Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Effectiveness of the Anti-adhesive Agent Protescal after Arthroscopic Rotator Cuff Repair: A Retrospective Study

  • Chung, Pill Ku (Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yoo, Jae Chul (Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jeong, Jeung Yeol (Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2016.07.09
  • Accepted : 2016.09.18
  • Published : 2017.03.31
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Abstract

Background: Many hyaluronic acid (HA)-based anti-adhesive agents have been commercialized for clinical use in the pharmaceutical market. But their efficacy in arthroscopic rotator cuff repairs remains elusive. To determine their efficacy, we performed a comparative analysis of the effects of two hyaluronate/carboxymethylcellulose (CMC)-based anti-adhesive agents, Protescal and Guardix. Methods: We recruited a total of 256 patients who had received an arthroscopic rotator cuff repair at our hospital between January 2014 and March 2015. Among them, 96 patients fulfilled the study's selection criteria and were enrolled as the final population sample. Thirty patients who had received a postoperative injection of Protescal were allocated into Group A. Another 30 patients who had received a postoperative injection of Guardix were allocated into Group B. As controls, 36 patients who did not receive any injection were allocated into Group C. The patients included in this study were aged between 19 and 75 years. For the clinical assessment, we measured the following clinical parameters-the visual analogue scale for pain (PVAS), the American Shoulder and Elbow Surgeons (ASES) score, and the constant score, as well as passive range of motions (ROMs)-at three time-points (preoperatively, 2-month postoperatively, and 6-month postoperatively). Results: We found that Group A compared to Group B tended to show a swifter recovery in passive anterior elevation and in internal rotation by the 2-month postoperative follow-up, but the differences were not statistically significant. Conclusions: We found that the effects of HA/CMC-based injections were minimal after arthroscopic rotator cuff repairs.

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References

  1. Blaine T, Moskowitz R, Udell J, et al. Treatment of persistent shoulder pain with sodium hyaluronate: a randomized, controlled trial. A multicenter study. J Bone Joint Surg Am. 2008;90(5):970-9. https://doi.org/10.2106/JBJS.F.01116
  2. Brislin KJ, Field LD, Savoie FH 3rd. Complications after arthroscopic rotator cuff repair. Arthroscopy. 2007;23(2):124-8. https://doi.org/10.1016/j.arthro.2006.09.001
  3. Chen WY, Abatangelo G. Functions of hyaluronan in wound repair. Wound Repair Regen. 1999;7(2):79-89. https://doi.org/10.1046/j.1524-475X.1999.00079.x
  4. Cho CH, Ye HU, Jung JW, Lee YK. Gender affects early postoperative outcomes of rotator cuff repair. Clin Orthop Surg. 2015;7(2):234-40. https://doi.org/10.4055/cios.2015.7.2.234
  5. Harryman DT 2nd, Matsen FA 3rd, Sidles JA. Arthroscopic management of refractory shoulder stiffness. Arthroscopy. 1997;13(2):133-47. https://doi.org/10.1016/S0749-8063(97)90146-8
  6. Fujii S, Shimada H, Ike H, et al. Reduction of postoperative abdominal adhesion and ileus by a bioresorbable membrane. Hepatogastroenterology. 2009;56(91-92):725-8.
  7. Huberty DP, Schoolfield JD, Brady PC, Vadala AP, Arrigoni P, Burkhart SS. Incidence and treatment of postoperative stiffness following arthroscopic rotator cuff repair. Arthroscopy. 2009;25(8):880-90. https://doi.org/10.1016/j.arthro.2009.01.018
  8. Kim JH, Lee JH, Yoon JH, Chang JH, Bae JH, Kim KS. Antiadhesive effect of the mixed solution of sodium hyaluronate and sodium carboxymethylcellulose after endoscopic sinus surgery. Am J Rhinol. 2007;21(1):95-9. https://doi.org/10.2500/ajr.2007.21.2911
  9. Kim T, Ahn KH, Choi DS, et al. A randomized, multi-center, clinical trial to assess the efficacy and safety of alginate carboxymethylcellulose hyaluronic acid compared to carboxymethylcellulose hyaluronic acid to prevent postoperative intrauterine adhesion. J Minim Invasive Gynecol. 2012;19(6):731-6. https://doi.org/10.1016/j.jmig.2012.08.003
  10. Yoo JC, Ahn JH, Koh KH, Lim KS. Rotator cuff integrity after arthroscopic repair for large tears with less-than-optimal footprint coverage. Arthroscopy. 2009;25(10):1093-100. https://doi.org/10.1016/j.arthro.2009.07.010
  11. Post M, Silver R, Singh M. Rotator cuff tear. Diagnosis and treatment. Clin Orthop Relat Res. 1983;(173):78-91.
  12. Oh CH, Oh JH, Kim SH, Cho JH, Yoon JP, Kim JY. Effectiveness of subacromial anti-adhesive agent injection after arthroscopic rotator cuff repair: prospective randomized comparison study. Clin Orthop Surg. 2011;3(1):55-61. https://doi.org/10.4055/cios.2011.3.1.55
  13. Oh JH, Kim SH, Lee HK, Jo KH, Bin SW, Gong HS. Moderate preoperative shoulder stiffness does not alter the clinical outcome of rotator cuff repair with arthroscopic release and manipulation. Arthroscopy. 2008;24(9):983-91. https://doi.org/10.1016/j.arthro.2008.06.007
  14. Na SY, Oh SH, Song KS, Lee JH. Hyaluronic acid/mildly crosslinked alginate hydrogel as an injectable tissue adhesion barrier. J Mater Sci Mater Med. 2012;23(9):2303-13. https://doi.org/10.1007/s10856-012-4689-0
  15. Oryan A, Moshiri A, Meimandi Parizi AH, Raayat Jahromi A. Repeated administration of exogenous Sodium-hyaluronate improved tendon healing in an in vivo transection model. J Tissue Viability. 2012;21(3):88-102. https://doi.org/10.1016/j.jtv.2012.06.002
  16. Shibata Y, Midorikawa K, Emoto G, Naito M. Clinical evaluation of sodium hyaluronate for the treatment of patients with rotator cuff tear. J Shoulder Elbow Surg. 2001;10(3):209-16. https://doi.org/10.1067/mse.2001.113501
  17. Parsons BO, Gruson KI, Chen DD, Harrison AK, Gladstone J, Flatow EL. Does slower rehabilitation after arthroscopic rotator cuff repair lead to long-term stiffness? J Shoulder Elbow Surg. 2010;19(7):1034-9. https://doi.org/10.1016/j.jse.2010.04.006
  18. Mitsui Y, Gotoh M, Nakama K, Yamada T, Higuchi F, Nagata K. Hyaluronic acid inhibits mRNA expression of proinflammatory cytokines and cyclooxygenase-2/prostaglandin E(2) production via CD44 in interleukin-1-stimulated subacromial synovial fibroblasts from patients with rotator cuff disease. J Orthop Res. 2008;26(7):1032-7. https://doi.org/10.1002/jor.20558
  19. Tuncay I, Ozbek H, Atik B, Ozen S, Akpinar F. Effects of hyaluronic acid on postoperative adhesion of tendo calcaneus surgery: an experimental study in rats. J Foot Ankle Surg. 2002;41(2):104-8. https://doi.org/10.1016/S1067-2516(02)80033-3