42.79 ± 4.44 kPa for females, and for non-dominant sides were 50.95 ± 3.24 kPa for males and 42.42 ± 3.66 kPa for females. After exercise, the mean Young's modulus values of infraspinatus tendon for dominant sides in neutral position were 54.56 ± 3.76 kPa for males and 46.66 ± 5.99 kPa for females. And for the maximum external rotation position, the values were 59.13 ± 3.78 kPa for males and 54.49 ± 5.67 kPa for females. The Young's modulus of infraspinatus tendon in the neutral and maximum external rotation positions showed statistically significant differences in males and females, as well as before and after exercise (P < 0.05). However, the difference in Young's modulus between the dominant and non-dominant sides was not statistically significant (P > 0.05). Intergroup reliability between both operators was excellent (ICC > 0.85)., Conclusion: There are gender-related differences and post-exercise increase in Young's modulus, yet such a difference cannot be witnessed between the dominant and non-dominant sides., (© 2021 The Authors. Orthopaedic Surgery published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.)

Purpose: To explore whether the critical shoulder angle (CSA) and acromion index (AI) on nonstandard anteroposterior (AP) radiographs could be used as parameters for rotator cuff tear (RCT) diagnosis and to determine the optimized parameters., Methods: This study included 174 patients with RCTs or intact rotator cuffs in whom AP radiographs were obtained at our hospital. The radiographs were assessed by 2 independent radiologists and were grouped according to the Suter-Henninger criteria. The CSA and AI were measured on all films. We performed receiver operating characteristic curve analysis by calculating the area under the curve (AUC) to compare the sensitivity and accuracy of both parameters., Results: Of the 174 enrolled patients, only 47 (27%) met the requirements for standard AP films (types A1 and C1). On standard AP films, both the CSA and AI were significantly different between the RCT and control groups (P < .001 for CSA and P < .001 for AI), with AUCs of 0.86 and 0.80 for the CSA and AI, respectively. On nonstandard AP films (other radiograph types), the mean CSA value was not significantly different between the RCT and control groups (P = .536) whereas the AI showed a significant difference (P = .024). The AUCs were 0.57 for the CSA and 0.64 for the AI., Conclusions: On standard AP films, both the CSA and AI could predict rotator cuff disorders, and the CSA had a higher diagnostic accuracy than the AI. In contrast, on nonstandard AP films, the diagnostic efficacy of the AI was better than that of the CSA. On the basis of this study, we suggest an evaluation of the AP films of patients before diagnosis to confirm whether the AP films meet the criteria for standard AP films., Level of Evidence: Level I, diagnostic study., (Copyright © 2019 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Objective: To determine the functional outcomes after a novel method of H‐loop knotless double‐row technique in patients with rotator cuff tears. Method: From June 2020 to September 2020, a total of six patients (five women, one man) with arthroscopic rotator cuff repair using the H‐loop knotless double‐row technique were enrolled in our study. The average age is 54 years (range: 50–61 years). The preoperative and final follow‐up clinical outcome were evaluated using the American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS), University of California Los Angeles (UCLA) score, and Constant–Murley score. The active shoulder range of motion (ROM) was also collected preoperatively and postoperatively at the final follow‐up (forward flexion and abduction). Accordingly, intraoperative and postoperative complications were observed as well. Result: There were six patients that underwent arthroscopic rotator cuff repair using the H‐loop knotless double‐row technique. The average follow‐up period was 7.52 ± 0.70 months. The VAS, UCLA, ASES, and Constant–Murley scores improved from 5 ± 2.45, 15.67 ± 3.44, 47.67 ± 17.41 and 49.17 ± 8.98 preoperatively, to 0.83 ± 0.75, 36.27 ± 3.83, 91.67 ± 10.76 and 85.83 ± 4.31 at the final follow‐up, with statistical significances of P = 0.009, P < 0.001, P = 0.006, and P = 0.001, respectively. Meanwhile, the active shoulder ROM (forward flexion and abduction) improved from 135.00 ± 46.80 and 125 ± 56.48 preoperatively, to 173.67 ± 4.13 and 172 ± 3.27 at final follow‐up, respectively (P = 0.082, P = 0.088). During the follow‐up, there were no postoperative complications such as wound‐site infection, nerve or vessel damage, subcutaneous hematoma, and suture anchor problems. Conclusion: With the benefit of reducing the possibility of strangulation and blood supply affection for the rotator cuff, The H‐loop knotless double row technique may be an alternative method to significantly improve subjective functional outcomes and increase the healing rate of medium‐sized rotator cuff tears with degeneration issues and poor tissue quality. [ABSTRACT FROM AUTHOR]

Background: The critical shoulder angle (CSA), which helps to predict patients who are at risk of rotator cuff tears (RCTs) with large degree and who are susceptible to osteoarthritis with low angle, has been identified as one of the most vital acromial parameters; anterolateral and lateral acromioplasties have been proven to be valid ways to reduce CSA. However, no study has compared the effect of different acromioplasties on the reduction of the large CSA (≥33°) clinically. Additionally, either anterolateral or lateral acromioplasty could not precisely correct large CSAs to a favorable range (30-33°) in each patient. Thus, we will propose a novel precise acromioplasty technique for the purpose of reducing CSA accurately and effectively, and compare the effectiveness of different acromioplasties on the reduction of the CSA.Methods: A total of 60 RCT patients who have indications for arthroscopic rotator cuff repair and with pre-operative CSA ≥33° will be recruited in outpatient center of Sun Yat-sen Memorial Hospital. Eligible participants will be randomly allocated to Group A (anterolateral acromioplasty), Group B (lateral acromioplasty) or Group C (precise acromioplasty) via a random, computer-generated number system. Three surgical plans will be made for each participant respectively by one professional surgeon according to the results of randomization allocation. The post-operative CSA will be measured 2 days post-operation. Follow-up will be maintained at 3, 6, and 12 months after surgery including the visual analog scale score, the University of California at Los Angeles score, the Constant Shoulder Score and the American Shoulder and Elbow Surgeon Shoulder Assessment Form. Finally, all outcomes will be assessed by two researchers who are blinded to the recruitment and allocation.Discussion: This is the first clinical trial to evaluate the impact of different acromioplasties on the reduction of the CSA. Additionally, this study will provide a new precise acromioplasty technique, which is a novel precision and individualized treatment to prevent degenerative RCTs by reducing the CSA.Trial Registration: ChiCTR2000032343 . Registered on April 26th, 2020. [ABSTRACT FROM AUTHOR]

Background: Lack of physical therapists has led to increment of self-managed rehabilitations in post-arthroscopic rotator cuff repair (ARCR) in the forms of booklets or leaflets. Purpose: The aim of study is to investigate 1) the acceptance of post-ARCR patients towards an education booklet, and 2) whether it could be a timesaving and laborsaving tool to physical therapists. Methods: An education booklet was established through a systematic review. Patients who underwent ARCR in our hospital were included and randomly assigned to the intervention or control group (27 women, 21 men, mean age = 57.06 years old). Patients in the intervention group received educational booklets, and an evaluation was also obtained after they finished reading. Patients' understanding of the booklet was determined by asking patients to re-enact training presented in the booklet. Then, a therapist blinded to allocations would personally demonstrate training to patients until patients fully understood the protocol. For the control group, the same therapist coached patients until the whole protocol was clearly understood. The coaching time for patients in both groups was recorded. Results: Out of 48 patients, 24 (50%) were randomly assigned to the intervention group, and 21 (87.50%) completed their questionnaire. Out of these 21 patients, 20 (95.24%) rated the booklet as "excellent and easy to read", and 17 (80.95%) felt that the booklet was helpful. The re-enaction accuracy was for strengthening training and specific training (71.43% and 61.90%, respectively). As compared to the control group, the time of coaching for the patients to fully master the protocol in the intervention group was significantly less (P< 0.01). Conclusion: Patients highly applauded this booklet, and they cherished the information and support it contained. Nevertheless, the re-enaction accuracy was not high, suggesting that the high level of acceptance does not guarantee full understanding of information sent to patients. [ABSTRACT FROM AUTHOR]