Rotator cuff injury is one of the common injuries of the shoulder joint. The tendon-bone interface is the special organizational structure of the multi-layer structure of bone, fibrocartilage and tendon. Further, it has stress concentration point. Thus, rotator cuff injury is often difficult to heal spontaneously once injuries and it has a higher re-tear rate after surgical intervention. Platelet-rich plasma (PRP) is obtained by concentrating autologous whole blood. Its platelet concentration is higher than the baseline level of whole blood. It also contains various growth factors and other blood components. At present, it has been widely used in treating orthopedics, skin and oral disorders. In recent years, the application of PRP in rotator cuff injury has attracted attention. PRP can assist the treatment of rotator cuff injury in regulating inflammation, angiogenesis, matrix synthesis and tissue remodeling. The use of PRP after rotator cuff repair can improve the postoperative shoulder joint function score, relieve postoperative pain in the short term, and effectively reduce the rotator cuff re-tear rate. However, the efficacy of PRP in treating rotator cuff injuries is affected by many factors, such as the type of PRP, the severity of rotator cuff tear, and different using approaches. Currently, we focus on PRP in the treatment of rotator cuff injury, aiming to systematically explain the differences among different studies and reveal the differences in the efficacy of PRP with varied components and different forms of administration. Moreover, we want to provide a reference for the proper and rational use of PRP in the treatment of various rotator cuff injuries. Meanwhile, the present review could provide a basis for future researches in the application of PRP for rotator cuff injury.

Objective:To investigate the long-term effect of open reduction and internal fixation and one stage rotator cuff repair in treatment of proximal humeral fractures combined with rotator cuff tear.Methods:A retrospective case series study was performed on clinical data of 40 patients with proximal humeral fractures combined with rotator cuff tear admitted to Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 2012 to December 2015. There were 24 males and 16 females, aged 52-93 years [(72.5±10.2)years]. According to Neer classification, there were 7 patients with two-part proximal humerus fractures, 27 with three-part proximal humerus fractures and 6 with four-part proximal humerus fractures. All patients received open reduction and internal fixation using locking plates and one stage rotator cuff repair. Functional shoulder exercises were carried out after operation. Fracture healing and wound healing were observed postoperatively. Shoulder active motion, visual analogue score (VAS) and University of California at Los Angeles (UCLA) shoulder rating scale were assessed and compared before operation and at the last follow-up.Results:All patients were followed up for 4.5-8.5 years [(6.2±1.2)years]. All wounds and fractures healed without infection or nonunion. At the last follow-up, the active forward elevation of affected shoulder was 100°-150° [(121.8±15.8)°], the external rotation with the shoulder in neutral position was 30°-80° [(47.0±15.9)°], the external rotation with the shoulder abduction was 60°-80° [(73. 5±6.2)°], the internal rotation with the shoulder abduction was 60°-80° [(70.5±7.1)°], showing significant differences compared to preoperative 30°-60° [(44.8±11.1)°], 0°-30° [(12.0±10.4)°], 0°-30° [(13.8±7.7)°], 30°-60° [(47.0±8.5)°], respectively (all P<0.01). The VAS was 1 (0, 1)points at the last follow-up, and was 6(5, 6)points before operation ( P<0.01). The UCLA shoulder rating scale was 28-35 points [(31.0±2.3)points] at the last follow-up, compared with preoperative 8-11 points [(10.3±0.8)points] ( P<0.01), and rated as excellent in 10 patients, good in 23 and poor in 7, with the excellent-good rate of 83%. Conclusion:For patients with proximal humeral fractures combined with rotator cuff tear, open reduction and internal fixation and one stage rotator cuff repair can significantly restore the shoulder motion, relieve the pain and recovery shoulder function, and the long-term therapeutic effect is satisfactory.

Objective To evaluate the prevalence of full thickness rotator cuff tear in patients with proximal humeral fractures,and the relationships between different risk factors.Methods Data of 113 patients with proximal humeral fractures from January 2014 to January 2016 who underwent surgical treatment were retrospectively analyzed.The general characteristics of patients (age,sex,cause of injury) were recorded and the rotator cuff was evaluated preoperatively on MRI and explored intra-operatively.We calculated and compared the incidence rate of age,sex in patients with and without rotator cuff tear.And the incidence rate of rotator cuff tear in different types of fracture according to Neer classification was calculated.Results The full thickness ro tator cuff tear were indentified in 28 patients (24.8％),and 21 of them had been confirmed by MRI preoperatively.Statistical significant difference was found between patients with rotator cuff tear group (average of 75.11± 10.89 years old) and without rotator cuff tear group (64.68± 13.43) for the age of the patient.Full thickness rotator cuff tear was most common in Neer 3 GT fracture (33.3％,8/54),followed by Neer 2 GT (26.67％,4/15) and Neer 2 SN (17.65,6/34),however,no full thickness rotator was found in Neer 4 type fracture.There were 4 patients with total rotator cuff tear who had symptom of shoulder before the operation.The other 24 patients had no symptom of shoulder.Conclusion Patient age was found as a risk factor for full thickness rotator cuff tear in humeral proximal fractures with the rate of 24.8％.Full thickness rotator cuff tear was most common in Neer 3 GT fracture.

Objective: To investigate the clinical efficacy of arthroscopic irrigation combined with surgical debridement in the treatment of shoulder infection after arthroscopic rotator cuff repair. Methods: Data of 4 post-operative infected patients [(male 3 cases, female 1 case; 55 years (51-61 years)] after arthroscopic rotator cuff repair who underwent arthroscopic irrigation combined with surgical debridement from January 2016 to June 2019 were retrospectively analyzed. Less than 1 month after surgery, swelling, pain in the surgical area occurred and all patients had fever, abscess and sinus. Hematology and radiology were conducted immediately after admission. Antibiotic treatment was applied, and adjusted according to the culture results timely. All patients underwent arthroscopic irrigation combined with surgical debridement. Antibiotics continued accordingly after the operation. Blood routine, erythrocyte sedimentation rate, C-reactive protein, X-ray, etc. were rechecked regularly to evaluate the symptomatic relief of the infection and prognosis. Visual analogue scale (VAS) and American Shoulder and Elbow Surgeons (ASES) score were used to evaluate shoulder function during the pre-operative and post-operative follow-up period. Results: The surgery was successfully completed in all 4 patients. One was treated with VSD for vacuum suction and the wound was closed one week later. The results of microbial culture showed that 2 cases were Mycobacterium tuberculosis positive, 1 case Pseudomonas aeruginosa positive, and 1 case was Staphylococcus aureus positive. After treatment, the shoulder sinuses of all patients were healed, without swelling, pain, etc. The follow-up time was 3, 4, 32, and 33 months, respectively. There was no recurrence of infection until the latest follow-up. The joint mobility and scores were better than the situation of preoperative. The VAS score and ASES score of 2 patients with early debridement (< 1 month duration of infected symptoms) were respectively improved significantly from 5 and 40, 6 and 23 before operation to 1 and 80, 1 and 73 respectively at the latest follow up. The VAS score and ASES score of other 2 patients (> 6 months duration of infected symptoms) were respectively improved from 6 and 28, 6 and 32 to 1 and 62, 2 and 65 respectively. All patients were satisfied with the results. Conclusion Early arthroscopic irrigation combined with surgical debridement is an effective method to treat the post-operative infections after arthroscopic rotator cuff repair.

BACKGROUNDThe purpose of this retrospective study was to compare the surgical outcomes of simple discectomy and instrumented posterior lumbar interbody fusion (iPLIF) in patients with lumbar disc herniation and Modic endplate changes. Our hypothesis was that iPLIF could provide better outcome for patients with refractory lumbar disc herniation and Modic changes (LDH-MC).

METHODSNinety-one patients with single-segment LDH-MC were recruited. All patients experienced low back pain as well as radicular leg pain, and low back pain was more severe than leg pain. Forty-seven patients were treated with discectomy and 44 were treated with iPLIF. The outcomes of both low back pain and radicular leg pain using visual analogue scale (VAS) as well as the clinical outcome related to low back pain using Japanese Orthopaedic Association (JOA) score were assessed before and 18 months after surgery, respectively.

RESULTSBoth low back and leg pain were significantly improved 18 months after simple discectomy and iPLIF. Compared to patients undergoing simple discectomy, low back pain was significantly reduced in patients undergoing iPLIF, but there was no significant difference in leg pain between two groups. Solid fusion was achieved in all patients who underwent iPLIF.

CONCLUSIONSIn patients with LDH-MC, iPLIF can yield significantly superior outcome on the relief of low back pain compared to simple discectomy. Simple discectomy can relieve radicular leg pain as efficient as iPLIF. Accordingly, iPLIF seems to be a reliable treatment for patients with LDH-MC and predominant low back pain.

Adult ; Diskectomy ; standards ; Female ; Humans ; Intervertebral Disc Displacement ; surgery ; Low Back Pain ; surgery ; Lumbar Vertebrae ; surgery ; Middle Aged ; Retrospective Studies ; Spinal Fusion ; standards