Predicting the Outcome of Exercise Therapy for Treatment of Rotator Cuff Tears

项目摘要 肩袖撕裂是一个重要的临床问题，导致30%的骨科医生就诊， 每年15万例外科手术。肩袖撕裂多发生于中晚期人群 并可能导致严重疼痛、残疾和活动受限。运动疗法通常用于初始 治疗肩袖撕裂，通常能有效缓解症状。然而，运动疗法未能 25 - 50%的病例症状缓解，需要手术干预。因此，我们进行了前瞻性研究， 对109例有症状的孤立性冈上肌腱撕裂患者进行观察性队列研究， 接受个性化运动治疗计划（POETT队列）。除了低得多的发病率外， 手术（6.4%）在2年随访时，我们的运动治疗计划导致被动 盂肱关节活动度、等长肌力、患者报告结局和体内 关节运动学而不增加肩袖撕裂尺寸。最初的计算建模工作使用主题- 具体的输入表明，接受手术的个体在手术后具有较不稳定的盂肱关节， 运动疗法由于POETT队列的手术发生率较低以及上述发现， 我们试图确定可能与改善结果相关的机制和临床因素。 因此，我们项目的总体目标是确定运动疗法的长期可行性 使用我们独特的POETT队列，通过评估 重要的生物力学和临床参数。该项目将实现三个具体目标： 确定运动治疗计划的持久性，为临床医生提供与因素相关的信息 与运动疗法的成功或失败相关。3年、4年和5年时PRO的变化;肩袖 5年时的撕裂尺寸; 5年时的体内盂肱关节运动学和运动后的后续手术 将收集治疗;目的2）评估关节运动学改善的相对幅度超过5- POETT队列相对于健康对照受试者的年;目的3）评估恢复和维持 肩袖撕裂患者在接受运动治疗后盂肱关节稳定性的变化。变化 将确定盂肱关节反作用力的大小和方向， 与接受后续手术和对照的患者相比， 使用肌肉骨骼模型的受试者。我们假设运动疗法可以维持患者的健康。 肩袖和关节功能将与年龄、性别和手优势频率相似 匹配的个体。这些分析将允许继续制定个性化的治疗方案 通过测定长期运动疗法的持久性，并与对照组和 接受了后续手术。肩袖撕裂患者的肩关节功能恢复对于 保持健康、积极的生活方式，特别是在人口老龄化的情况下。

Project Summary Rotator cuff tears are a significant clinical problem, resulting in 30% of all visits to orthopaedic surgeons and over 150,000 surgical procedures per year. Rotator cuff tears occur frequently in the middle-to-late aged population and can cause severe pain, disability and activity limitations. Exercise therapy is typically prescribed for initial treatment of rotator cuff tears and is often effective at relieving symptoms. However, exercise therapy fails to relieve symptoms in 25-50% of cases, requiring surgical intervention. Thus, we conducted a prospective observational cohort study of 109 individuals with a symptomatic isolated supraspinatus tendon tear who underwent a personalized exercise therapy program (POETT Cohort). In addition to a much lower incidence of surgery (6.4%) at 2-year follow-up, our exercise therapy program led to significant improvements in passive glenohumeral range of motion, isometric muscle strength, patient-reported outcomes, and in-vivo arthrokinematics without increases in rotator cuff tear size. Initial computational modeling efforts using subject- specific inputs demonstrate that individuals who underwent surgery have less stable glenohumeral joints after exercise therapy. Due to the lower incidence of surgery in the POETT Cohort and the aforementioned findings, we seek to determine the mechanistic and clinical factors that could be associated with the improved outcomes. Therefore, the overall objective of our project is to determine the long-term viability of exercise therapy for treatment of individuals with rotator cuff tears using our unique POETT Cohort by assessing important biomechanical and clinical parameters. The project will address three specific aims: Aim 1) Determine durability of an exercise therapy program to provide clinicians with information related to factors associated with the success or failure of exercise therapy. Changes in PROs at 3-, 4-, and 5-years; rotator cuff tear size at 5-years; in-vivo glenohumeral kinematics at 5-years and subsequent surgery following exercise therapy will be collected; Aim 2) Assess the relative magnitude of improvements in arthrokinematics over 5- years for the POETT Cohort with respect to healthy control subjects; Aim 3) Assess restoration and maintenance of glenohumeral joint stability in subjects with a rotator cuff tear that undergo exercise therapy. Changes in the magnitude and direction of the glenohumeral joint reaction force will be determined for those that were successfully treated with exercise therapy compared to those that underwent subsequent surgery and control subjects utilizing musculoskeletal models. We hypothesize that exercise therapy maintains the health of the rotator cuff over a period of 5-years and joint function will be similar to age-, sex- and hand dominance frequency matched individuals. These analyses will allow for continued development of individualized treatment protocols through determination of the durability of exercise therapy long-term and comparisons to controls and those who underwent subsequent surgery. Restoration of shoulder function for those with a rotator cuff tear is essential for maintaining a healthy, active lifestyle, particularly in our aging population.