| 1. |
|
|
| 2. |
- Farfaras, Stefanos, et al.
(författare)
-
Increased levels of inflammatory markers in the subscapularis tendon and joint capsule in patients with subacromial impingement
- 2021
-
Ingår i: Knee Surgery Sports Traumatology Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 29, s. 2228-2236
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose To analyze biopsy samples from the subscapularis tendon and from the joint capsule from male patients with subacromial impingement syndrome and compare them with samples from male patients with post-traumatic recurrent shoulder instability, to detect increased inflammatory activity that might be present inside the humeroscapular joint. Methods Twenty male patients scheduled for surgery for either subacromial decompression or Bankart reconstruction were included. Four biopsies from each patient were obtained during surgery from the capsule and the subscapularis tendon. Each specimen was analyzed for TNF-alpha, IL-6, CD-3 and CD-72. Multiplex fluorescence immunohistochemistry was performed on histological samples from the capsule and tendon to demonstrate the level of inflammatory markers. Fluorescence microscope images were acquired using an automated scanning system. On each slide, the number of pixels was registered and used in the analyses. Results The subacromial impingement syndrome group comprised eight patients, median age 53 (45-74) years, while the instability group 12, median age 27 (22-48) years (p < 0.00001). The amount of IL-6 and TNF-alpha was significantly higher in the subscapularis tendon of the patients with subacromial impingement syndrome compared with instability patients (p = 0.0015 and p = 0.0008 respectively). In the capsular samples, significantly higher amount of TNF-alpha and CD-72 was found in patients with subacromial impingement syndrome compared with instability patients (p < 0.0001 for both). On the other hand, the amount of CD-3 was significantly higher in the instability group (p = 0.0013). Conclusions This study provides evidence that an extended inflammatory process is present, not only in the subacromial bursa but also in the glenohumeral joint in patients with subacromial impingement syndrome.
|
|
| 3. |
- Farfaras, Stefanos, et al.
(författare)
-
More histologic and ultrastructural degenerative signs in the subscapularis tendon and the joint capsule in male patients with shoulder impingement
- 2018
-
Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 26:1, s. 79-87
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of the present study was to analyze biopsy samples from the subscapularis tendon and from the joint capsule from male patients with shoulder impingement syndrome (SAIS) and compare them with samples from male patients with post-traumatic recurrent shoulder instability. The hypothesis of the study was that patients with SAIS would have more histologic and ultrastructural degenerative changes in their subscapularis tendon and joint capsule than patients with post-traumatic recurrent shoulder instability. Methods: Male patients scheduled for surgery, with either subacromial decompression or Bankart reconstruction, were included. Four biopsies from each patient were obtained from the capsule and four from the subscapularis tendon during arthroscopic surgery. The histologic characteristics and the presence of glycosaminoglycans were assessed using the light microscope, and the ultrastructure was assessed using a transmission electron microscope. Results: Eight patients, median age 53 (45–74) years (p < 0.0001), were included in the impingement group, and 12 patients, median age 27 (22–48) years, were included in the instability group. The histologic assessment revealed significantly higher cellularity and total degeneration score in the capsule (p = 0.016 and p = 0.014 respectively) in patients with subacromial impingement compared with the instability patients. The corresponding finding was not made for the subscapularis tendon. The ultrastructural evaluation revealed that the instability patients had more fibrils with a large diameter (indicating less degeneration) in both the subscapularis tendon and the capsule compared with the impingement patients (p < 0.0001). Conclusion: Male patients with subacromial impingement have more histologic and ultrastructural degenerative changes in their shoulder compared with patients with post-traumatic recurrent shoulder instability. Clinical relevance: It appears that in patients with subacromial impingement, the whole shoulder joint is affected and not only the subacromial space. It is the opinion of the authors that intra-articular therapeutic injections could be tried more often in these patients. Level of evidence: III.
|
|
| 4. |
- Farfaras, Stefanos
(författare)
-
Shoulder impingement; Evaluation of the clinical outcome, radiographic findings, histology, ultrastructure and biochemistry
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis had two main purposes: on the one hand, to assess and evaluate the clinical outcome of different treatment strategies for subacromial impingement syndrome (SAIS), in both the short and the long term and, on the other hand, to investigate and illuminate the pathophysiology of the syndrome in terms of the radiographic, histological, ultrastructural and biochemical appearance. In Study I, the clinical outcome was assessed two to three years after intervention, in patients with SAIS who underwent either surgical (subacromial decompression using the open or arthroscopic technique) or non-surgical treatment. Eighty-seven patients with SAIS were randomised to three groups: open acromioplasty (OSG), arthroscopic acromioplasty (ASG) or physical treatment (PTG). The main outcome measurement, the Constant Score, showed no significant difference when comparing the three groups before intervention and at follow-up. However, when comparing each group separately over time, the two surgical groups had improved significantly at follow-up. The Watson & Sonnabend score had improved significantly for more parameters in the OSG, compared with both the ASG and PTG. Furthermore, the OSG revealed a better outcome for strength measurement at follow-up. In Study II, the same group of patients was assessed, a minimum of 10 years after intervention, for the same clinical outcomes. In addition, the development of osteoarthritis (OA) and rotator cuff tears was assessed. In the long term, the surgical groups revealed a better outcome. The Constant Score increased significantly more over time (baseline vs follow-up), for both the OSG and the ASG compared with the PTG. Moreover, the OSG had a significantly better Constant Score compared with the PTG, when comparing the three groups. Both surgical groups also revealed better strength and better active elevation. Radiographically, no differences in OA or rotator cuff tears were found between the three treatment groups. In Study III, the histological and ultrastructural appearance of tissue samples from the subscapularis tendon and joint capsule were assessed. Male patients with SAIS were compared with male patients with recurrent shoulder dislocations, in terms of degenerative signs. The fibril diameter and the Total Degeneration Score (TDS) were assessed. The SAIS group was significantly older than the instability group, but the correlation coefficient between age and fibril diameter was r = -0.20 for the subscapularis tendon and r = -0.25 for the capsule. The instability group had significantly “thicker” fibrils compared with the SAIS group and a better TDS. This indicates the presence of a degenerative process in patients with SAIS. In Study IV, the expression of different inflammatory markers in the same population was assessed. The analysis of the samples revealed a significantly larger amount of interleukin-6 (IL-6) and tumour necrosis factor-α (TNF-α) in the subscapularis tendon of patients with SAIS. In the capsular samples, a significantly higher TNF-α and cluster of differentiation 72 (CD 72), a marker of B-cell activity, was found. This indicates that an inflammatory process is present in patients with SAIS, both in the subscapularis tendon and in the adjacent joint capsule.
|
|
| 5. |
- Farfaras, Stefanos, et al.
(författare)
-
Subacromial Decompression Yields a Better Clinical Outcome Than Therapy Alone: A Prospective Randomized Study of Patients With a Minimum 10-Year Follow-up.
- 2018
-
Ingår i: The American journal of sports medicine. - : SAGE Publications. - 1552-3365 .- 0363-5465. ; 46:6, s. 1397-1407
-
Tidskriftsartikel (refereegranskat)abstract
- The long-term outcome after the treatment of subacromial impingement syndrome (SAIS) with either nonsurgical or surgical methods has not been thoroughly investigated. Hypothesis/Purpose: The purpose was to evaluate the long-term clinical outcome and the presence of rotator cuff injuries and osteoarthritis (OA) after the surgical and nonsurgical treatment of SAIS. The hypothesis was that, at a minimum 10 years after the initial treatment, patients who had undergone acromioplasty would have a better clinical outcome and run a lower risk of developing rotator cuff ruptures and OA as compared with those treated with physical therapy.Randomized controlled trial; Level of evidence, 2.Eighty-seven patients with SAIS were randomized to 3 groups: open acromioplasty (open surgery group [OSG]), arthroscopic acromioplasty (arthroscopic surgery group [ASG]), and nonsurgical treatment (physical therapy group [PTG]). The Constant score, the Watson and Sonnabend score, and the 36-Item Short Form Health Survey (SF-36) questionnaire were used as outcome measurements. Furthermore, bilateral ultrasound examinations were performed to detect rotator cuff ruptures and bilateral radiographs to detect OA. Sixty-six patients (76%) attended the clinical follow-up at least 10 years after the initial treatment.The groups were demographically comparable at baseline. The Constant score improved significantly at follow-up for the OSG ( P = .003) and ASG ( P = .011), while no significant improvement was detected for the PTG. The OSG revealed a significant improvement versus the PTG at follow-up ( P = .011); otherwise, no significant differences were found. For the Watson and Sonnabend score, the OSG revealed a significant improvement in 13 of 14 questions. The corresponding finding was made for the ASG and PTG in 9 of 14 questions ( P = .14). According to ultrasound, 1 of 20 patients in the OSG had a full-thickness rotator cuff rupture on the index side. The corresponding finding was made for 1 of 18 patients in the ASG and 4 of 28 in the PTG ( P = .29). Per the radiographs, 3 of 20 patients in the OSG had moderate or severe OA in the index shoulder. The corresponding finding was made for 1 of 18 patients in the ASG and 0 of 28 in the PTG ( P = .12).After a minimum 10 years of follow-up, the surgical treatment of SAIS appears to render better clinical results than physical therapy alone. No significant differences were found among the groups in terms of the presence of full-thickness rotator cuff ruptures and OA.
|
|
