The purpose of this study was to examine five-year outcomes of patients previously enrolled in a non-operative rotator cuff study.

Patients with chronic, full-thickness rotator cuff tears (demonstrated on imaging) who were referred to one of two senior shoulder surgeons were enrolled in the study between October 2008 and September 2010. Patients participated in a comprehensive non-operative, home-based treatment program. After three months patients were defined as “successful” or “failed”. “Successful” patients were essentially asymptomatic and did not require surgery. “Failed” patients were symptomatic and consented to surgical repair. All patients were followed up at one year, two years, and five-plus years.

Original results of our study showed that 75% of patients were treated successfully with non-operative treatment, while 25% went on to surgery. These numbers were maintained at two-year follow-up (previously reported) and five-year follow-up. At five+ years, 88 patients were contacted for follow-up. Fifty-eight (66%) responded. The non-operative success group had a mean RC-QOL score of 80 (SD 18) at previously reported two-year follow-up. At five-year follow-up this score did not decrease (RCQOL = 82 (SD 16)). Furthermore, between two and five years, only two patients who had previously been defined as “successful” became more symptomatic and underwent surgical rotator cuff repair. From the original cohort of patients, those who failed non-operative treatment and underwent surgical repair had a mean RC-QOL score of 89 (SD 12) at five-year follow-up. The operative and non-operative groups at five-year follow-up were not significantly different (p = 0.07).

Non-operative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. While some may argue that non-operative treatment delays inevitable surgical fixation, our study shows that patients can do extremely well over time.

To identify the differences in inflammatory profiles between hip OA, knee OA and non-OA control cohorts and investigate the association between cytokine expression and clinical outcome measurements, specifically pain.

A total of 250 individuals were recruited in three cohorts (100 knee OA, 50 hip OA, 100 control). Serum was collected and inflammatory profiles analysed using the Multiplex Human Cytokine Panel (Millipore) on the Luminex 100 platform (Luminex Corp., Austin, TX). The pain, physical function and activity limitations of hip OA cohort were scored using the WOMAC, SF-36, HHS and UCLA scores. All cytokine levels were compared between cohorts individually using Mann–Whitney–Wilcoxon (MWW) test with Bonferroni multiple comparison correction. Within hip OA cohorts, the effect of hip alignment (impingement and dysplasia) and radiographic grade (Kellgren and Lawrence grade, K/L grade) on cytokine levels were accessed by MWW test. Spearman's rank correlation test used to assess the association between cytokines and pain levels.

The three cohorts showed distinct inflammatory profiles. Specifically, EGF, FGF-2, MCP-3, MIP-1a, IL-8 were significant different between knee and hip OA; FGF-2, GRO, IL-8, MCP-1, VEGF were significant different between hip OA and control; Eotaxin, GRO, MCP-1, MIP-1b, VEGF were significant different between knee OA and control (p-value < 0.0012). For hip OA cohorts, cytokines do not differ between K/L grade three and K/L grade four or between patients that displayed either impingement or dysplasia. Three cytokines were significant associated with pain: IL-6 (p-value = 0.045), MDC (p-value = 0.032) and IP-10 (p-value = 0.038).

We have demonstrated that differences in serum inflammatory profiles exist between hip and knee OA patients. These differences suggest that OA may include different inflammatory subtypes according to affected joints. We also identified that the cytokine IL-6, MDC and IP-10 are associated with pain level in hip OA patients. These cytokines might help explain the inconsistent of presentation of pain with radiographical severity of OA joints. Future studies are needed to validate our findings and then to understand the following questions: (1) how differently affected joints are reflected in systematic biomarkers; (2) how these cytokines are biologically involved in the OA pain pathway.

Purpose

Stress fractures (SFs) are highly prevalent in female athletes, especially runners (1337%), and result in pain and lost training time. There are numerous risk factors for SFs in athletes; however, the role of bone quality in the etiology of SFs is currently unknown. Therefore, our primary objective was to examine whether there are characteristic differences in bone quality and bone strength in female athletes with lower limb SFs using high-resolution peripheral quantitative computed tomography (HR-pQCT). A secondary objective was to compare muscle strength between SF subjects and controls.