Rotator cuff repair: an analysis of failure mechanisms and predictors of structural and clinical repair outcomes

Post-operative Re-Rupturen stellen die wohl grösste Herausforderung bei der chirurgischen Versorgung von Rotatorenmanschettenrupturen dar. Inwieweit diese Re-Defekte klinische Relevanz haben, wird derzeit kontrovers diskutiert. Diese Dissertation untersucht mögliche Mechanismen, welche zur Entstehung von Re-Defekten führen. Um die klinische Relevanz dieser Mechanismen zu bewerten, das Verhältnis von strukuturellem und klinischem Operationsergebnis zu untersuchen und mögliche Ergebnisprediktoren zu identifzieren, wurde eine Meta-Analyse von 31 klinischen Studien durchgeführt. Die Daten dieser Analyse bewiesen, dass auch in Patienten mit post-operativer Re-Ruptur, eine signifikante Verbesserung klinischer Symptome erzielt wird. Jedoch zeigte der Vergleich der Daten re-rupturierter und intakter Sehnen, einen statistisch signifikanten Unterschied zu Gunsten post-operativ intakter Manschetten. Hinsichtlich predominanter Fehlermechanismen konnte die Analyse klinischer Studien nur begrenzt Aufschluss geben. Nach Zusammenfassung der klinischen Daten, sowie den Ergebnissen einer generellen Literaturrecherche, konnten bestimmte Problemzonen heutiger Behandlungstechniken identifiziert werden. Abschliessend wird ein ovines Manschettenmodel präsentiert, welches in erster Linie die Untersuchung einer post-operativen Lückenbildung zwischen der re-inserierten Sehne und ihrem knöchernen Ursprung ermöglicht. Zudem erlaubt es die Untersuchung genereller Aspekte der Heilung reparierter Manschetten. Post-operative re-tearing represents a major challenge in the surgical treatment of rotator cuff tears. Whether or not re-torn cuffs inevitably cause inferior clinical outcomes is temporarily a subject of controversial debate. This thesis investigates the occurrence of rotator cuff re-tearing by analyzing the repair components of current surgical concepts and discussing potential failure mechanisms. In order to evaluate the clinical relevance of these mechanisms, investigate the relation of structural repair failure and clinical outcome and furthermore identify predictors of structural and clinical outcomes, a meta-analysis of 31 studies (3611 shoulders in total) was performed. The data showed significant relief of clinical symptoms and an increase in shoulder function in both, patients with intact repairs and those showing cuff re-tears. However, it also confirmed a correlation between re-torn cuffs and generally lower clinical results. The meta-analysis of patient, surgical, imaging and clinical follow-up data could only very limitedly provide information about the underlying mechanisms of failure. When synthesizing results from the clinical study meta-analysis and general research including animal and ex-vivo studies, several hot spots in current concepts were identified. Finally, an ovine model is presented that allows further investigation of repair site gap formation and assessment of general aspects and timing of rotator cuff healing

Helping your partner with chronic pain: the importance of helping motivation, received social support, and its timeliness

Objective Like all intentional acts, social support provision varies with respect to its underlying motives. Greater autonomous or volitional motives (e.g., enjoyment, full commitment) to help individuals with chronic pain (ICPs) are associated with greater well-being benefits for the latter, as indexed by improved satisfaction of their psychological needs for autonomy, competence, and relatedness. The present study investigates the processes explaining why partners’ autonomous or volitional helping motivation yields these benefits. Methods A total of 134 couples, where at least one partner had chronic pain, completed a 14-day diary. Partners reported on their daily helping motives, whereas ICPs reported on their daily received support, timing of help, need-based experiences, and pain. Results On days when partners provided help for volitional motives, ICPs indicated receiving more help, which partially accounted for the effect of autonomous helping motivation on ICP need-based experiences. Timing of help moderated the effects of daily received support on ICP need-based experiences. Conclusions Findings highlight the importance of ICPs of receiving support in general and the role of timing in particular, which especially matters when there is little support being received.info:eu-repo/semantics/acceptedVersio