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

Disclosure

Össur: supply of the abduction braces

2 NVA Jaarcongres | F. Hollman | 4 april 2014

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

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

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

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

ResultsPain

7 NVA Jaarcongres | F. Hollman | 4 april 2014

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

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

Complicatiebespreking | R.Huijbregts | 22 april 202310