The American Academy of Orthopaedic Surgeons (AAOS) released the updated Evidence-Based Clinical Practice Guideline for the Management of Rotator Cuff Injuries in August 2025. The guideline provides 25 recommendations and 4 consensus statements across diagnosis, treatment decision-making, biologic interventions, and postoperative rehabilitation, with the strength of each recommendation graded according to the quality of supporting evidence. The updated guideline highlights several key advances, including establishing CT as an important adjunctive imaging modality, providing specific recommendations on repair strategies for high-grade partial-thickness rotator cuff tears, and clearly restricting the use of platelet-rich plasma and marrow stimulation in rotator cuff repair, as well as limiting the application of prolotherapy in the treatment of full-thickness rotator cuff tears. In addition, the guideline emphasizes the potential benefits of early mobilization in patients with small to medium-sized tears.
Objective To explore the factors influencing the Constant-Murley score at 3 months after arthroscopic rotator cuff repair, and to provide evidence for early identification of patients at risk of poor recovery and for the development of individualized rehabilitation protocols. Methods Using a convenience sampling method, 146 patients with rotator cuff injury who underwent arthroscopic rotator cuff repair between May 2025 and August 2025 were enrolled. There were 68 males and 78 females, with ages ranging from 41 to 74 years (mean, 56.2 years). At 3 months postoperatively, shoulder function was assessed using the Constant-Murley score, pain intensity was evaluated with the visual analogue scale (VAS) score, exercise adherence was measured with the Orthopedic Patient Functional Exercise Compliance Scale, and active shoulder forward flexion and abduction ranges were recorded. The independent variables included gender, age, body mass index (BMI), affected side, smoking history, alcohol consumption, educational level, acromial type, hypertension, diabetes mellitus, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, as well as postoperative acromiohumeral distance, VAS score, and the Orthopedic Patient Functional Exercise Compliance Scale score. The dependent variable was the 3-month Constant-Murley score. Univariate analysis and multiple linear regression were performed to identify influencing factors associated with the Constant-Murley score. Results At 3 months postoperatively, the acromiohumeral distance ranged from 6 to 16 mm (mean, 9.19 mm); VAS scores ranged from 0 to 6 (mean, 3.2); Orthopedic Patient Functional Exercise Compliance Scale scores ranged from 20 to 70 (mean, 50.1); Constant-Murley scores ranged from 35 to 100 (mean, 73.7); active forward flexion ranged from 55° to 180° (mean, 128.84°); and active abduction ranged from 25° to 170° (mean, 122.81°). Univariate analysis showed that smoking history, educational level, acromial type, hypertension, diabetes mellitus, BMI, VAS score, and Orthopedic Patient Functional Exercise Compliance Scale score were significantly associated with the 3-month Constant-Murley score (P<0.05). Multiple linear regression revealed that hypertension, diabetes mellitus, and higher VAS score were independent risk factors for Constant-Murley score (P<0.05), while a higher BMI and Orthopedic Patient Functional Exercise Compliance Scale score were protective factors for Constant-Murley score (P<0.05). Conclusion Overall, shoulder function recovered well at 3 months after rotator cuff repair, but there remains room for further improvement. Clinicians should emphasize perioperative management of patients with comorbid chronic diseases, strengthen pain intervention, and promote exercise adherence in order to optimize early postoperative functional recovery.
ObjectiveTo evaluate the effectiveness of robot-guided percutaneous fixation and decompression via small incision in treatment of advanced thoracolumbar metastases. Methods A clinical data of 57 patients with advanced thoracolumbar metastases admitted between June 2017 and January 2021 and met the selection criteria was retrospectively analyzed. Among them, 26 cases were treated with robot-guided percutaneous fixation and decompression via small incision (robot-guided group) and 31 cases with traditional open surgery (traditional group). There was no significant difference in gender, age, body mass index, lesion segment, primary tumor site, and preoperative Tokuhashi score, Tomita score, Spinal Instability Neoplastic Score (SINS), visual analogue scale (VAS) score, Oswestry disability index (ODI), Karnofsky score, and Frankel grading between groups (P>0.05). The operation time, hospital stays, hospital expenses, intraoperative blood loss, postoperative drainage volume, duration of intensive care unit (ICU) stay, blood transfusion, complications, and survival time were compared. The pedicle screw placement accuracy was evaluated according to the Gertzbein-Robbins grading by CT within 4 days after operation. The pain, function, and quality of life were evaluated by VAS score, ODI, Karnofsky score, and Frankel grading. Results During operation, 257 and 316 screws were implanted in the robot-guided group and the traditional group, respectively; and there was no significant difference in pedicle screw placement accuracy between groups (P>0.05). Compared with the traditional group, the operation time, hospital stays, duration of ICU stay were significantly shorter, and intraoperative blood loss and postoperative drainage volume were significantly lesser in the robot-guided group (P<0.05). There was no significant difference in hospital expenses, blood transfusion rate, and complications between groups (P>0.05). All patients were followed up 8-32 months (mean, 14 months). There was no significant difference in VAS scores between groups at 7 days after operation (P>0.05), but the robot-guided group was superior to the traditional group at 1 and 3 months after operation (P<0.05). The postoperative ODI change was significantly better in the robot-guided group than in the traditional group (P<0.05), and there was no significant difference in the postoperative Karnofsky score change and Frankel grading change when compared to the traditional group (P>0.05). Median overall survival time was 13 months [95%CI (10.858, 15.142) months] in the robot-guided group and 15 months [95%CI (13.349, 16.651) months] in the traditional group, with no significant difference between groups (χ2=0.561, P=0.454) . Conclusion Compared with traditional open surgery, the robot-guided percutaneous fixation and decompression via small incision can reduce operation time, hospital stays, intraoperative blood loss, blood transfusion, and complications in treatment of advanced thoracolumbar metastases.