Rotator Cuff Repair
Rotator-cuff-repair (RCR) surgery is a common orthopedic procedure performed in the outpatient setting with an estimated 300,000 procedures performed per year in the United States[2].
Nutritional status is a key determinant of post-op clinical outcomes.
The rate of RCR is highest in individuals 45–74 years old, in which higher rates of poor nutritional status are observed.
Malnutrition has been shown to be an important risk factor for infections, poor patient outcomes and increased morbidity and mortality. This has been identified in the orthopedic trauma, total joint arthroplasty, and spine as well as rotator cuff repair literature [9,10,12,15–19]
Albumin is a common biomarker used to assess malnutrition, offering a quick and reliable method to screen and diagnose poor nutritional status.
Preoperative Nutrition Impacts Retear Rate After Arthroscopic Rotator Cuff Repair
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Poor nutritional status increases:
*Hospital Readmission (OR 4.16;p = 0.002)
*Extended Length of Stay (LOS) (OR 7.47; p < 0.001)
P. J. McGlone (2020)
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Poor nutritional status increases:
Preoperative hypoalbuminemia significantly increased adjusted odds ratio of:
*Postoperative admission ; 1.7X
*Extended length of stay; 2.0X
T. Quan Journal of Orthopedics (2022)
Poor nutritional status has been linked to higher post-op complication in both arthroscopic and open rotator cuff repair.
Targeted Nutritional Supplementation (TNS) has been successfully used in multiple clinical settings. Enhanced outcomes have been seen for many years in burn, plastic, ulcer, and reconstructive surgery of head & neck cancer. The rationale for supplementing is based primarily on studies that show an increase in wound breaking strength and collagen formation in these challenging patient populations.
Rotator cuff healing similarly requires robust collagen synthesis to allow for tendon incorporation. Rotator cuff repairs augmented with TNS may similarly demonstrate improved healing rates.
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References
- Quan T, Lopez JD, Chen FR, Manzi JE, Best MJ, Srikumaran U, Zimmer ZR. A retrospective study evaluating the association between hypoalbuminemia and postoperative outcomes for patients receiving open rotator cuff repair. J Orthop. 2022 Feb 23;30:88-92. doi: 10.1016/j.jor.2022.02.023. eCollection 2022 Mar-Apr. PMID: 35250196
- McGlone PJ, Li LT, Bokshan SL, O'Donnell R, Owens BD. Preoperative malnutrition increases odds of hospital admission and extended length of stay following arthroscopic rotator cuff repair. Phys Sportsmed. 2021 May;49(2):236-240. doi: 10.1080/00913847.2020.1824535. Epub 2020 Sep 23. PMID: 32928015
- Arginine L-alpha-ketoglutarate, methylsulfonylmethane, hydrolyzed type I collagen and bromelain in rotator cuff tear repair: a prospective randomized study. Gumina S, Passaretti D, Gurzì MD, Candela V. Curr Med Res Opin. 2012 Nov;28(11):1767-74. doi: 10.1185/03007995.2012.737772. Epub 2012 Oct 19. PMID: 23043451 Clinical Trial.