The role of endothelial dysfunction on the recovery of rotator cuff reconstruction; prospective non-randomized trial
Project objectives
Several studies have stated that repetitive mechanical stresses in the hypovascularized insertional region of the supraspinatus tendon lead to alteration of the vessel walls and therefore to an imbalance between vasodilator and vasoconstrictor substances produced by the endothelium in the direction of the latter. The "critical" area of the supraspinatus tendon is, in fact, most affected by tendon injuries. It is assumed that an altered vasodilation in response to a condition of "haemodynamic stress" is a systemic condition, therefore not exclusive to the critical area of the rotator cuff (CR).
For this reason, post-ischemic vasodilatation of the brachial artery (FMD) is measured through an echo-Doppler evaluation. Subsequently, at the operative site, the extent of the rotator cuff tear is assessed using the Cofield classification. Patients are classified into 2 subgroups according to lesion size, i.e. lesions ≤ 3 cm in size and lesions > 3 cm. Finally, we proceed to a statistical analysis of the correlation between ultrasound data and the size of the CR lesions.
Our study aims to verify the primary hypothesis: the state of vascular alteration (endothelium mediated), understood as an increase in the diameter of the brachial artery from baseline to reactive hyperemia of less than 11% after ischemic insult with a pneumatic cuff insufflated for 5 minutes at a pressure greater than 50 mmHg with respect to the systolic pressure of the subject, is the cause of a lower degree of post-operative recovery (quantified by functional score: modified ASES).
With the secondary hypothesis we want to verify if it is possible to confirm the primary hypothesis also with other clinical scores such as UCLA and Constant score.
The tertiary hypothesis is to verify a positive association between the size of the rotator cuff lesion and the mean post-ischemic diameter of the brachial artery.
Start and end date
17/06/2015 - In progress
Project managers
- Prof. Vincenzo Denaro
- Prof. Rocco Papalia
Coordinating institution of the project
Università Campus Bio-Medico di Roma
Other Institutions involved in the project
University of Milan, IRCCS, Policlinico San Donato - Milan
Funding source
No profit