Analysis of the effect of asymptomatic hyperuricemia on the effectiveness after arthroscopic rotator cuff repair_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HAN Zengshuai , ZHAO Xia , MA Wenru , LI Tianyu , ZHANG Yi , QI Chao ,  YU Tengbo

Department of Orthopedic Sports Medicine, the Affiliated Hospital of Qingdao University, Qingdao Shandong, 266100, P.R.China;

Corresponding author：

YU Tengbo, Email: ytb8912@hotmail.com

Keywords：

Rotator cuff tear; rotator cuff repair; serum uric acid; clinical prognosis

DOI：

10.7507/1002-1892.202102004

Video：

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Objective To investigate the effect of asymptomatic hyperuricemia on the effectiveness of arthroscopic rotator cuff repair.Methods The clinical data of 80 patients who underwent arthroscopic rotator cuff repair and met the selection criteria between March 2018 and December 2019 were retrospectively analyzed. According to the serum uric acid level, the patients were divided into hyperuric acid group (46 cases, the serum uric acid level was more than 417 μmol/L in males and was more than 357 μmol/L in females) and normal group (34 cases, serum uric acid level was lower than the above standard). There was no significant difference in gender, age, side, body mass index, blood glucose level, total cholesterol level, rotator cuff tear size, and preoperative shoulder motion, visual analogue scale (VAS) score, University of California-Los Angeles (UCLA) score, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and other general data between the two groups (P>0.05). The range of motion of abduction, forward flexion, and external rotation at 90° abduction were recorded and compared between the two groups before operation and at last follow-up; the improvement of shoulder pain was evaluated by VAS score; the improvement of shoulder function was evaluated by UCLA score, Constant score, and ASES score; and the shoulder joint MRI grade was evaluated according to Sugaya evaluation criteria.Results All patients were followed up 9-16 months, with an average of 11.9 months; there was no significant difference in the follow-up time between the two groups (t=0.968, P=0.336). There were 2 cases of retear in the hyperuric acid group (including 1 case of severe tear) and 1 case of light retear in the normal group. The remaining patients in the two groups had no early-related complications. At last follow-up, the range of motion of the shoulder joints (abduction, forward flexion, external rotation at 90° abduction), VAS score, UCLA score, Constant score, and ASES score of the two groups were significantly improved when compared with preoperative ones (P<0.05); the above indicators in the normal group were significantly better than those in the hyperuric acid group (P<0.05). The MRI grade of the shoulder joint in the normal group was significantly better than that in the hyperuric acid group (Z=–2.000, P=0.045).Conclusion Compared with patients with normal serum uric acid level, asymptomatic hyperuricemia can lead to worse recovery after arthroscopic rotator cuff repair in patients with rotator cuff tears.

Citation： HAN Zengshuai, ZHAO Xia, MA Wenru, LI Tianyu, ZHANG Yi, QI Chao, YU Tengbo. Analysis of the effect of asymptomatic hyperuricemia on the effectiveness after arthroscopic rotator cuff repair. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(6): 667-672. doi: 10.7507/1002-1892.202102004 Copy

1.	Wilson L, Saseen JJ. Gouty arthritis: A Review of acute management and prevention. Pharmacotherapy, 2016, 36(8): 906-922.
2.	Choi HK, Mount DB, Reginato AM, et al. Pathogenesis of gout. Ann Intern Med, 2005, 143(7): 499-516.
3.	Shields GE, Beard SM. A systematic review of the economic and humanistic burden of gout. Pharmacoeconomics, 2015, 33(10): 1029-1047.
4.	Andia I, Abate M. Hyperuricemia in tendons. Adv Exp Med Biol, 2016, 920: 123-132.
5.	Campion EW, Glynn RJ, DeLabry LO. Asymptomatic hyperuricemia. Risks and consequences in the normative aging study. Am J Med, 1987, 82(3): 421-426.
6.	程留慧, 王道清, 张保朋, 等. 无症状高尿酸血症患者及痛风患者四肢关节尿酸盐结晶的双源CT对比分析. 中华风湿病学杂志, 2015, 19(10): 686-689.
7.	Bedi A, Fox AJ, Harris PE, et al. Diabetes mellitus impairs tendon-bone healing after rotator cuff repair. J Shoulder Elbow Surg, 2010, 19(7): 978-988.
8.	Kim JM, Kim MW, Do HJ. Influence of hyperlipidemia on the treatment of supraspinatus tendinopathy with or without tear. Ann Rehabil Med, 2016, 40(3): 463-469.
9.	Huang SW, Wu CW, Lin LF, et al. Gout can increase the risk of receiving rotator cuff tear repair surgery. Am J Sports Med, 2017, 45(10): 2355-2363.
10.	孙琳, 王桂侠, 郭蔚莹. 高尿酸血症研究进展. 中国老年学杂志, 2017, 37(4): 1034-1038.
11.	Zhang Y, Zhai S, Qi C, et al. A comparative study of arthroscopic débridement versus repair for Ellman grade Ⅱ bursal-side partial-thickness rotator cuff tears. J Shoulder Elbow Surg, 2020, 29(10): 2072-2079.
12.	周立飞, 周晓波. 痛风性肩关节炎一例. 中国骨伤, 2000, 13(4): 203.
13.	O’leary ST, Goldberg JA, Walsh WR. Tophaceous gout of the rotator cuff: a case report. J Shoulder Elbow Surg, 2003, 12(2): 200-201. doi: 10.1067/mse.2003.24.
14.	Chang CH, Lu CH, Yu CW, et al. Tophaceous gout of the rotator cuff. A case report. J Bone Joint Surg (Am), 2008, 90(1): 178-182.
15.	邢丹谋, 彭正人, 任东, 等. 肩关节痛风石伴肩袖损伤一例报告. 中华骨科杂志, 2005, 25(11): 703-704.
16.	陈宜, 祝云利, 钱齐荣. 肩关节巨大痛风石1例. 实用骨科杂志, 2009, 15(3): 234.
17.	钟名金, 柳海峰, 欧阳侃, 等. 痛风性肩关节炎伴痛风石误诊一例并文献复习. 中华骨科杂志, 2020, 40(7): 441-444.
18.	郝丹, 杨玉兰. 以肩关节发病的不典型痛风验案 1 则. 湖南中医杂志, 2017, 33(9): 117-118.
19.	郑凯, 于秀淳, 付志厚, 等. 肩关节镜诊疗痛风性肩关节炎一例报道. 中华关节外科杂志 (电子版), 2015, (2): 263-264.
20.	Ichiseki T, Ueda S, Matsumoto T. Rare coexistence of gouty and septic arthritis after arthroscopic rotator cuff repair: a case report. Int J Clin Exp Med, 2015, 8(3): 4718-4720.
21.	Tierra Rodriguez AM, Pantoja Zarza L, Brañanova López P, et al. Tophaceous gout of the shoulder joint. Reumatol Clin, 2019, 15(5): e55-e56.
22.	Abate M, Schiavone C, Salini V, et al. Occurrence of tendon pathologies in metabolic disorders. Rheumatology (Oxford), 2013, 52(4): 599-608.
23.	郭家全, 李玲, 郭振中, 等. 关节镜下修复肩袖损伤的临床结果及其与年龄因素的相关性分析. 湖南师范大学学报 (医学版), 2015, 12(6): 64-66.
24.	Tashjian RZ, Hollins AM, Kim HM, et al. Factors affecting healing rates after arthroscopic double-row rotator cuff repair. Am J Sports Med, 2010, 38(12): 2435-2442.
25.	Aydin N, Karaismailoglu B, Gurcan M, et al. Arthroscopic double-row rotator cuff repair: a comprehensive review of the literature. SICOT J, 2018, 4: 57. doi: 10.1051/sicotj/2018048.
26.	Pineda C, Amezcua-Guerra LM, Solano C, et al. Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: an ultrasound controlled study. Arthritis Res Ther, 2011, 13(1): R4. doi: 10.1186/ar3223.
27.	Bullocks JM, Downey CR, Gibler DP, et al. Crystal deposition disease masquerading as proliferative tenosynovitis and its associated sequelae. Ann Plast Surg, 2009, 62(2): 128-133.
28.	Patten A, Pun WK. Spontaneous rupture of the tibialis anterior tendon: a case report and literature review. Foot Ankle Int, 2000, 21(8): 697-700.
29.	Lagoutaris ED, Adams HB, DiDomenico LA, et al. Longitudinal tears of both peroneal tendons associated with tophaceous gouty infiltration. A case report. J Foot Ankle Surg, 2005, 44(3): 222-224.
30.	Radice F, Monckeberg JE, Carcuro G. Longitudinal tears of peroneus longus and brevis tendons: a gouty infiltration. J Foot Ankle Surg, 2011, 50(6): 751-753.
31.	Chhana A, Callon KE, Dray M, et al. Interactions between tenocytes and monosodium urate monohydrate crystals: implications for tendon involvement in gout. Ann Rheum Dis, 2014, 73(9): 1737-1741.
32.	Ruggiero C, Cherubini A, Ble A, et al. Uric acid and inflammatory markers. Eur Heart J, 2006, 27(10): 1174-1181.
33.	Grainger R, McLaughlin RJ, Harrison AA, et al. Hyperuricaemia elevates circulating CCL2 levels and primes monocyte trafficking in subjects with inter-critical gout. Rheumatology (Oxford), 2013, 52(6): 1018-1021.
34.	Martin WJ, Grainger R, Harrison A, et al. Differences in MSU-induced superoxide responses by neutrophils from gout subjects compared to healthy controls and a role for environmental inflammatory cytokines and hyperuricemia in neutrophil function and survival. J Rheumatol, 2010, 37(6): 1228-1235.

1. Wilson L, Saseen JJ. Gouty arthritis: A Review of acute management and prevention. Pharmacotherapy, 2016, 36(8): 906-922.
2. Choi HK, Mount DB, Reginato AM, et al. Pathogenesis of gout. Ann Intern Med, 2005, 143(7): 499-516.
3. Shields GE, Beard SM. A systematic review of the economic and humanistic burden of gout. Pharmacoeconomics, 2015, 33(10): 1029-1047.
4. Andia I, Abate M. Hyperuricemia in tendons. Adv Exp Med Biol, 2016, 920: 123-132.
5. Campion EW, Glynn RJ, DeLabry LO. Asymptomatic hyperuricemia. Risks and consequences in the normative aging study. Am J Med, 1987, 82(3): 421-426.
6. 程留慧, 王道清, 张保朋, 等. 无症状高尿酸血症患者及痛风患者四肢关节尿酸盐结晶的双源CT对比分析. 中华风湿病学杂志, 2015, 19(10): 686-689.
7. Bedi A, Fox AJ, Harris PE, et al. Diabetes mellitus impairs tendon-bone healing after rotator cuff repair. J Shoulder Elbow Surg, 2010, 19(7): 978-988.
8. Kim JM, Kim MW, Do HJ. Influence of hyperlipidemia on the treatment of supraspinatus tendinopathy with or without tear. Ann Rehabil Med, 2016, 40(3): 463-469.
9. Huang SW, Wu CW, Lin LF, et al. Gout can increase the risk of receiving rotator cuff tear repair surgery. Am J Sports Med, 2017, 45(10): 2355-2363.
10. 孙琳, 王桂侠, 郭蔚莹. 高尿酸血症研究进展. 中国老年学杂志, 2017, 37(4): 1034-1038.
11. Zhang Y, Zhai S, Qi C, et al. A comparative study of arthroscopic débridement versus repair for Ellman grade Ⅱ bursal-side partial-thickness rotator cuff tears. J Shoulder Elbow Surg, 2020, 29(10): 2072-2079.
12. 周立飞, 周晓波. 痛风性肩关节炎一例. 中国骨伤, 2000, 13(4): 203.
13. O’leary ST, Goldberg JA, Walsh WR. Tophaceous gout of the rotator cuff: a case report. J Shoulder Elbow Surg, 2003, 12(2): 200-201. doi: 10.1067/mse.2003.24.
14. Chang CH, Lu CH, Yu CW, et al. Tophaceous gout of the rotator cuff. A case report. J Bone Joint Surg (Am), 2008, 90(1): 178-182.
15. 邢丹谋, 彭正人, 任东, 等. 肩关节痛风石伴肩袖损伤一例报告. 中华骨科杂志, 2005, 25(11): 703-704.
16. 陈宜, 祝云利, 钱齐荣. 肩关节巨大痛风石1例. 实用骨科杂志, 2009, 15(3): 234.
17. 钟名金, 柳海峰, 欧阳侃, 等. 痛风性肩关节炎伴痛风石误诊一例并文献复习. 中华骨科杂志, 2020, 40(7): 441-444.
18. 郝丹, 杨玉兰. 以肩关节发病的不典型痛风验案 1 则. 湖南中医杂志, 2017, 33(9): 117-118.
19. 郑凯, 于秀淳, 付志厚, 等. 肩关节镜诊疗痛风性肩关节炎一例报道. 中华关节外科杂志 (电子版), 2015, (2): 263-264.
20. Ichiseki T, Ueda S, Matsumoto T. Rare coexistence of gouty and septic arthritis after arthroscopic rotator cuff repair: a case report. Int J Clin Exp Med, 2015, 8(3): 4718-4720.
21. Tierra Rodriguez AM, Pantoja Zarza L, Brañanova López P, et al. Tophaceous gout of the shoulder joint. Reumatol Clin, 2019, 15(5): e55-e56.
22. Abate M, Schiavone C, Salini V, et al. Occurrence of tendon pathologies in metabolic disorders. Rheumatology (Oxford), 2013, 52(4): 599-608.
23. 郭家全, 李玲, 郭振中, 等. 关节镜下修复肩袖损伤的临床结果及其与年龄因素的相关性分析. 湖南师范大学学报 (医学版), 2015, 12(6): 64-66.
24. Tashjian RZ, Hollins AM, Kim HM, et al. Factors affecting healing rates after arthroscopic double-row rotator cuff repair. Am J Sports Med, 2010, 38(12): 2435-2442.
25. Aydin N, Karaismailoglu B, Gurcan M, et al. Arthroscopic double-row rotator cuff repair: a comprehensive review of the literature. SICOT J, 2018, 4: 57. doi: 10.1051/sicotj/2018048.
26. Pineda C, Amezcua-Guerra LM, Solano C, et al. Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: an ultrasound controlled study. Arthritis Res Ther, 2011, 13(1): R4. doi: 10.1186/ar3223.
27. Bullocks JM, Downey CR, Gibler DP, et al. Crystal deposition disease masquerading as proliferative tenosynovitis and its associated sequelae. Ann Plast Surg, 2009, 62(2): 128-133.
28. Patten A, Pun WK. Spontaneous rupture of the tibialis anterior tendon: a case report and literature review. Foot Ankle Int, 2000, 21(8): 697-700.
29. Lagoutaris ED, Adams HB, DiDomenico LA, et al. Longitudinal tears of both peroneal tendons associated with tophaceous gouty infiltration. A case report. J Foot Ankle Surg, 2005, 44(3): 222-224.
30. Radice F, Monckeberg JE, Carcuro G. Longitudinal tears of peroneus longus and brevis tendons: a gouty infiltration. J Foot Ankle Surg, 2011, 50(6): 751-753.
31. Chhana A, Callon KE, Dray M, et al. Interactions between tenocytes and monosodium urate monohydrate crystals: implications for tendon involvement in gout. Ann Rheum Dis, 2014, 73(9): 1737-1741.
32. Ruggiero C, Cherubini A, Ble A, et al. Uric acid and inflammatory markers. Eur Heart J, 2006, 27(10): 1174-1181.
33. Grainger R, McLaughlin RJ, Harrison AA, et al. Hyperuricaemia elevates circulating CCL2 levels and primes monocyte trafficking in subjects with inter-critical gout. Rheumatology (Oxford), 2013, 52(6): 1018-1021.
34. Martin WJ, Grainger R, Harrison A, et al. Differences in MSU-induced superoxide responses by neutrophils from gout subjects compared to healthy controls and a role for environmental inflammatory cytokines and hyperuricemia in neutrophil function and survival. J Rheumatol, 2010, 37(6): 1228-1235.

Chinese Journal of Reparative and Reconstructive Surgery

Analysis of the effect of asymptomatic hyperuricemia on the effectiveness after arthroscopic rotator cuff repair

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