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Guevara-Alvarez A, Valencia-Ramón E, Lopez-Villers A, Navarro-Pérez LF, Gonzalez-Rizo I, Gomez GE, Laedermann A. Reinforcements and augmentations with the long head of the biceps tendon in shoulder surgery: a narrative review. EFORT Open Rev 2025; 10:297-308. [PMID: 40326542 PMCID: PMC12061019 DOI: 10.1530/eor-2024-0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2025] Open
Abstract
The long head of the biceps tendon (LHBT) has recently emerged as a therapeutic option for various shoulder pathologies. Synthetic materials and allografts have not shown sufficient resistance or favorable outcomes to restore rotator cuff native tissue properties, leading to consideration of using LHBT as biological augmentation. LHBT mimics adjacent structures, such as the rotator cuff, is easily accessible during surgery, and is a good source of live autologous cells for regenerative augmentation in rotator cuff repair, as a superior capsular reconstruction in irreparable cuff tears, in subscapularis augmentation in shoulder replacement and as a stabilizer in anterior shoulder instability. This narrative review aims to collect, synthesize and critically evaluate the literature on the use of the LHBT and its current applications in the field of shoulder surgery, improving the understanding of the terminology and consolidating the concepts related to the various procedures in shoulder surgery.
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Affiliation(s)
- Alberto Guevara-Alvarez
- Instituto de Hombro IDH, Hospital Angeles Centro Sur, Querétaro, Mexico
- Instituto Queretano de Alta Especialidad en Ortopedia IQAEO. Hospital Angeles Centro Sur, Querétaro, Mexico
| | - Edwin Valencia-Ramón
- Instituto de Hombro IDH, Hospital Angeles Centro Sur, Querétaro, Mexico
- Instituto Queretano de Alta Especialidad en Ortopedia IQAEO. Hospital Angeles Centro Sur, Querétaro, Mexico
| | - Alejandro Lopez-Villers
- Instituto de Hombro IDH, Hospital Angeles Centro Sur, Querétaro, Mexico
- Instituto Queretano de Alta Especialidad en Ortopedia IQAEO. Hospital Angeles Centro Sur, Querétaro, Mexico
| | - Luis Fernando Navarro-Pérez
- Instituto de Hombro IDH, Hospital Angeles Centro Sur, Querétaro, Mexico
- Instituto Queretano de Alta Especialidad en Ortopedia IQAEO. Hospital Angeles Centro Sur, Querétaro, Mexico
| | - Israel Gonzalez-Rizo
- Instituto de Hombro IDH, Hospital Angeles Centro Sur, Querétaro, Mexico
- Instituto Queretano de Alta Especialidad en Ortopedia IQAEO. Hospital Angeles Centro Sur, Querétaro, Mexico
| | | | - Alexandre Laedermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
- FORE (Foundation for Research and Teaching in Orthopedics, Sports Medicine, Trauma, and Imaging in the Musculoskeletal System), Meyrin, Switzerland
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Tsai MH, Chen P, Lädermann A, Yang CP, Cheng YH, Hsu CH, Chiu JCH. Arthroscopic additional biceps augmentation and biceps superior capsular reconstruction yield similar clinical and radiological outcomes for patients with medium to large rotator cuff tears. J Orthop Surg (Hong Kong) 2025; 33:10225536251345183. [PMID: 40401686 DOI: 10.1177/10225536251345183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2025] Open
Abstract
Purpose: To compare the outcomes of additional biceps augmentation (ABA) and biceps superior capsule reconstruction (BSCR) in arthroscopic medium to large rotator cuff tear (RCT) repair. Hypothesis: Both ABA and BSCR yielded comparable clinical and radiological outcomes and retear rates at the 2-year follow-up in patients with medium to large RCTs. Methods: Patients undergoing ABA or BSCR for RCT repairs were included retrospectively between January 2019 and May 2020. The preoperative and postoperative Constant-Murley score (CMS), American Shoulder and Elbow Surgeons (ASES) score, subjective shoulder value (SSV), visual analog scale (VAS), and range of motion (ROM) were recorded, as well as the radiographic evaluation. Results: 67 patients (41 with ABA, 26 with BSCR) were included. There were no significant differences regarding preoperative patient demographics between groups unless forward flexion. In the ABA group, CMS, ASES, SSV, and VAS improved significantly from 33.9 ± 6.0, 37.3 ± 8.7, 24.9 ± 12.3, and 5.1 ± 1.1 to 79.3 ± 8.4, 82.7 ± 8.4, 77.5 ± 10.9, and 2.4 ± 0.6, at 2-year follow-up (all p < .001). In the BSCR group, the CMS, ASES, SSV, and VAS significantly improved from 33.9 ± 5.5, 33.5 ± 11.6, 20.8 ± 9.8, and 5.3 ± 1.5 to 72.8 ± 12.9, 79.6 ± 12.1, 73.1 ± 10.2, and 2.7 ± 0.8, at follow-up (all p < .001). All ROM improved at follow-up in both groups (all p < .001). No significant differences were found between the two groups regarding the postoperative clinical and radiological results. All patients reached minimal clinically important differences for CMS, ASES, SSV, and VAS at the final follow-up. The retear rates in the ABA and BSCR groups were 0% and 7.7%, respectively (p = .001). Conclusions: Both ABA and BSCR provided similar clinical and radiological outcomes in patients with medium to large RCTs. The BSCR group had a higher retear rate than the ABA group. Level of Evidence: Level III, Retrospective comparative therapeutic trial. Clinical Relevance: Both ABA and BSCR provided comparable clinical and radiological outcomes in patients with medium to large RCTs.
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Affiliation(s)
- Meng Huan Tsai
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Comprehensive Sports Medicine Center (CSMC) Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Poyu Chen
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Alexandre Lädermann
- Division of Orthopedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Orthopedics and Trauma Service, University Hospitals of Geneva, Geneva, Switzerland
| | - Cheng-Pang Yang
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Comprehensive Sports Medicine Center (CSMC) Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - You-Hung Cheng
- Department of Orthopedic Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Chen-Heng Hsu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Joe Chih-Hao Chiu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Comprehensive Sports Medicine Center (CSMC) Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Kilinc BE, Bilgin E, Eren O, Oc Y, Yilmaz B. The role of sagittal axis in biceps tenodesis for superior capsular reconstruction in massive irreparable rotator cuff tears. BMC Musculoskelet Disord 2025; 26:361. [PMID: 40229790 PMCID: PMC11995516 DOI: 10.1186/s12891-025-08615-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2024] [Accepted: 04/03/2025] [Indexed: 04/16/2025] Open
Abstract
BACKGROUND This study aims to compare histopathological results following a 6-week postoperative follow-up of biceps tenodesis (BT) at 1/3 median, 1/3 posterior, and 1/3 anterior locations to the rotator cuff footprint (RCF) in cases of massive irreparable rotator cuff tears (MIRCT). MATERIALS AND METHODS Thirty rabbits were assigned to three groups. BT for superior capsular reconstruction (SCR) was performed on rabbits 1-10 at the 1/3 median part of the RCF along the sagittal axis using a transosseous reinforced suture with the modified Mason-Allen technique, maintaining consistent pressure in the groove (Group 1). In rabbits 11-20 (Group 2), tenodesis was performed 1/3 posterior to the RCF, while rabbits 21-30 (Group 3) underwent tenodesis 1/3 anterior to the RCF. Following the 6-week follow-up, the shoulders were excised en bloc, and histopathological evaluation was conducted using a modified Bonar's scale. Results were statistically compared among the groups. RESULTS The level of cell morphology was significantly lower in Group 2 compared to the other groups (p < 0.05). The extracellular matrix level was also significantly lower in Group 2 compared to the others (p < 0.05). There were no statistically significant differences in collagen levels across Groups 1, 2, and 3 (p > 0.05), nor in cellularity levels among the groups (p > 0.05). General score evaluation levels were significantly lower in Group 2 than in the other groups (p < 0.05). DICSUSSION BT performed on the 1/3 posterior part of the RCF demonstrated greater success compared to procedures conducted at the 1/3 median and 1/3 anterior locations for MIRCT.
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Affiliation(s)
- Bekir Eray Kilinc
- Department of Orthopedics and Traumatology, Health Sciences University Fatih Sultan Mehmet Training and Research Hospital, D100 Uzeri Hastane Sok. No:1/8 34752 Icerenkoy Atasehir, Istanbul, Turkey.
| | - Emre Bilgin
- Department of Orthopedics and Traumatology, Health Sciences University Fatih Sultan Mehmet Training and Research Hospital, D100 Uzeri Hastane Sok. No:1/8 34752 Icerenkoy Atasehir, Istanbul, Turkey
| | - Olcay Eren
- Department of Orthopedics and Traumatology, Health Sciences University Fatih Sultan Mehmet Training and Research Hospital, D100 Uzeri Hastane Sok. No:1/8 34752 Icerenkoy Atasehir, Istanbul, Turkey
| | - Yunus Oc
- Department of Orthopedics, BHT Clinic Thema Hospital, Istanbul, Turkey
| | - Baris Yilmaz
- Department of Orthopedics and Traumatology, Health Sciences University Fatih Sultan Mehmet Training and Research Hospital, D100 Uzeri Hastane Sok. No:1/8 34752 Icerenkoy Atasehir, Istanbul, Turkey
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Paccot D, Fleet CT, Johnson JA, Athwal GS. Superior capsular reconstruction using the long head of biceps tendon: a biomechanical assessment of tenodesis location and angle of fixation. J Shoulder Elbow Surg 2025; 34:688-698. [PMID: 39153566 DOI: 10.1016/j.jse.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/07/2024] [Accepted: 07/04/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Massive irreparable rotator cuff tears (MIRCTs) treated with superior capsular reconstruction (SCR) using the long head of the biceps tendon have shown satisfactory early results. Different techniques and positions for biceps tenodesis have been described. This study aimed to evaluate the effect of tenodesis location and glenohumeral fixation angle for graft tensioning on the biomechanics of an SCR using a single-strand biceps technique. METHODS Eight cadaveric shoulders were mounted onto a custom biomechanical simulator that used static tone loads to the deltoid and rotator cuff muscles. All cadavers were first tested in the intact condition, and then in the simulated MIRCT condition by sectioning the tendinous insertions of the supraspinatus and upper border of the infraspinatus. SCR using the long head of the biceps tendon was then evaluated. Three biceps tenodesis locations relative to the greater tuberosity (anterior, middle, and posterior) and 2 glenohumeral fixation angles (0° and 30°) for graft tensioning were tested. An optical tracking system was used to quantify superior-inferior and anterior-posterior humeral head translation relative to the glenoid, whereas the functional abduction force was quantified using a load sensor. All tests were conducted at 0°, 30°, and 60° of glenohumeral abduction in a randomized fashion. RESULTS When assessing isolated superior humeral head migration, all biceps tenodesis locations were effective at decreasing superior migration, with no tenodesis location significantly better than the other (P = .213). However, biceps grafts tensioned at 30° of glenohumeral abduction were significantly better at reducing proximal humeral migration as compared to graft tensioning at 0° abduction (P = .008). Posterior humeral head translation observed in the MIRCT condition was significantly reduced when tensioning the biceps tendon at 30° of glenohumeral abduction compared with 0° for all tenodesis locations (P ≤ .043). The tenodesis location also significantly influenced posterior humeral head translation (P = .001), with the middle and posterior positions restoring near normal humeral head position when fixed at 30° glenohumeral abduction. All SCR techniques using the biceps tendon improved the functional abduction force relative to the MIRCT condition, although no statistically significant differences were observed relative to the intact condition (P ≥ .448). DISCUSSION SCR using the long head of the biceps tendon is biomechanically effective in reducing posterosuperior translation of the humeral head in the setting of an MIRCT. Graft tensioning and fixation at 30° of glenohumeral abduction combined with either a middle or posterior tenodesis location on the greater tuberosity most effectively restores near normal time-zero humeral head kinematics.
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Affiliation(s)
- Daniel Paccot
- Roth | McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, ON, Canada
| | - Cole T Fleet
- Roth | McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Department of Mechanical and Materials Engineering, Western University, London, ON, Canada
| | - James A Johnson
- Roth | McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Department of Mechanical and Materials Engineering, Western University, London, ON, Canada
| | - George S Athwal
- Roth | McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Department of Surgery, Western University, London, ON, Canada.
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Khanfar A, Alswerki MN, Alelaumi AF, Al-Tamimi S, Saimeh TH, Keilani LZ, Keilani DZ, Altarawneh TA, Barakat M, Alelaumi OF, Almomani A, Hammad R, Theeb L, Al Qaroot B. A combined anterior and posterior cuff transfer: a novel technique for massive irreparable rotator cuff tears. Musculoskelet Surg 2025:10.1007/s12306-025-00882-0. [PMID: 39891872 DOI: 10.1007/s12306-025-00882-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2024] [Accepted: 01/14/2025] [Indexed: 02/03/2025]
Abstract
INTRODUCTION Irreparable rotator cuff tears (IRCTs) are large tears that can't be surgically repaired due to poor tissue quality, degeneration, or severe tendon retraction. These tears often involve multiple tendons and lead to fatty infiltration, humeral head migration, and tendon retraction. Patients with IRCTs typically present with pseudoparalysis, muscle atrophy, or anterosuperior escape. While various surgical options exist, outcomes are often inconsistent. This case series presents a novel technique for managing massive IRCTs, showing excellent, consistent results and offering a promising advancement for treating these challenging cases. METHODOLOGY Our case series involved 20 patients with massive irreparable rotator cuff tears, presenting clinically with pseudoparalysis and radiographically with signs of fatty infiltration, anterosuperior escape, and tendon retraction. The outcomes of interest included the Western Ontario Rotator Cuff Index (WORI), Oxford Shoulder Score (OSS), and range of motion arc (forward flexion and abduction), measured both preoperatively and postoperatively. RESULTS The mean age of our patient cohort was 53.6 years, with a mean follow-up time of 40 months. The mean preoperative WORI score was 155.3, which improved to 54.2 postoperatively, showing an improvement of 101 points from the baseline. The mean preoperative OSS was 34.4, improving to 10.5 postoperatively, with a gain of 23.8 points. The mean preoperative range of motion for forward flexion was 67.0°, which improved to 164° postoperatively, resulting in a mean gain of 97°. The mean preoperative abduction was 57°, which improved to 166° postoperatively, with a mean gain of 109°. All these findings were statistically significant (p < 0.05). CONCLUSION In our surgical technique, all patients demonstrated clinically and statistically significant improvements in both range of motion and patient-reported outcomes. This makes our approach a novel, robust, and reliable technique for managing massive irreparable tears, particularly in young adult patients. LEVEL OF EVIDENCE Case Series, Level IV.
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Affiliation(s)
- A Khanfar
- Upper Limb and Orthopedic Surgery Consultant, Jordan University Hospital, Associate Professor, University of Jordan, Amman, Jordan
| | - M N Alswerki
- Department of Orthopedic Surgery, Jordan University Hospital, P.O. Box: 13046, Amman, Jordan.
| | - A F Alelaumi
- Department of Orthopedic Surgery, Jordan University Hospital, P.O. Box: 13046, Amman, Jordan
| | | | - T H Saimeh
- Jordan University Hospital, Amman, Jordan
| | | | | | | | - M Barakat
- Jordan University Hospital, Amman, Jordan
| | - O F Alelaumi
- Jordan University Science and Technology, Irbid, Jordan
| | - A Almomani
- Jordan University Hospital, Amman, Jordan
| | - R Hammad
- Jordan University Hospital, Amman, Jordan
| | - L Theeb
- Faculty of Medicine, University of Jordan, Amman, Jordan
| | - B Al Qaroot
- Faculty of Rehabilitation Science, University of Jordan, Amman, Jordan
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Gómez DJ, Ávila Posada S, Gabotto N, Viollaz GM, Muratore ÁJ, Altamirano NN, Moya D. Superior capsular reconstruction of the shoulder with biceps autograft vs. Achilles allograft: A 2-year comparative study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024:S1888-4415(24)00208-X. [PMID: 39681194 DOI: 10.1016/j.recot.2024.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 11/19/2024] [Accepted: 11/29/2024] [Indexed: 12/18/2024] Open
Abstract
PURPOSE To retrospectively evaluate the clinical-functional outcomes, healing rates, complications, and surgical time in patients treated with superior capsular reconstruction (SCR) using long head of the biceps autograft (LHB) and Achilles allograft (AA). MATERIALS AND METHODS This retrospective study included 24 patients with irreparable rotator cuff tears of the supraspinatus and infraspinatus, treated with SCR. Two treatment groups were formed: one with 12 cases using AA and another with 12 cases using LHB. All patients were followed for a minimum of 2 years. RESULTS The SSV was 73.7±25.3 vs. 86.0±8.7 (p=0.26), the Constant score was 76.8±20.1 vs. 83.7±4.6 (p=0.12), and the VAS was 1.6±2.3 vs. 1.7±0.5 (p=0.9) for the LHB and AA groups, respectively. Tendon healing was 66.7% in AA and 100% in LHB (p=0.001). Complications were 50% in AA and 0% in LHB. The average surgical time was 127.7±37.6minutes for AA and 84.3±14.3min for LHB (p=0.01). CONCLUSIONS SCR with LHB showed better results in terms of tendon healing, fewer complications, and reduced surgical time compared to the use of AA.
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Affiliation(s)
- D J Gómez
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina.
| | - S Ávila Posada
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - N Gabotto
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - G M Viollaz
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Á J Muratore
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - N N Altamirano
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - D Moya
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
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von Knoch M, Hoffmann DB, Baums MH. Which Factors Are Associated With Rerupture After Superior Capsular Reconstruction of the Shoulder With Autologous Long Biceps Tendon? - A Systematic Review. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:606-613. [PMID: 37967830 DOI: 10.1055/a-2195-0790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Based on a systematic review, the present work analyses factors associated with the rerupture rate or non-healing after superior capsular reconstruction with autologous long biceps tendon in the reconstruction of the rotator cuff of the shoulder.A systematic review of the U.S. National Library of Medicine/National Institutes of Health (PubMed) database and the Cochrane Library was conducted in September 2021 using the PRISMA checklist. Articles were identified and analysed that contained data on the rerupture rate after superior capsular reconstruction with autologous long biceps tendon in reconstruction of the rotator cuff of the shoulder. The aim was to identify factors associated with rerupture or non-healing. The risk of bias was determined using the Newcastle-Ottawa scale.Primarily 86 hits could be generated. Seven articles from 2020 and 2021 met the inclusion criteria and were further analysed in terms of content. The evidence level was III to IV. Follow-up was between 12 (minimum) and 24 to 48 months. The risk of bias was not low. Factors that may be associated with rerupture or non-healing are diabetes mellitus and high-grade fatty degeneration of the subscapularis, infraspinatus, or teres minor as preoperative factors. Age, percent footprint coverage, tear size, symptom duration, number of bundles, acromioplasty performed, and tear configuration were not significant factors. Gender, degree of fatty degeneration of the supraspinatus and lesions of the subscapularis tendon were rated differently.According to the literature, but still currently with short-term observation periods, superior capsular reconstruction with an autologous long biceps tendon is another treatment option in the case of massive tears and elderly patients, if there is no high-grade fatty degeneration of the subscapularis, infraspinatus or teres minor. Diabetes mellitus has an unfavorable prognosis. Additional acromioplasty has so far not been associated with better outcomes.
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Affiliation(s)
- Marius von Knoch
- Schulterchirurgie, Kreiskrankenhaus Osterholz, Osterholz-Scharmbeck, Deutschland
- Schulterchirurgie, AMEOS Klinikum Seepark Geestland, Geestland, Deutschland
| | - Daniel B Hoffmann
- Klinik für Unfallchirurgie, Orthopädie und plastische Chirurgie, Universitätsmedizin Göttingen, Gottingen, Deutschland
| | - Mike H Baums
- Fachbereich Orthopädie, Unfallchirurgie und Sporttraumatologie, Katholisches Klinikum Ruhrgebiet Nord GmbH, Dorsten, Deutschland
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Wegmann S, Kahmann S, Marchal C, Leschinger T, Wegmann K, Mueller LP, Hackl M. Improved restoration of biomechanical factors using a narrow-box shaped reconstruction compared to a wide one in superior capsular reconstruction for irreparable supraspinatus tendon tears: a biomechanical study using a static shoulder simulator. J Shoulder Elbow Surg 2024; 33:2472-2481. [PMID: 39032687 DOI: 10.1016/j.jse.2024.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 05/10/2024] [Accepted: 05/19/2024] [Indexed: 07/23/2024]
Abstract
HYPOTHESIS AND/OR BACKGROUND Extensive, irreparable rotator cuff tears remain a surgical challenge and multiple treatment options are proposed and currently in use. To biomechanically compare superior glenohumeral translation, subacromial contact pressures, and area in a box-shaped reconstruction using the long head of the biceps tendon (LHBT) in an irreparable supraspinatus tendon tear model. METHODS Seven cadaveric shoulders (mean age 61 years; range 32-84 years; standard deviation 22.3) were tested with a custom testing rig used to evaluate superior translation; subacromial contact pressures; and areas at 0°, 30°, and 60° of glenohumeral abduction. Conditions tested included the native state; a complete tear of the supraspinatus tendon; a wide box-shaped, double-bundle LHBT superior capsular reconstruction (BS-SCR); and a narrow BS-SCR. RESULTS Compared with the wide BS-SCR, the narrow BS-SCR had statistically significantly lower median contact pressure at 30° and 60°. The subacromial contact area showed a statistically significant difference at 0° (P = .001) and 30° (P = .004) for the narrow BS-SCR compared with the wide BS-SCR. At an abduction angle of 0°, the narrow BS-SCR could restore superior translation significantly better compared with the wide construct. For all angles, the wide and narrow BS-SCR increased the median subacromial distance statistically significantly. The contact areas in 30° and 60° of abduction were higher for all scenarios, both peaking in the intact state in 30° with approximately 600 mm2. CONCLUSIONS In comparison to a wide BS-SCR, a narrow BS-SCR using the LHBT has biomechanical advantages in regard to subacromial contact pressures, the subacromial contact areas, as well as the acromiohumeral distance. The width of the reconstruction, therefore, has a direct influence on the success of the technique.
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Affiliation(s)
- Sebastian Wegmann
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany.
| | - Stephanie Kahmann
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany
| | | | - Tim Leschinger
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Kilian Wegmann
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany; OCM (Orthopädische Chirurgie München) Clinic, Munich, Germany
| | - Lars-Peter Mueller
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany
| | - Michael Hackl
- Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany
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Pastor PCS, Ramos IP, Roig AG, Safont JA. Long head of biceps tendon augmentation in rotator cuff repair enhances tendon healing, shoulder function and patient-reported outcomes one-year post-surgery. J Exp Orthop 2024; 11:e70033. [PMID: 39391567 PMCID: PMC11465290 DOI: 10.1002/jeo2.70033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Revised: 08/27/2024] [Accepted: 09/03/2024] [Indexed: 10/12/2024] Open
Abstract
Purpose The aim is to determine the effect on healing and functionality of patients after 1 year of biceps augmentation of a rotator cuff repair (RCR) compared to RCR plus long head of the biceps (LHB) tenotomy. In addition, to analyse the main factors involved in the recovery after the surgery. Methods A prospective, comparative, non-randomized study (Level of Evidence III) was conducted. Patients with repairable rotator cuff tears were allocated to either the control group, with a double row transosseous equivalent RCR with LHB tenotomy, or the RCR+augmentation with LHB group. Patients were evaluated for radiological (MRI), clinical (cuff size, Patte and Goutallier scales) and functional variables (Constant and American Shoulder and Elbow Surgeons [ASES] scales) before the intervention. At 1-year follow-up cuff healing was confirmed through MRI and functional evaluation with Constant, ASES, simple shoulder test [SST] and Disabilities of the Arm, Shoulder and Hand scales. Results Seventy-seven patients underwent control or RCR+augmentation with LHB, there were no preoperative differences between the groups. After 1 year of the surgery, re-rupture occurred in 38.5% and 16% of the patients in control and RCR+augmentation with LHB groups, respectively (p = .026). Total functionality was higher (p < .05) in RCR+augmentation with LHB than in the control group: Constant, SST and ASES scales. Among the explored factors involved in healing, re-rupture occurred in 100% of the cases with high fatty degeneration. Besides, higher initial functionality (Constant scale) and RCR+augmentation with LHB increased the odds of healing (odds ratio [OR] = 1.12 [1.04-1.21]; OR = 5 [1, 61], respectively), while higher cuff length had a detrimental effect (OR = 0.92 [0.85-0.99]). Conclusion RCR+augmentation with LHB achieves a higher healing percentage and a better functional evolution than RCR+LHB tenotomy, 1 year after cuff repair. Fatty degeneration, cuff length and initial functionality are the main factors involved in cuff healing. Level of Evidence Level III randomized controlled trial.
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Affiliation(s)
- Pablo Cañete San Pastor
- Doctoral School, Catholic Unversity of Valencia San Vicente Martir Hospital de ManisesManisesValenciaSpain
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Rhee YG, Kim YS, Lee IE, Kim SY, Ham HJ, Rhee SM, Kantanavar R. Does timing influence rehabilitation outcomes in arthroscopic rotator cuff repair with biceps rerouting? a prospective randomized study. J Shoulder Elbow Surg 2024; 33:1928-1937. [PMID: 38428476 DOI: 10.1016/j.jse.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Arthroscopic rotator cuff repair with biceps rerouting (ABR) has emerged as a reliable option for treating large posterosuperior rotator cuff tears (RCTs). This study aims to compare functional and structural outcomes of early vs. delayed motion rehabilitation protocols following ABR. METHODS A total of 101 patients with semirigid, large, posterosuperior RCTs undergoing ABR were randomized into 2 groups: group I (early motion) with 53 patients (34 females, 19 males) and group II (delayed motion) with 48 patients (31 females, 17 males). In group I, the mean age was 63.9 years (range, 46-79), and in group II, it was 65.4 years (range, 43-78). The mean follow-up periods for group I and group II were 16.2 and 15.5 months, respectively. Preoperative and postoperative assessments were conducted at 3, 6, and 12 months, with structural integrity assessed with magnetic resonance imaging at a minimum follow-up of 12 months. Statistical analyses were performed to compare outcomes between the 2 groups. RESULTS Both groups demonstrated significant improvements in visual analog scale score (group I: 4.0-1.6, group II: 3.7-1.4, P = .501), University of California-Los Angeles shoulder score (group I: 21.5-31.4, group II: 22.4-30.6, P = .331), and acromiohumeral interval (group I: 8.2 mm-9.1 mm, group II: 8.6 mm-9.5 mm, P = .412), with no statistically or clinically meaningful differences. Active range of movements (ROM) were not significantly different between groups, except for active forward flexion at 3 months (group I: 140.1°, group II: 119.2°, P = .006), that was not shown to be translated clinically into differences in function or healing between the groups in this study. Notably, retear rates were similar between groups (group I: 22.6%, group II: 20.8%, P = .826). CONCLUSION This study's findings reveal no clinically discernible differences in active range of motion at 1-year follow-up between patients who underwent ABR for semirigid, large, posterosuperior RCTs and were assigned to either early or delayed motion protocols. Notably, the early motion group demonstrated a plateau in maximum range of movement improvement as early as 3 months postsurgery. Based on these results, implementing an early motion protocol is recommended as an effective approach in the postoperative rehabilitation following ABR.
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Affiliation(s)
- Yong Girl Rhee
- Department of Orthopedic Surgery, Shoulder & Elbow Clinic, Myongji Hospital, Goyang-si, Republic of Korea
| | - Yang-Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - In El Lee
- Department of Orthopedic Surgery, Shoulder & Elbow Clinic, Myongji Hospital, Goyang-si, Republic of Korea
| | - Se Yeon Kim
- Department of Orthopedic Surgery, Shoulder & Elbow Clinic, Myongji Hospital, Goyang-si, Republic of Korea
| | - Hyun Joo Ham
- Department of Orthopedic Surgery, Shoulder & Elbow Clinic, Myongji Hospital, Goyang-si, Republic of Korea
| | - Sung Min Rhee
- Department of Orthopedic Surgery, Shoulder & Elbow Clinic, College of Medicine, KyungHee University Hospital, Seoul, Republic of Korea
| | - Radhakrishna Kantanavar
- Department of Orthopedic Surgery, Shoulder & Elbow Clinic, Myongji Hospital, Goyang-si, Republic of Korea.
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Pastor PCS, Ramos MIP, Roig AG, Safont JA. Superior capsular reconstruction with the long head of the biceps tendon achieves excellent clinical results and low rotator cuff rerupture rates one year after cuff repair surgery. INTERNATIONAL ORTHOPAEDICS 2024; 48:2121-2128. [PMID: 38796811 DOI: 10.1007/s00264-024-06223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 05/19/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE To analyze the clinical one-year evolution of healed and rerupture lesions in patients who received a rotator cuff repair plus Superior Capsular Reconstruction (SCR) with the long head of the biceps (LHB). Moreover, to compare this evolution between men and women. METHODS A pilot study was conducted on patients who underwent a rotator cuff repair plus SCR with LHB between February 2021 and June 2022. All patients completed pre-operative and one-year post-operative evaluations for tendon type of tear and tendon integrity using Magnetic Resonance Imaging (MRI)after one year of the surgery. Besides, functionality was evaluated with the American Shoulder and Elbow Surgeons (ASES) score; the visual analog scale for pain (VAS); and the Constant score. RESULTS A total of 38 patients completed the one-year final evaluation, they presented an increased functionality score to 83 and 86 in Constant and ASES scales (p < .001), respectively. Besides, 84% of the patients presented a healed cuff, while rerupture occurred in 16% of the patients. There were differences between the healed and rerupture patients in the total Constant score, with a remarkable increase in the strength subscale, almost double for patients with healed cuff (p < .001); in the same way, daily life activity score, and balance subscale increased, while pain score decreased in the healed cuff group (p < .05). There was no difference in functionality between men and women (p > .05). Besides, almost all patients achieved the MCID in both ASES and Constant total scores, irrespectively of the healing group. CONCLUSION The cuff repair using SCR with the LHB achieved a low percentage of rerupture and a functional improvement after one year of follow-up. Patients who healed the lesion presented more strength and better performance in daily life activities than those with cuff repurture. Thus, SCR + LHB procedure can be considered an efficient technique for rotator cuff repair surgery for both men and women. Although a comparison with a control group is needed to confirm these findings.
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Affiliation(s)
- Pablo Cañete San Pastor
- Universidad Católica de Valencia San Vicente Mártir. Escuela de Doctorado, Valencia, Spain.
- Hospital de Manises, Manises, Spain.
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Bonfatti R, Smith AF, Ledoux A, Lefebvre Y, Neyton L. "Shoe Shop" Lacing Technique: A New Biceps-Augmented Knotless Suture for Arthroscopic Rotator Cuff Repair. Arthrosc Tech 2024; 13:102980. [PMID: 39036405 PMCID: PMC11258873 DOI: 10.1016/j.eats.2024.102980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/08/2024] [Indexed: 07/23/2024] Open
Abstract
Advancements in rotator cuff tear repair have led to innovative techniques for complex cases. In this article, we introduce the "shoe shop" lacing technique, a knotless, side-to-side, and tendon-to-bone suture method augmented with the long head of the biceps tendon (LHBT) for anterior margin-deficient massive rotator cuff tears. This approach offers simplicity, durability, and potential advantages in biomechanics. The LHBT integration and knotless sutures make it a promising solution for challenging tear patterns. This technique provides an attractive option for arthroscopic repair, improving outcomes in cases where anterior cable reinforcement is essential.
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Affiliation(s)
- Rocco Bonfatti
- Orthopaedic Surgery and Traumatology Department, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Yves Lefebvre
- Clinique Rhena, Chirurgie orthopédique et traumatologique, Strasbourg, France
| | - Lionel Neyton
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
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13
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Bilgin E, Kilinc BE, Arican CD, Yilmaz B. Investigation of the pressure value while performing biceps tenodesis for superior capsuler reconstruction. J Orthop Surg Res 2024; 19:222. [PMID: 38576016 PMCID: PMC10993498 DOI: 10.1186/s13018-024-04692-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND To compare the histopathological results of biceps tenodesis (BT) performed with normal, low, and high pressures for superior capsule reconstruction (SCR) in rabbits with massive rotator cuff tears. MATERIALS AND METHODS Thirty rabbits were divided into three groups. Rabbits 1-10 underwent SCR with BT at the same pressure (Group 1), value measured in the groove; 50% lower (Group 2); 50% higher (Group 3). After the 4-week follow-up, shoulder were en-bloc excised and histopathological evaluation was performed with modified Bonar's scale. Results were compared between the groups, statistically. RESULTS Extracellular matrix were significantly lower in group 2 compared to the other groups (p < 0.05). Cellularity levels were significantly lower in group 2 compared to the other groups (p < 0.05). Group 2 had no difference between the sides (p > 0.05). Group 2 had lower vascularity levels compared to the other groups (p = 0.01). DICSUSSION When the biceps tendon was in the bicipital groove and in a more mobile state with lower pressure exposure. BT performed with a tension that creates less pressure than the biceps in the groove is more successful in SCR.
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Affiliation(s)
- Emre Bilgin
- Department of Orthopedics and Traumatology, Health Sciences University Fatih Sultan Mehmet Training and Research Hospital, D100 Uzeri Hastane Sok. No:1/8 34752 Icerenkoy Atasehir, Istanbul, Turkey
| | - Bekir Eray Kilinc
- Department of Orthopedics and Traumatology, Health Sciences University Fatih Sultan Mehmet Training and Research Hospital, D100 Uzeri Hastane Sok. No:1/8 34752 Icerenkoy Atasehir, Istanbul, Turkey.
| | - Cigdem Dicle Arican
- Department of Pathology, Health Sciences University, Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Baris Yilmaz
- Department of Orthopedics and Traumatology, Health Sciences University Fatih Sultan Mehmet Training and Research Hospital, D100 Uzeri Hastane Sok. No:1/8 34752 Icerenkoy Atasehir, Istanbul, Turkey
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14
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Mundakkal A, Panakkal JJ, Nair AV, Ahammad S, Meleppuram JJ, Khan PS. Arthroscopic Double-Row Rotator Cuff Repair With Biceps Augmentation. Arthrosc Tech 2024; 13:102858. [PMID: 38435254 PMCID: PMC10907911 DOI: 10.1016/j.eats.2023.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/30/2023] [Indexed: 03/05/2024] Open
Abstract
Arthroscopic repair of chronic retracted rotator cuff tears remains challenging to shoulder arthroscopy surgeons. With the recent technical advances, most of the massive rotator cuff tears are managed successfully. The biceps tendon is highly vascular and a rich source of tenocytes and fibroblasts, which can promote biological healing. In massive degenerate rotator cuff tears in which the rotator cuff tissue can be released and fixed onto the footprint without much tissue tension, long head of the biceps tendon can act as an augment providing structural support to the poor-quality rotator cuff tissue and also enhancing the healing process. In this Technical Note, we describe arthroscopic rotator cuff repair using biceps augmentation for a massive degenerate rotator cuff tear with the excursion of the cuff onto the footprint with minimal tissue tension.
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Affiliation(s)
- Arun Mundakkal
- Department of Orthopaedic Surgery, Aster MIMS, Calicut, Kerala, India
| | - Jiss Joseph Panakkal
- Department of Orthopaedic Surgery, Sree Narayana Institute of Medical Sciences, Ernakulam, Kerala, India
| | - Ayyappan V. Nair
- Department of Orthopaedic Surgery, Manipal Whitefield Hospital, Banglore, Karnataka, India
| | - Siyad Ahammad
- Department of Orthopaedic Surgery, Aster MIMS, Calicut, Kerala, India
| | - Jimmy Joseph Meleppuram
- Department of Orthopaedic Surgery, Apollo Adlux Hospital, Angamaly, Ernakulam, Kerala, India
| | - Prince Shanavas Khan
- Department of Orthopaedic Surgery, Apollo Adlux Hospital, Angamaly, Ernakulam, Kerala, India
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Lädermann A. Superior capsular reconstruction for irreparable posterosuperior rotator cuff tears. Orthop Traumatol Surg Res 2024; 110:103758. [PMID: 37972708 DOI: 10.1016/j.otsr.2023.103758] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 07/03/2023] [Indexed: 11/19/2023]
Abstract
Although the superior portion of the shoulder joint capsule is a clearly distinct structure, its ability to prevent vertical humeral head translation in irreparable rotator cuff tears remains controversial. The clinical results of superior capsule reconstruction (SCR) in this context are satisfactory but the radiological outcomes are poor in up to two-thirds of patients. Moreover, there is no proof that SCR is more beneficial than simply doing a subacromial debridement, a partial repair or a tenotomy of the long head of biceps. Furthermore, graft healing is not predictive of success. Given the lack of comparative studies with high level of evidence (level 1 or 2), we cannot conclude that this surgical technique (and its many variants) has a place in our treatment paradigm. Also, it seems that xenografts are no longer being used given the high rate of structural failure seen on MRI and the large number of complications. If the long head of biceps tendon is still intact at the time of surgery, it is a feasible option for SCR given the reasonable cost and minimal complications. If it is not - but the subscapularis tendon is intact or repairable - an allograft or a non-local autograft should be considered, despite its unpredictable clinical results. Surgeons should inform patients of the high rate of radiological repair failure and the worse results if a reverse shoulder arthroplasty should be needed subsequently. Level of evidence: 4.
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Affiliation(s)
- Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Avenue J.-D.-Maillard 3, CH-1217 Meyrin, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
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16
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Nair AV, Mohan PK, Krishna P, Jangale A, Kareemulla S, Rambhojun M, Thampy S. Arthroscopic Superior Capsular Reconstruction Using Hybrid Autologous Fascia Lata and the Long Head of Biceps Tendon Graft: the Central Beam Concept. Arthrosc Tech 2024; 13:102829. [PMID: 38312886 PMCID: PMC10838020 DOI: 10.1016/j.eats.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/05/2023] [Indexed: 02/06/2024] Open
Abstract
Superior capsular reconstruction is a joint salvage treatment option for retracted irreparable rotator cuff tears in relatively young patients. Various graft options have been described in the literature, including autologous fascia lata graft, synthetic graft, and dermal patches. Superior capsular reconstruction using long head of biceps tendon autograft alone has also been described by few authors. In this technical note, we describe a modified technique of performing arthroscopic superior capsular reconstruction using both fascia lata graft and the intra articular portion of the long head of biceps tendon. Our technique resembles central beam concept over which the fascia lata graft is anchored, providing good structural support to the graft and enabling graft healing and improved clinical outcomes.
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17
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McClatchy SG, Parsell DE, Hobgood ER, Field LD. Augmentation of Massive Rotator Cuff Repairs Using Biceps Transposition Without Tenotomy Improves Clinical and Patient-Reported Outcomes: The Biological Superior Capsular Reconstruction Technique. Arthroscopy 2024; 40:47-54. [PMID: 37355182 DOI: 10.1016/j.arthro.2023.06.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To evaluate the outcomes of a consecutive series of patients after transposition of the biceps without tenotomy (biological superior capsular reconstruction [bio-SCR] technique) to augment massive rotator cuff repairs. METHODS Thirty massive rotator cuff tears repaired and augmented using the bio-SCR technique between June 2018 and July 2021 were identified and retrospectively reviewed. American Shoulder and Elbow Surgeons (ASES) scores, visual analog scale pain scores, supraspinatus and infraspinatus strength, and range of motion were collected preoperatively and postoperatively. RESULTS The average age of patients undergoing bio-SCR augmentation was 67.0 years (range, 28.4-81.9 years), and the mean clinical follow-up period was 2.9 years (range, 1.8-4.5 years). The average ASES score improved from 33.2 preoperatively to 80.8 at 6 months postoperatively, 92.0 at 1 year, and 87.0 at 2 years (P < .001). The minimal clinically important difference for the ASES score was exceeded at all postoperative intervals. Active forward flexion improved from 120.6° to 156.8° (P < .001). The pain score improved from 7.1 to 0.9 (P < .001). Postoperatively, 1 complication (3.3%) occurred: a proximal biceps rupture. CONCLUSIONS Incorporating a transposed biceps tendon into the repair of a massive rotator cuff tear using the bio-SCR technique resulted in significant clinical improvements with a low complication rate. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - Douglas E Parsell
- Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, U.S.A
| | | | - Larry D Field
- Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, U.S.A..
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18
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Vij N, Liu JN, Amin N. Radiofrequency in arthroscopic shoulder surgery: a systematic review. Clin Shoulder Elb 2023; 26:423-437. [PMID: 36330719 DOI: 10.5397/cise.2022.01067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Radiofrequency has seen an increase in use in orthopedics including cartilage lesion debridement in the hip and knee as well as many applications in arthroscopic shoulder surgery. The purpose of this systematic review is to evaluate the safety and usage of radiofrequency in the shoulder. METHODS This systematic review was registered with PROSPERO (international registry) and followed the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) guidelines. Embase and PubMed were searched using: "shoulder," "rotator cuff," "biceps," "acromion" AND "monopolar," "bipolar," "ablation," "coblation," and "radiofrequency ablation." The title and abstract review were performed independently. Any discrepancies were addressed through open discussion. RESULTS A total of 63 studies were included. Radiofrequency is currently utilized in impingement syndrome, fracture fixation, instability, nerve injury, adhesive capsulitis, postoperative stiffness, and rotator cuff disease. Adverse events, namely superficial burns, are limited to case reports and case series, with higher-level evidence demonstrating safe use when used below the temperature threshold. Bipolar radiofrequency may decrease operative time and decrease the cost per case. CONCLUSIONS Shoulder radiofrequency has a wide scope of application in various shoulder pathologies. Shoulder radiofrequency is safe; however, requires practitioners to be cognizant of the potential for thermal burn injuries. Bipolar radiofrequency may represent a more efficacious and economic treatment modality. Safety precautions have been executed by institutions to cut down patient complications from shoulder radiofrequency. Future research is required to determine what measures can be taken to further minimize the risk of thermal burns.
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Affiliation(s)
- Neeraj Vij
- Department of Orthopedic Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Joseph N Liu
- Department of Orthopedic Surgery, Keck Hospital of the University of Southern California, Los Angeles, CA, USA
| | - Nirav Amin
- Premier Orthopaedic & Trauma Specialists, Pomona, CA, USA
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19
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Wan RW, Luo ZW, Yang YM, Zhang HL, Chen JN, Chen SY, Shang XL. Long head of biceps tendon transposition for massive and irreparable rotator cuff tears: A systematic review and meta-analysis. World J Orthop 2023; 14:813-826. [PMID: 38075475 PMCID: PMC10698337 DOI: 10.5312/wjo.v14.i11.813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/21/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Superior capsular reconstruction (SCR) with long head of biceps tendon (LHBT) transposition was developed to massive and irreparable rotator cuff tears (MIRCTs); however, the outcomes of this technique remain unclear. AIM To perform a systematic review of biomechanical outcomes and a meta-analysis of clinical outcomes after LHBT transposition for MIRCTs. METHODS We performed a systematic electronic database search on PubMed, EMBASE, and Cochrane Library. Studies of SCR with LHBT transposition were included according to the inclusion and exclusion criteria. Biomechanical studies were assessed for main results and conclusions. Included clinical studies were evaluated for quality of methodology. Data including study characteristics, cohort demographics, and outcomes were extracted. A meta-analysis was conducted of the clinical outcomes. RESULTS According to our inclusion and exclusion criteria, a total of six biomechanical studies were identified and reported an overall improvement in subacromial contact pressures and prevention of superior humeral migration without limiting range of motion (ROM) after LHBT transposition for MIRCTs. A total of five clinical studies were included in the meta-analysis of LHBT transposition outcomes, consisting of 253 patients. The results indicated that compared to other surgical methods for MIRCTs, LHBT transposition had advantages of more significant improvement in ROM (forward flexion mean difference [MD] = 6.54, 95% confidence interval [CI]: 3.07-10.01; external rotation [MD = 5.15, 95%CI: 1.59-8.17]; the acromiohumeral distance [AHD] [MD = 0.90, 95%CI: 0.21-1.59]) and reducing retear rate (odds ratio = 0.27, 95%CI: 0.15-0.48). No significant difference in American Shoulder and Elbow Surgeons score, visual analogue scale score, and University of California at Los Angles score was demonstrated between these two groups for MIRCTs. CONCLUSION In general, SCR with LHBT transposition was a reliable and economical technique for treating MIRCTs, both in terms of biomechanical and clinical outcomes, with comparable clinical outcomes, improved ROM, AHD, and reduced the retear rates compared to conventional SCR and other established techniques. More high-quality randomized controlled studies on the long-term outcomes of SCR with LHBT transposition are required to further assess.
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Affiliation(s)
- Ren-Wen Wan
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhi-Wen Luo
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yi-Meng Yang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Han-Li Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jia-Ni Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Shi-Yi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xi-Liang Shang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
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Besnard M, Favard L, Benhenneda R. Arthroscopic advancement of the supraspinatus muscle and tendon for posterosuperior massive rotator cuff tears. Orthop Traumatol Surg Res 2023; 109:103536. [PMID: 36574836 DOI: 10.1016/j.otsr.2022.103536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/20/2022] [Accepted: 09/07/2022] [Indexed: 12/25/2022]
Abstract
The tension-free repair of retracted supraspinatus tears with the open muscle and tendon advancement technique first described by Debeyre in 1965 gave satisfactory clinical results. The purpose of this anatomical study was to test the feasibility of an arthroscopic supraspinatus advancement technique. A total of 10 cadaveric shoulders were operated. We assessed the feasibility, measured the slide distance, and recorded the position of the suprascapular nerve (SSN) for each shoulder. Reattachment of the tendon to its native footprint was achieved in all cases. The mean slide distance was 38.8 mm ± 3.6 (33-44). The SSN was released and tension-free in all shoulders. Arthroscopic advancement of the supraspinatus muscle and tendon enables complete rotator cuff repair in irreparable retracted posterosuperior tears and is a noteworthy alternative to the other techniques. Level of Evidence: IV.
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Affiliation(s)
- Marion Besnard
- Centre hospitalier inter-communal Amboise-Château-Renault, hôpital Robert-Debré, rue des Ursulines, BP 329, 37403 Amboise cedex, France
| | - Luc Favard
- Service de chirurgie orthopédique, centre hospitalier universitaire de Tours, université François-Rabelais de Tours, PRES centre-Val de Loire université, Tours, France; Faculté de médecine, université de Tours, 10, boulevard Tonnellé, 37000 Tours, France
| | - Rayane Benhenneda
- Service de chirurgie orthopédique, centre hospitalier universitaire de Tours, université François-Rabelais de Tours, PRES centre-Val de Loire université, Tours, France; Faculté de médecine, université de Tours, 10, boulevard Tonnellé, 37000 Tours, France.
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Gao Q, Qiao Y, Guan Y, Zhang Y, Xu T, Duan Z, Fan L, Li Z, Li G, Sun J. Superior capsular reconstruction using the long head of the biceps to treat massive rotator cuff tears improves patients shoulder pain, mobility and function. Knee Surg Sports Traumatol Arthrosc 2023; 31:4559-4565. [PMID: 37338624 DOI: 10.1007/s00167-023-07489-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 06/09/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE Arthroscopic superior capsule reconstruction (SCR) with the long head of the biceps (LHBT) was performed to restore structural stability, force couple balance, and shoulder joint function. This study aimed to evaluate the functional outcomes of SCR using the LHBT over at least 24 months of follow-up. METHOD This retrospective study included 89 patients with massive rotator cuff tears who underwent SCR using the LHBT, met the inclusion criteria and underwent follow up for at least 24 months. The preoperative and postoperative shoulder range of motion (forward flexion, external rotation, and abduction), acromiohumeral interval (AHI), visual analog scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score and Constant-Murley score were obtained, and the tear size, and Goutallier and Hamada grades were also investigated. RESULTS Compared with those measured preoperatively, the range of motion, AHI, and VAS, Constant-Murley, and ASES scores were significantly improved immediately postoperatively (P < 0.001) and at the 6-month, 12-month, and final follow-ups (P < 0.001). At the last follow-up, the postoperative ASES score and Constant-Murley score increased from 42.8 ± 7.6 to 87.4 ± 6.1, and 42.3 ± 8.9 to 84.9 ± 10.7, respectively; with improvements of 51 ± 21.7 in forward flexion, 21.0 ± 8.1 in external rotation, and 58.5 ± 22.5 in abduction. The AHI increased 2.1 ± 0.8 mm and the VAS score significantly changed from 6.0 (5.0, 7.0) to 1.0 (0.0, 1.0), at the final follow-up. Eleven of the 89 patients experienced retears, and one patient needed reoperation. CONCLUSION In this study with at least 24-months of follow-up, SCR using the LHBT for massive rotator cuff tears could effectively relieve shoulder pain, restore shoulder function and increase shoulder mobility to some extent. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Qiuming Gao
- Department of Orthopedics, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, People's Republic of China
| | - Yue Qiao
- Department of Orthopedics, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, People's Republic of China
| | - Yonghao Guan
- Department of Orthopedics, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, People's Republic of China
| | - Yiwei Zhang
- Department of Orthopedics, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, People's Republic of China
| | - Tianyang Xu
- Department of Orthopedics, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, People's Republic of China
| | - Zhengwei Duan
- Department of Orthopedics, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, People's Republic of China
| | - Lin Fan
- Department of Orthopedics, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, People's Republic of China
| | - Zihua Li
- Department of Orthopedics, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, People's Republic of China.
| | - Guodong Li
- Department of Orthopedics, School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, 200072, People's Republic of China.
| | - Jian Sun
- Department of Orthopedics, Shanghai Jiangqiao Hospital, Jiading Branch of Shanghai General Hospital, Shanghai, 201803, China.
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Cañete San Pastor P, Prosper Ramos I, Garcia Roig A. Arthroscopic Superior Capsular Reconstruction With the Long Head of the Biceps Tendon to Reinforce the Repair of a Supraspinatus Tear and Increase Healing. Arthrosc Tech 2023; 12:e1457-e1465. [PMID: 37654873 PMCID: PMC10466433 DOI: 10.1016/j.eats.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/14/2023] [Indexed: 09/02/2023] Open
Abstract
Rotator cuff tears continue to be a challenge for the shoulder surgeon since there is still a high rate of retears. To increase the rate of repair and decrease the number of retears, we present a technique, in which we reinforce a tension-free double-row repair of the supraspinatus with reconstruction of the superior capsule with the long head of the biceps (LHB). With this reinforcement of the cuff suture using the LHB, we increase both the biomechanics and biology of the repair and decrease the rate of reruptures.
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Affiliation(s)
- Pablo Cañete San Pastor
- Doctoral School, Catholic University of Valencia San Vicente Martir, Hospital de Manises, Valencia, Spain
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23
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Kandeel AAM. Biceps-based 3-layer reconstruction of the irreparable rotator cuff: a technical note on biceps tendon as a common local graft for in-situ superior capsular reconstruction, partial cuff repair, and middle trapezius tendon transfer. J Orthop Surg Res 2023; 18:499. [PMID: 37454106 PMCID: PMC10349402 DOI: 10.1186/s13018-023-03978-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND For irreparable rotator cuff tears, 3-layer tendon reconstruction (in which in-situ superior capsular reconstruction-reinforced partial rotator cuff repair was augmented with hamstring-sheet-lengthened middle trapezius tendon transfer) was recently reported to achieve satisfactory postoperative outcomes. To avoid hamstring graft-related drawbacks, the current note describes a technical modification of that reconstruct; wherein long head of biceps tendon is used as a cornerstone structure for simultaneously reconstructing the superior capsule; lengthening the transferred middle trapezius tendon; and augmenting the partially-repaired rotator cuff. METHODS Via sub-pectoral approach, long head of biceps tendon is distally-tenotomized. Through McKenzie approach, proximal stump of the tenotomized long head of biceps is retrieved to the sub-acromial space where double-row biceps tenodesis (into a trough at the greater tuberosity) is performed for reconstructing the superior capsule. Next, postero-superior rotator cuff is partially repaired, and side-to-side sutured to the reconstructed capsule. Through a 7-8-cm skin incision over the medial scapular spine, middle trapezius tendon is released. Portion of long head of biceps tendon distal to the tenodesis site is retrieved via a sub-trapezius/sub-acromial corridor to the scapular wound where it is re-attached to the released middle trapezius tendon. RESULTS Use of long head of biceps tendon as a common local graft (for simultaneously reconstructing the superior capsule, lengthening the transferred middle trapezius tendon, and augmenting the partially-repaired rotator cuff) is technically feasible provided that the harvested tendon stump is at least 10 cm in length. CONCLUSION While avoiding hamstring graft-related complications, the currently-reported biceps-based 3-layer rotator cuff tendon reconstruction might offer the advantages of reproducibility, safety, simplicity and quickness; however, it should be validated via further studies. Trial registration The present study was approved by the Institutional Committee of Scientific Research and Ethics (3-2023Orth10-1).
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Affiliation(s)
- Amr Abdel-Mordy Kandeel
- Department of Orthopedics and Traumatology, Faculty of Medicine, Menoufia University, Gamal Abdel-Nasser Street, Shebien El-kom, Menoufia Governorate, Egypt.
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Zhou X, Zhang X, Jin X, Deng J, Zhang Z, Yu Y. Multiple surgical treatment comparisons for irreparable rotator cuff tears: A network meta-analysis. Medicine (Baltimore) 2023; 102:e33832. [PMID: 37266652 PMCID: PMC10238028 DOI: 10.1097/md.0000000000033832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/08/2023] [Accepted: 05/03/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND To evaluate the effect of different surgical methods in the treatment of patients with irreparable rotator cuff tears (IRCTs) using a network meta-analysis. METHODS A search of the PubMed, EMbase, The Cochrane Library, VIP, WanFang Data, and CNKI databases was performed in January 2023 to search for randomized controlled trials and cohort studies of different surgical methods in the treatment of IRCTs. Risk assessment of the included randomized controlled trials was conducted using the risk of bias assessment tool recommended by the Cochrane Manual, and the Newcastle-Ottawa Scale was used for the risk assessment of cohort studies. Data were analyzed and plotted using Stata 15.0 software. RESULTS A total of 17 studies involving 2123 patients and 10 surgical methods were included in this study. According to the surface under the cumulative ranking curve, the probability ranking in descending order is latissimus dorsi transfer (LDT) + partial repair > LDT > reverse total shoulder arthroplasty > superior capsular reconstruction > patch > partial repair > debridement + tenotomy of the long head of the biceps > debridement > in space subacromial balloon spacer + tenotomy of the long head of the biceps > in space subacromial balloon spacer. CONCLUSION Among the multiple surgical treatments for patients with IRCTs, LDT + partial repair may have the best effect, and more randomized controlled trials with larger sample sizes are needed for further verification.
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Affiliation(s)
- Xin Zhou
- Department of Orthopedics, Chongqing University Jiangjin Hospital, Centre Hospital of Jiangjin District, Chongqing, P. R. China
| | - Xiaohua Zhang
- Department of Orthopedics, Chongqing University Jiangjin Hospital, Centre Hospital of Jiangjin District, Chongqing, P. R. China
| | - Xianrong Jin
- Department of Orthopedics, Chongqing University Jiangjin Hospital, Centre Hospital of Jiangjin District, Chongqing, P. R. China
| | - Jialin Deng
- Department of Orthopedics, Chongqing University Jiangjin Hospital, Centre Hospital of Jiangjin District, Chongqing, P. R. China
| | - Zhongzu Zhang
- Department of Orthopedics, The Yongchuan Hospital of Chongqing Medical University, Chongqing, P. R. China
| | - Yating Yu
- Department of Orthopedics, Chongqing University Jiangjin Hospital, Centre Hospital of Jiangjin District, Chongqing, P. R. China
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Krishnan P, Maassen N, Lee C, Baker H, Koh J, Amirouche F, Athiviraham A. Long Head of the Biceps Autograft Performs Biomechanically Similar to Human Dermal Allograft for Superior Capsule Reconstruction After Rotator Cuff Tear. Arthroscopy 2023; 39:706-715. [PMID: 36395965 DOI: 10.1016/j.arthro.2022.10.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To provide a biomechanical comparison between human dermal (HD) allograft and long head of biceps tendon (LHBT) autograft with and without posterior side-to-side suturing for superior capsule reconstruction. METHODS Eight fresh-frozen cadaveric shoulder specimens were tested in 5 conditions: (1) intact, (2) complete supraspinatus tear, (3) LHBT, (4) LHBT with side-to-side suturing, and (5) HD allograft with side-to-side suturing. Functional abduction force, superior translation of humeral head, translational range of motion, and rotational range of motion were tested at 0°, 30°, 60°, and 90° of abduction within each condition. Data were analyzed using analysis of variance with post-hoc Tukey testing for pairwise comparison, with a significance value set at .05. RESULTS Functional abduction force in the LHBT, LHBT + suture, and HD + suture conditions was significantly increased compared with the supraspinatus tear condition at abduction angles of 30° (P = .011, .001, and .017, respectively), 60° (P = .004, .001, and .002, respectively), and 90° (P = .013, .001, and .038, respectively). In addition, superior translation of the humeral head in the LHBT, LHBT + suture, and HD + suture conditions was significantly decreased compared with the tear condition at abduction angles of 30° (P = .03, .049, .03, respectively) and 60° (P = .02, .04, .03, respectively). All 3 reconstructive techniques were statistically identical to the intact rotator cuff condition in regard to translational and rotational range of motion. CONCLUSIONS Superior capsule reconstruction with LHBT autograft without side-to-side suturing, LHBT with posterior side-to-side suturing, and HD allograft with posterior side-to-side suturing all equivalently restore functional abduction force and decrease superior translation of the humeral head after a complete supraspinatus tear. CLINICAL RELEVANCE Superior capsule reconstruction with long head of the biceps tendon autograft and human dermal allograft both restore functional abduction force and decrease superior translation of the humeral head, while displaying no losses in the range of motion in a cadaveric model.
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Affiliation(s)
- Pranav Krishnan
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, U.S.A
| | - Nicholas Maassen
- Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois, U.S.A
| | - Cody Lee
- Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois, U.S.A
| | - Hayden Baker
- Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois, U.S.A
| | - Jason Koh
- Department of Orthopaedic Surgery, Northshore University Health System, Chicago, Illinois, U.S.A
| | - Farid Amirouche
- Department of Orthopaedic Surgery, Northshore University Health System, Chicago, Illinois, U.S.A.; Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois, U.S.A
| | - Aravind Athiviraham
- Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois, U.S.A..
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Berthold DP. Editorial Commentary: Shoulder Superior Capsular Reconstruction Remains to Be Proven Superior to Partial Repair of the Rotator Cuff for Active Patients With Irreparable Tears and Without Osteoarthritis. Arthroscopy 2023; 39:716-718. [PMID: 36740294 DOI: 10.1016/j.arthro.2022.11.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 02/07/2023]
Abstract
The management of irreparable rotator cuff tears in active patients without severe osteoarthritis is challenging. Retracted tears of the superior cuff result in devastating glenohumeral kinematics and decreased shoulder function. Surgical solutions such as superior capsular reconstruction (SCR) or tendon transfers may improve shoulder function. Regarding SCR, the superior capsule has been described as a static stabilizer allowing for the centering of the humeral head. However, some bases for SCR are based on biomechanical studies that should be regarded as time zero, absent healing, and generally oversimplified as ball-and-socket research rather than replicating complex functional shoulder kinematics. SCR may be waning in popularity. SCR using autograft may, or may not, prove effective in the long run. For now, it remains to be seen whether SCR is superior to partial repair of the rotator cuff.
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Chen P, Yeh HW, Lu Y, Chen ACY, Chan YS, Lädermann A, Chiu JCH. Comparison of suture-bridge and independent double-row techniques for medium to massive posterosuperior cuff tears: a two-year retrospective study. BMC Musculoskelet Disord 2023; 24:154. [PMID: 36855071 PMCID: PMC9972682 DOI: 10.1186/s12891-023-06256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Transosseous-equivalent suture-bridge (TOE-SB) and independent double-row (IDR) repair techniques were developed to treat rotator cuff tears. The study was designed to prove that both TOE-SB and IDR techniques provided comparable clinical results and retear rate for medium to massive posterosuperior rotator cuff tears, while the surgical time and number of suture anchor used were less in the IDR group. STUDY DESIGN Level of evidence: level III, Retrospective comparative study. METHODS Patients with medium to massive posterosuperior rotator cuff tears receiving arthroscopic TOE-SB and IDR between November 2016 to October 2019 were retrospectively enrolled. All patients were confirmed to have grade ≤ 2 fatty infiltration in the muscles of the torn tendons. Revision, concomitant subscapularis tear, acromiohumeral distance < 7 mm, glenohumeral osteoarthritis, partial repair, incomplete repair, partial thickness, or irreparable posterosuperior cuff tear were excluded. Surgical time, number of suture anchor used for the surgery, pre-operative, and post-operative clinical scores such as Constant-Murley score, subjective shoulder value (SSV), and visual analog scale (VAS) were compared. The retear rates between groups were evaluated by ultrasound. RESULTS Thirty-five IDR and thirty-five TOE-SB repairs were enrolled. The IDR technique required much fewer anchors than TOE-SB did to complete the cuff repair. The mean operation time in IDR and TOE-SB group were 86(18.23), and 114(18.7) (min), respectively (P < 0.01). The mean number of anchors used to complete the cuff repair was 2(0.17) in IDR and 3(0.61) in TOE-SB (P < 0.01). The Constant-Murley score improved from 34.9 ± 6.6 to 80.6 ± 9.4 in the IDR group, and 37.4 ± 6 to 81.9 ± 4.6 in the TOE-SB group (both P < 0.001). SSV improved from 24.6 ± 9.6 to 79.3 ± 10.6 in the IDR, and 27.9 ± 9 to 82.9 ± 6.9 in the TOE-SB group (both P < 0.001). VAS improved from 7.9 ± 0.6 to 1.5 ± 0.7 in the IDR, and 8 ± 0.5 to 1.3 ± 0.6 in the TOE-SB group (both P < 0.001) at final follow-up. No significant difference was found between the retear rates (14.3% in the IDR vs. 17.1% in the TOE-SB, respectively) in the 2-year follow-up. CONCLUSIONS Both IDR and TOE-SB group provided comparable clinical results and retear rates for medium to massive posterosuperior rotator cuff tears. The surgical time and number of anchors used were less in the IDR group than in the TOE-SB group.
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Affiliation(s)
- Poyu Chen
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fusing St., Gueishan District, Taoyuan City, 333 Taiwan
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Han-Wei Yeh
- Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi Lu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fusing St., Gueishan District, Taoyuan City, 333 Taiwan
| | - Alvin Chao-Yu Chen
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fusing St., Gueishan District, Taoyuan City, 333 Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Comprehensive Sports Medicine Center (CSMC) Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Sheng Chan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Comprehensive Sports Medicine Center (CSMC) Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Orthopedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Alexandre Lädermann
- Division of orthopedics and Trauma Surgery, Hôpital de la Tour, Meyrin, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Orthopedics and Trauma Service, University Hospitals of Geneva, Geneva, Switzerland
| | - Joe Chih-Hao Chiu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fusing St., Gueishan District, Taoyuan City, 333 Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Comprehensive Sports Medicine Center (CSMC) Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Kandeel AAM. Middle Trapezius Tendon Transfer for Augmentation of In Situ Superior Capsular Reconstruction-Reinforced Partial Rotator Cuff Repair: Short-term Outcomes of a Prospective Cohort Study. Orthop J Sports Med 2023; 11:23259671221147537. [PMID: 36814770 PMCID: PMC9940178 DOI: 10.1177/23259671221147537] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Middle trapezius tendon (MTT) transfer has been described for dynamic reproduction of supraspinatus function. For management of irreparable rotator cuff (RC) tears, this procedure can be coupled with in situ (long head of the biceps tendon-based) superior capsular reconstruction (SCR) and partial RC repair. PURPOSE To investigate the functional outcomes of augmentation of in situ SCR-reinforced partial RC repair with MTT transfer for the management of irreparable posterosuperior RC tears. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Conducted between September 2014 and March 2022, this study included 24 patients with irreparable posterosuperior RC tears who were allocated into 2 groups: patients managed with 2-layer tendon construct (in situ SCR-reinforced partial RC repair) (group A; n = 15) and patients managed with 3-layer tendon construct (MTT transfer-augmented, in situ SCR-reinforced partial RC repair) (group B; n = 9). Outcome measures included 2-year postoperative pain, range of motion (ROM) in forward flexion and external rotation, and the American Shoulder and Elbow Surgeons (ASES) and the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores. For data comparison, independent and paired t tests were used for parametric quantitative variables, and Mann-Whitney and Wilcoxon signed-rank tests were used for nonparametric quantitative variables; Fisher exact and McNemar tests were used for qualitative variables. RESULTS The mean age of the patients was 58.40 ± 4.54 years in group A and 59.22 ± 4.46 years in group B; there were no between-group differences in baseline patient characteristics. Patients in both groups had significant preoperative to postoperative improvement on all outcome measures (P < .05 for all). Group B had a significantly higher magnitude of postoperative improvement compared with group A in forward flexion ROM (88.88° ± 29.34° vs 46.66° ± 20.93°; P = .001), external rotation ROM (32.22° ± 14.81° vs 16.0° ± 9.10°; P = .002), ASES score (71.07 ± 8.26 vs 57.87 ± 8.39; P = .001), and QuickDASH score (-70.20 ± 6.95 vs -58.34 ± 12.52; P = .007). CONCLUSION Augmentation of in situ SCR-reinforced partial RC repair with MTT transfer in a 3-layer tendon construct led to significantly greater improvement in postoperative ROM and functional scores compared with a 2-layer construct.
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Affiliation(s)
- Amr Abdel-Mordy Kandeel
- Department of Orthopedics & Traumatology, Faculty of Medicine, Menoufia University, Shebien El-kom, Egypt
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康 运, 郭 标, 许 健, 毕 文, 马 炜, 杨 东, 崔 红, 付 鹏, 刘 一, 田 进, 刘 义. [Effectiveness of arthroscopic long head of biceps tendon transposition combined with Swivelock anchor double fixation for massive and irreparable rotator cuff tears]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1459-1464. [PMID: 36545852 PMCID: PMC9763067 DOI: 10.7507/1002-1892.202207102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/30/2022] [Accepted: 10/12/2022] [Indexed: 12/24/2022]
Abstract
Objective To investigate the effectiveness of arthroscopic long head of biceps tendon (LHBT) transposition combined with Swivelock anchor double fixation in treatment of massive and irreparable rotator cuff tears. Methods Between June 2019 and November 2021, 25 patients with massive and irreparable rotator cuff tears were treated by arthroscopic LHBT transposition combined with Swivelock anchor double fixation. There were 12 males and 13 females. The age ranged from 47 to 74 years (mean, 62.4 years). The disease duration ranged from 1 to 62 months (median, 7 months). The rotator cuff tears were classified as Hamada grade 2 in 25 cases and Goutallier grade 1 in 2 cases, grade 2 in 22 cases, and grade 3 in 1 case. Pre- and post-operative shoulder range of motion (ROM), visual analogue scale (VAS) score, University of California Los Angeles (UCLA) score, and Constant-Murley score were recorded. Postoperative complications were observed. The reconstructed tissue integrity was confirmed by MRI. Results All operations were successfully completed. The operation time was 120-330 minutes (mean, 189.6 minutes). All incisions healed by first intention. All patients were followed up 10-36 months (mean, 22.0 months). At last follow-up, the ROM in forward flexion, abduction, and external rotation, VAS score, UCLA score, and Constant-Murley score were superior to those before operation, and the differences were significant ( P<0.05). According to UCLA scoring standard, shoulder joint function was rated as excellent in 5 cases, good in 18 cases, and poor in 2 cases, with an excellent and good rate of 92.0%. No other complications occurred except shoulder joint adhesion in 2 cases. At last follow-up, MRI examination showed no retear of rotator cuff, and LHBT was intact. Conclusion For massive and irreparable rotator cuff tears, arthroscopic LHBT transposition combined with Swivelock anchor double fixation can increase the force of pressing the humeral head, effectively relieve the pain, improve the ROM of joints, maximize the recovery of shoulder function, and do not increase the number of anchor nails.
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Affiliation(s)
- 运康 康
- 安徽医科大学附属阜阳人民医院（阜阳市人民医院）骨科（安徽阜阳 236000）Department of Orthopedics, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang City People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 标 郭
- 安徽医科大学附属阜阳人民医院（阜阳市人民医院）骨科（安徽阜阳 236000）Department of Orthopedics, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang City People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 健 许
- 安徽医科大学附属阜阳人民医院（阜阳市人民医院）骨科（安徽阜阳 236000）Department of Orthopedics, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang City People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 文智 毕
- 安徽医科大学附属阜阳人民医院（阜阳市人民医院）骨科（安徽阜阳 236000）Department of Orthopedics, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang City People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 炜 马
- 安徽医科大学附属阜阳人民医院（阜阳市人民医院）骨科（安徽阜阳 236000）Department of Orthopedics, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang City People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 东强 杨
- 安徽医科大学附属阜阳人民医院（阜阳市人民医院）骨科（安徽阜阳 236000）Department of Orthopedics, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang City People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 红林 崔
- 安徽医科大学附属阜阳人民医院（阜阳市人民医院）骨科（安徽阜阳 236000）Department of Orthopedics, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang City People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 鹏飞 付
- 安徽医科大学附属阜阳人民医院（阜阳市人民医院）骨科（安徽阜阳 236000）Department of Orthopedics, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang City People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 一军 刘
- 安徽医科大学附属阜阳人民医院（阜阳市人民医院）骨科（安徽阜阳 236000）Department of Orthopedics, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang City People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 进翔 田
- 安徽医科大学附属阜阳人民医院（阜阳市人民医院）骨科（安徽阜阳 236000）Department of Orthopedics, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang City People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 义峰 刘
- 安徽医科大学附属阜阳人民医院（阜阳市人民医院）骨科（安徽阜阳 236000）Department of Orthopedics, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang City People’s Hospital), Fuyang Anhui, 236000, P. R. China
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Li Y, Mei L, Li T, Pang L, Tang X, Li J. Clinical outcomes of patients with pigmented villonodular synovitis of the shoulder after arthroscopic synovectomy. BMC Musculoskelet Disord 2022; 23:1023. [PMID: 36443777 PMCID: PMC9706979 DOI: 10.1186/s12891-022-05978-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/11/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Shoulder pigmented villonodular synovitis (PVNS) is a severe clinical condition, while few studies have focused on this situation due to its rarity. This study was to investigate the efficacy of arthroscopic treatment of patients diagnosed with shoulder PVNS. METHODS From Jan 1st, 2010 to Dec. 31st, 2019, 6 patients (5 females and 1 male) diagnosed with shoulder PVNS underwent arthroscopic synovectomy in our hospital and combined rotator cuff repair was performed in 3 of them. The outcomes of this study include Constant score, Visual Analogue Scale (VAS), University of California, Los Angeles (UCLA) score and American Shoulder and Elbow Surgeons (ASES) score. The data were retrieved from the patients' medical records. RESULTS With a mean follow-up of 52.0 months (range, 28-92 months), the mean difference of Constant, VAS, UCLA and ASES scores were 27.83 ± 21.60, 2.83 ± 2.56, 11.67 ± 10.93 and 17.83 ± 25.35, respectively. Statistically significant improvements were detected in all the patient-reported outcomes except ASES score. One of the patients suffered from recurrence. Two patients suffered from mild complications after the surgeries while both of them achieved satisfactory recovery finally. CONCLUSION Arthroscopic synovectomy in the setting of shoulder PVNS can improve patients' function. A concurrent rotator cuff repair is recommended if it is needed. The conclusion still needs testifying by further high-quality research with larger sample size.
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Affiliation(s)
- Yinghao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Lu Mei
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.,West China School of Nursing, Sichuan University, Chengdu, China
| | - Tao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Long Pang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Xin Tang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
| | - Jian Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan, China
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Cregar WM, Izquierdo R, Trenhaile SW. Arthroscopic Superior Capsular Reconstruction Using Hamstring Allograft. Arthrosc Tech 2022; 11:e2135-e2142. [PMID: 36632395 PMCID: PMC9826886 DOI: 10.1016/j.eats.2022.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
Superior capsular reconstruction (SCR) has become an acceptable treatment option for patients with chronic shoulder pain in the setting of an irreparable rotator cuff tear. Several different techniques have been described with varying graft options. In this Technical Note, we introduce a technique for arthroscopic SCR using hamstring allograft tendon. Our described technique allows for a "one-size-fits-all" graft with a "build as you go" construct with no need for intraoperative dimensional defect measurements or specific graft modifications. This technique provides a reliable and reproducible procedure using readily available graft tissue.
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Affiliation(s)
- William M. Cregar
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago Illinois, U.S.A.,Address correspondence to William M. Cregar, M.D., Midwest Orthopedics at Rush, 1611 W. Harrison St., Suite 201, Chicago, IL 60612, U.S.A.
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Lädermann A, Rashid M. Superior Capsular Reconstruction-Technical Marvel or Fading Fashion? Arthroscopy 2022; 38:2954-2956. [PMID: 36344054 DOI: 10.1016/j.arthro.2022.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Faculty of Medicine, University of Geneva, Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Mustafa Rashid
- Wrightington Hospital, Wigan, Lancashire, United Kingdom
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Celli A, Paroni C, Bonucci P, Celli L. Long-term outcomes of teres major transfer for irreparable posterosuperior rotator cuff tears in patients aged <65 years. JSES Int 2022; 7:35-43. [PMID: 36820419 PMCID: PMC9937853 DOI: 10.1016/j.jseint.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Background Massive rotator cuff tears are defined as irreparable when tendon-to-bone or tendon-to-tendon continuity with the adducted arm cannot be restored and severe muscle fatty infiltration is present. Tendon transfer is a palliative procedure that improves shoulder function and relieves pain. Methods We reviewed the records of patients aged <65 years, whose irreparable posterosuperior rotator cuff tears had been managed with teres major tendon transfer at our institution. Their 5- and 10-year clinical and radiographic follow-up records were examined to assess long-term outcomes. Patients' Constant Score, Disabilities of the Arm, Shoulder, and Hand score, and the visual analog scale for pain were calculated before the procedure and at 5 and 10 years. Results There were 24 consecutive patients aged <65 years (mean, 59; 12 men and 12 women) who had received no prior treatment except rehabilitation. All patients underwent teres major tendon transfer due to the failure of conservative treatment. The mean Constant Score was 26 preoperatively and 68 and 66 at 5 and 10 years, respectively (P = .0001 and P = .25). The mean Disabilities of the Arm, Shoulder, and Hand scores were 62.2 preoperatively and 7.8 and 9.3 at 5 and 10 years, respectively (P = .0009 and P = .1). The mean visual analog scale scores at rest were 6.1 preoperatively, and 0.3 and 0.5 at 5 and 10 years, respectively (P = .0003 and P = .1). Based on Hamada's classification, at 5 years, 3 patients showed grade 2 changes, and another had grade 3 changes; at 10 years, 7 patients showed grade 2 changes, and one showed grade 3 changes. Complications (8%) developed after the 10-year evaluation and included pain in 1 patient and secondary rupture of the transfer in another. Discussion Improving shoulder function and reducing pain in relatively young patients with irreparable posterosuperior cuff tears involves replacing the lost muscle with a muscle-tendon transfer. The chief aims of the procedure are to restore the balance with the subscapularis muscle, achieve joint stability, keep the humeral head in the glenoid cavity, and improve shoulder abduction and external rotation. Teres major tendon transfer can achieve these goals. Altogether, 22 of our 24 patients experienced improved daily activity function and pain relief that became stable after 5 years. Teres major transfers are useful surgical procedures, particularly in younger patients and in those with high functional demands, providing good and stable long-term results.
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Affiliation(s)
- Andrea Celli
- Corresponding author: Andrea Celli, MD, Via Emilia Est 380∖1 Modena 41124, Italy.
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Llinás PJ, Bailie DS, Sanchez DA, Chica J, Londono JF, Herrera GA. Partial Superior Capsular Reconstruction to Augment Arthroscopic Repair of Massive Rotator Cuff Tears Using Autogenous Biceps Tendon: Effect on Retear Rate. Am J Sports Med 2022; 50:3064-3072. [PMID: 35983981 DOI: 10.1177/03635465221112659] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Massive rotator cuff tears have a high incidence of postoperative retear that can reach 90%. It is still unclear which intervention may reduce the incidence of retear and improve the functional and clinical outcomes. PURPOSE/HYPOTHESIS The purpose of this study was to investigate the clinical and structural outcomes at 2 years after repair of reparable massive rotator cuff tears with and without the use of partial superior capsular reconstruction (pSCR), using the autologous long head of the biceps tendon (LHBT) as a graft. It was hypothesized that augmentation with a pSCR would decrease retear rates. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The authors compared arthroscopic repair of massive posterosuperior rotator cuff tears with and without augmentation using the LHBT for pSCR between 2015 and 2017. After applying the selection criteria, 106 patients were included in the study and distributed into 2 groups of 50 and 56 patients. Patients in the first group (50 patients) underwent arthroscopic repair without use of the LHBT (AR group), and patients in the second group (56 patients) underwent arthroscopic repair with use of the LHBT for pSCR (AR-LHBT group). The structural outcome was evaluated by ultrasound at 2 years of follow-up. Function and pain were evaluated preoperatively and at the 2-year follow-up using the American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS). Pre- and postoperative active range of motion, including forward elevation, external rotation, and abduction, were also documented. RESULTS No significant differences were found between groups regarding the baseline characteristics. After 24 months, both groups showed significant improvement from preoperative ASES scores, VAS score, and active range of motion (P < .01 for all). Patients in the AR-LHBT group showed significant improvements in postoperative functional and pain scores compared with the AR group in all measurements at the 2-year follow-up (ASES score: 77.23 ± 7.45 vs 71.04 ± 9.28, P < .01; VAS score: 1.64 ± 1.03 vs 2.12 ± 1.06, P < .01). Final range of motion was significantly increased for the AR-LHBT group for forward elevation (155 [interquartile range {IQR}, 150-160] vs 150 [IQR, 140-170]; P < .01) and abduction (150 [IQR, 140-157.5] vs 120 [IQR, 100-140]; P < .01), but external rotation was significantly greater for the AR group (54.43 ± 10.55 vs 59.5 ± 10.55; P < .01). Postoperative ultrasonography at the 2-year follow-up revealed a higher retear rate in the AR group than in the AR-LHBT group (46% vs 14%; P < .01). CONCLUSION Use of the LHBT for pSCR to augment massive rotator cuff tears resulted in markedly lower retear rates and modestly improved pain and function outcomes compared with repair alone.
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Affiliation(s)
- Paulo J Llinás
- Fundación Valle del Lili, Cali, Colombia.,Universidad ICESI Facultad de Medicina, Cali, Colombia
| | - David S Bailie
- Arizona Institute for Sports, Knees, and Shoulders, LLC, Scottsdale, Arizona, USA
| | | | - Julian Chica
- Fundación Valle del Lili, Clinical Research Center, Cali, Colombia
| | - Juan Francisco Londono
- Fundación Valle del Lili, Cali, Colombia.,Fundación Valle del Lili, Clinical Research Center, Cali, Colombia
| | - Gilberto A Herrera
- Fundación Valle del Lili, Cali, Colombia.,Universidad ICESI Facultad de Medicina, Cali, Colombia
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Wang Y, Ding W, Xu J, Ruan D, Heng BC, Ding Q, Shen L, Ding S, Shen W. Arthroscopic Superior Capsular Reconstruction for Massive Irreparable Rotator Cuff Tears Results in Significant Improvements in Patient Reported Outcomes and Range of Motion: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e1523-e1537. [PMID: 36033196 PMCID: PMC9402467 DOI: 10.1016/j.asmr.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose The purposes of this study were to evaluate the clinical outcomes (with the minimum mean follow-up period of 2 years) of arthroscopic superior capsular reconstruction (ASCR) using different grafts for massive irreparable rotator cuff tears (MIRCTs) and to explore whether margin convergence in ASCR affects range of motion (ROM) outcomes. Methods This systematic review was registered in PROSPERO and was then conducted following PRISMA guidelines by searching the databases: MEDLINE, EMBASE, Web of Science, and Cochrane Library database before April 2021. These literature searches investigating the clinical outcomes of ASCR were included. The methodological quality of included studies was assessed using the MINORS criteria. The data, including margin convergence, patient-reported outcome scores, range of motion, and complications, were extracted and analyzed. The minimal clinically important differences (MCID) criteria was used to define clinical significance. Results 15 studies met the inclusion criteria. All studies reported statistically significant improvements in visual analog scale scores (range: 2.07 to 7.1) and American Shoulder and Elbow Surgeons scores (range: 18.1 to 58). Significant improvements of Constant scores were noted in 4 of 5 reporting studies (mean improvement ranged from 14.64 to 50.79). Active forward flexion/elevation (11 studies), active abduction (4 studies), and active external rotation (8 studies) displayed improvements in all reporting studies, with mean changes ranging from 12 to 73.68, 19 to 89.21, and 1 to 24.74, respectively. The mean change of postoperative acromiohumeral distance ranged from −0.86 mm to 3.2 mm in 9 studies. The postoperative complication rate of ASCR ranged from 4.5% to 47.6%. The anterior margin convergence in SCR was associated with a relatively poor improvement in active external rotation. Conclusions ASCR contributes to significant improvements in patient-reported clinical outcomes and ROM at follow-up after a mean of more than two years, emerging as a viable option for patients with MIRCTs. The anterior margin convergence should be prudently chosen, especially in ASCR using fascia lata autograft, on account of the probable restriction on postoperative active external rotation. Level of Evidence Level IV, systematic review of Level III and IV studies.
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Affiliation(s)
- Yongjian Wang
- Department of Orthopedics, First People’s Hospital of Wenling, Affiliated Wenling Hospital of Wenzhou Medical University, Wenling, hejiang, PR China
| | - Wei Ding
- Department of Orthopedic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, PR China
| | - Jungang Xu
- Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Dengfeng Ruan
- Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Boon Chin Heng
- Peking University School of Stomatology, Beijing, PR China
| | - Qianhai Ding
- Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lingfang Shen
- Air Force Health Care Center for Special Services, Hangzhou, PR China
| | - Shaohua Ding
- Department of Orthopedic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, PR China
- Shaohua Ding, M.D., Department of Orthopedic Surgery, Ningbo Medical Center Lihuili Hospital, 57 Xingning Road, Ningbo, 315000, PR China.
| | - Weiliang Shen
- Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Orthopaedics Research Institute of Zhejiang University, Zhejiang, PR China; China Orthopaedic Regenerative Medicine (CORMed), Hangzhou, PR China; Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, Zhejiang, PR China; Department of Sports Medicine, School of Medicine, Zhejiang University, Zhejiang, PR China; Department of Orthopedics, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Zhejiang University Huzhou Hospital, Huzhou, Zhejiang, PR China
- Address correspondence to Weiliang Shen, M.D., Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie Fang Road, Hangzhou 310009, China.
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[Comparison of the effectiveness of the long head of the biceps tendon with or without proximal amputation after arthroscopic repair of the rotator cuff]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:845-852. [PMID: 35848181 PMCID: PMC9288905 DOI: 10.7507/1002-1892.202203056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To compare the effectiveness of the long head of the biceps tendon (LHBT) with or without proximal amputation after arthroscopic rotator cuff repair in the treatment of repairable rotator cuff tear with LHBT injury. METHODS The clinical data of 68 patients with LHBT injury combined with supraspinatus tendon tear who met the selection criteria between January 2016 and June 2020 were retrospectively analyzed. According to whether the proximal end of LHBT was cut off or not after arthroscopic rotator cuff repair, they were divided into LHBT fixation without cutting group (group A, 32 cases) and LHBT fixation with cutting group (group B, 36 cases). There was no significant difference in gender, age, operating side, preoperative supraspinatus tear width, Constant-Murley shoulder function scale, University of California Los Angeles (UCLA) score, and visual analogue scale (VAS) score between the two groups ( P>0.05). The operation time, elbow flexion muscle strength, and postoperative complications were compared between the two groups. The Constant-Murley shoulder function scale, UCLA score, and VAS score were used to evaluate the recovery of shoulder function before operation and at 3, 6, 12 months after operation. The acromion-humeral distance (AHD) was measured by Y-view X-ray film of the shoulder joint immediately after operation and at last follow-up. AHD and acromion-greater tubercle distance (AGT) were measured by musculoskeletal ultrasound at 0°, 30°, 60°, and 90° of abduction. RESULTS There was no significant difference in operation time between the two groups ( t=-0.740, P=0.463). Patients in both groups were followed up (13.0±0.7) months in group A and (13.1±0.8) months in group B, with no significant difference ( t=0.127, P=0.899). At last follow-up, the elbow flexor muscle strength of the two groups reached grade Ⅴ. Complications (including shoulder pain, deltoid atrophy, and rotator cuff re-tear) occurred in 6 patients (18.75%) in group A and 9 patients (25.00%) in group B, without neurovascular injury, surgical site infection, joint stiffness, LHBT spasmodic pain, and Popeye deformity. There was no significant difference in the incidence of complications between the two groups ( χ 2=0.385, P=0.535). The Constant-Murley shoulder function scale, UCLA score, and VAS score significantly improved in both groups at 3, 6, and 12 months after operation ( P>0.05). The above scores in group B were significantly better than those in group A at 3 and 6 months after operation ( P<0.05), and there was no significant difference between the two groups at 12 months after operation ( P>0.05). Y-view X-ray film measurement of the shoulder joint showed that the AHD of the two groups at last follow-up was less than that at immediate after operation, but the difference was not significant ( Z=-1.247, P=0.212); the AHD of group A was significantly greater than that of group B at last follow-up ( t=-2.291, P=0.025). During musculoskeletal ultrasound detection of abduction and shoulder lift, there was no significant difference in the reduction degree of AHD and AGT in group A with abduction of 0°-30° compared with group B ( P>0.05). The reduction degree of AHD and AGT in group A with abduction of 30°-60°, and the reduction degree of AGT in group A with abduction of 60°-90° were significantly smaller than those in group B ( P<0.05). CONCLUSION In arthroscopic rotator cuff repair, whether the proximal structure of LHBT is cut off or not after LHBT fixation can effectively improve the symptoms of patients and promote the recovery of shoulder joint function. Compared with preserving the proximal structure of LHBT, cutting the proximal structure of LHBT after LHBT fixation has more obvious pain relief within 6 months, and the latter had better stability above the shoulder joint.
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Chiu CH, Yang CP, Tang HC, Weng CJ, Hsu KY, Chen ACY, Chan YS. Arthroscopic-Assisted Lower Trapezius Tendon Transfer With Autologous Semitendinosus Tendon and Long Head of Biceps Superior Capsule Reconstruction for Massive Irreparable Posterosuperior Rotator Cuff Tears. Arthrosc Tech 2022; 11:e1251-e1259. [PMID: 35936855 PMCID: PMC9353193 DOI: 10.1016/j.eats.2022.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 03/04/2022] [Indexed: 02/03/2023] Open
Abstract
We present a surgical technique combining arthroscopic-assisted lower trapezius tendon (LTT) transfer with autologous semitendinosus tendon and long head of biceps tendon (LHBT) superior capsule reconstruction (SCR) for massive irreparable posterosuperior rotator cuff tears. The patients are placed in the beach-chair position with the ipsilateral lower leg prepared simultaneously. After both tendons are harvested, 1 limb of a semitendinosus graft is fixed with the LTT via a Krakow suture. The LHBT is then fixed by an anchor 5 to 8 mm posterior to the bicipital groove and tenotomized distally. The transverse humeral ligament is released afterward to provide better visualization. A Beath pin is introduced from anterolateral portal, aiming at the bicipital groove, and drilled posteriorly until it exits at the infraspinatus footprint. Next, 4.5- and 8-mm cannulated drills are used sequentially to create a humeral tunnel. A shuttle suture passed through infraspinatus fascia in the back brings the EndoButton and looped semitendinosus graft from posterior to anterior of the humerus, until the EndoButton flips and is fixed inside the bicipital groove. The shoulder is placed in 45° abduction and 30° external rotation. The free limb of semitendinosus tendon is then sutured with LTT with the desired tension.
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Affiliation(s)
- Chih-Hao Chiu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Cheng-Pang Yang
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Hao-Che Tang
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chun-Jui Weng
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kuo-Yao Hsu
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Alvin Chao-Yu Chen
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yi-Sheng Chan
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou, Taiwan
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
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Cromheecke M, Garret J, Deranlot J, Bonnevialle N, Gaudin S, Lädermann A, Nourissat G. Low healing rates and moderate functional outcome after arthroscopic superior capsular reconstruction using a porcine xenograft. Knee Surg Sports Traumatol Arthrosc 2022; 30:2528-2534. [PMID: 35199186 DOI: 10.1007/s00167-022-06916-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE In the absence of arthropathy, symptomatic massive irreparable rotator cuff tears contribute to a therapeutic challenge for orthopedic surgeons. The concept of superior capsular reconstruction (SCR) was introduced as an option for these challenging cases. The purposes of this study were to evaluate the clinical outcome scores when using a decellularized porcine xenograft and to evaluate the graft healing and incorporation. METHODS A multicentric retrospective study of consecutive SCR's performed between 2016 and 2019 by four surgeons in four centers. Preoperative and postoperative Constant score, Subjective shoulder value (SSV) and Visual analog scale for pain (VAS) were recorded. Graft healing was evaluated by ultrasound or magnetic resonance imaging (MRI). RESULTS A total of 28 shoulders were retrospectively analyzed with an average follow-up of 24 ± 9 months. One infection and four revisions (14%) to reversed shoulder arthroplasty (RSA) were reported at the final follow-up. The absolute Constant score showed a moderate, but significant improvement from 40 ± 12 to 57 ± 20 (P = 0.001). A significant improvement in pain scores was observed (P < 0.001). For patients undergoing SCR as a primary surgery, an average postoperative Constant score of 62 ± 16 was observed. This was in contrast to 43 ± 22 for patients who underwent SCR after failed rotator cuff repair. Although a strong trend in absolute differences was observed in regard to the Constant score, they did not reach statistical significance. For all other recorded outcome scores, a significant difference was reported between these groups. Graft healing was observed in (7/22) 30% of the patients. In the case of graft incorporation, an absolute constant score of 70 ± 9 was observed compared to 48 ± 21 in the graft failure group (P = 0.003). All cases with graft healing were considered to have a successful clinical outcome. This compared to only (7/15) 47% in the case of graft failure. CONCLUSIONS In these series, SCR with a dermal xenograft successfully alleviated pain, but provided only a moderate improvement in functional outcome. In the case of graft healing, satisfactory clinical outcomes and patient satisfaction were observed. The present study indicates the benefit of performing SCR as a primary surgery, yet warns against using SCR as a salvage option for failed rotator cuff repair. In this group, the use of dermal xenografts is limited by the low healing rates and high complication rate. LEVEL OF EVIDENCE IV. Retrospective case series, treatment study.
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Affiliation(s)
- Michiel Cromheecke
- Clinique du parc de Lyon, 155 boulevard Stalingrad, 69006, Lyon, France. .,AZ Maria Middelares, Buitenring-Sint-Denijs 30, 9000, Ghent, Belgium.
| | - Jérôme Garret
- Clinique du parc de Lyon, 155 boulevard Stalingrad, 69006, Lyon, France
| | | | - Nicolas Bonnevialle
- Hôpital Pierre Paul Riquet, Allée Jean Dausset, 31059, Toulouse Cedex 09, France.,Institut de Recherche Riquet (I2R), Place du Docteur Baylac, 31059, Toulouse, France
| | - Samuel Gaudin
- Clinique du parc de Lyon, 155 boulevard Stalingrad, 69006, Lyon, France
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Geoffroy Nourissat
- Clinique des Maussins - Ramsay Santé, 69 rue de Romainville, 75019, Paris, France
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Aydemir D, Eren I, Demirhan M, Ulusu NN. Evaluation of the Cell Behavior and Growth Characteristics of the Porcine Dermal Xenograft Patch in Relation to the Surface Properties. Front Bioeng Biotechnol 2022; 10:811446. [PMID: 35706504 PMCID: PMC9189373 DOI: 10.3389/fbioe.2022.811446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Duygu Aydemir
- Department of Medical Biochemistry, School of Medicine, Koc University, Istanbul, Turkey
- Koc University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
| | - Ilker Eren
- Department of Orthopedic Surgery, School of Medicine, Koc University, Istanbul, Turkey
| | - Mehmet Demirhan
- Department of Orthopedic Surgery, School of Medicine, Koc University, Istanbul, Turkey
| | - Nuriye Nuray Ulusu
- Department of Medical Biochemistry, School of Medicine, Koc University, Istanbul, Turkey
- Koc University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
- *Correspondence: Nuriye Nuray Ulusu,
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Park MC, Detoc E, Lee TQ. Anterior Cable Reconstruction: Prioritize Rotator Cable and Tendon Cord When Considering Superior Capsular Reconstruction. Arthroscopy 2022; 38:1705-1713. [PMID: 35314273 DOI: 10.1016/j.arthro.2022.03.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 03/14/2022] [Indexed: 02/02/2023]
Abstract
Although distinct in name, the anterior cable of the superior capsule and tendon cord of the supraspinatus are structurally one in the same at the attachment on the greater tuberosity footprint. Force transmission through both structures where they converge and interdigitate at this location is disproportionately high, which has implications on functional impact. Superior capsule reconstruction, and, specifically, the anterior cable of the superior capsule, has been shown to assist in maintaining superior stability and a functional fulcrum of the glenohumeral joint, without overconstraining range of motion. Anterior cable reconstructions have been described for specific indications, including full-thickness tears of the supraspinatus and anterior one-half of the infraspinatus. Cord-like grafts, including long head biceps tendon autografts and semitendinosus allografts, can provide relative technical ease during surgery compared to sheet-like grafts for this indication. Side-to-side sutures between anterior cable reconstruction graft and posterosuperior capsule retension the native capsule to optimize its natural functional role. Accounting for abduction and rotation at the time of fixation and employing "loop-around" fixation sutures (no sutures through the graft), are critical concepts to consider in terms of kinematics and limiting graft failure. With both the biomechanically and clinically based literature demonstrating functionality with maintenance of the superior capsule (and specifically the anterior cable of the capsule), despite rotator cuff tendon insufficiency or irreparability, the anterior cable of the superior capsule should be prioritized when considering full-thickness rotator cuff tears that naturally involve both the capsular cable and the supraspinatus tendon cord. LEVEL OF EVIDENCE: Level V (expert opinion).
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Affiliation(s)
- Maxwell C Park
- Southern California Permanente Medical Group, Woodland Hills, California; Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California.
| | - Emma Detoc
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California
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Evuarherhe A, Condron NB, Gilat R, Knapik DM, Patel S, Wagner KR, Garrigues GE, Romeo A, Verma N, Cole BJ. Defining Clinically Significant Outcomes Following Superior Capsular Reconstruction With Acellular Dermal Allograft. Arthroscopy 2022; 38:1444-1453.e1. [PMID: 34863902 DOI: 10.1016/j.arthro.2021.11.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/12/2021] [Accepted: 11/20/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To define clinically significant outcomes (CSO) thresholds for minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptomatic state (PASS) in patients undergoing superior capsular reconstruction (SCR) with an acellular dermal allograft. We also evaluated patient-specific variables predictive of achieving CSO thresholds. METHODS The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Single Assessment Numeric Evaluation (SANE), and subjective Constant-Murley (Constant) scores were collected preoperatively and at the most recent follow up for patients undergoing SCR from 2010 to 2019. A distribution-based approach was used to calculate MCID, and an anchor-based approach was used to calculate SCB and PASS. Logistic regression was used to determine factors associated with CSO achievement. RESULTS Fifty-eight patients were identified (n = 39 males; n = 19 females) with a mean age of 53.4 ± 14.1 years at surgery and an average follow-up of 23 months. The MCID, SCB, and PASS were 11.2, 18.02, and 68.82 for ASES, 14.5, 23.13, and 69.9 for SANE, and 3.6, 10, and 18 for Constant, respectively. Subscapularis tear, female sex, and workers compensation (WC) status reduced odds of achieving MCID. Reduced odds of achieving Constant SCB were associated with older age, female sex, and WC status, while concomitant distal clavicle excision during SCR and lower preoperative ASES increased odds of achieving ASES SCB. Reduced odds for achieving ASES PASS were associated with female sex and WC status, while reduced odds for achieving SANE PASS were associated with subscapularis tearing preoperatively. CONCLUSION On the basis of calculated values for MCID, SCB, and PASS, subscapularis tearing, WC status, age, and sex are associated with failure to achieve clinically significant outcomes following SCR. Concomitant distal clavicle excision during SCR and lower preoperative ASES was predictive for achievement of MCID and SCB. By defining the thresholds and variables predictive of achieving CSOs following SCR, surgeons may better counsel patients prior to SCR. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Aghogho Evuarherhe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago Illinois, U.S.A
| | - Nolan B Condron
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago Illinois, U.S.A
| | - Ron Gilat
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago Illinois, U.S.A
| | - Derrick M Knapik
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago Illinois, U.S.A
| | - Sumit Patel
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago Illinois, U.S.A
| | - Kyle R Wagner
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago Illinois, U.S.A
| | - Grant E Garrigues
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago Illinois, U.S.A
| | - Anthony Romeo
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago Illinois, U.S.A
| | - Nikhil Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago Illinois, U.S.A
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago Illinois, U.S.A..
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Ma M, Pan Z, Lu L. Clinical effect of arthroscopic long head of biceps transfer and tenodesis on irreparable rotator cuff tear. J Orthop Surg Res 2022; 17:220. [PMID: 35399092 PMCID: PMC8996574 DOI: 10.1186/s13018-022-03121-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objective
To explore the clinical effect of arthroscopic long head of biceps transfer and tenodesis for on irreparable rotator cuff tear.
Methods
A total of 18 patients with irreparable rotator cuff tear who were treated in the Dongfang Hospital Affiliated to Tongji University School of Medicine from April 2018 to March 2020 were included in this study. They all underwent arthroscopic long head of biceps transfer and tenodesis. Shoulder joint motions (forward flexion, abduction, and external rotation angle) and magnetic resonance imaging (MRI) were performed. Moreover, visual analogue scale (VAS) and university of California Los Angeles (UCLA) score were conducted during follow-up.
Results
Preoperative symptoms lasted from 3 to 16 months, with an average duration of 10 months. All patients healed in the first stage without obvious complications were included. All patients were followed up for 4 to 14 months after the surgery, with an average duration of 11.1 months. The range of shoulder joint motions, including forward flexion (80.52° ± 31.19° vs. 149.47° ± 28.36°), abduction (65.13° ± 37.59° vs. 152.46° ± 28.64°) and lateral rotation (30.17° ± 15.15° vs. 71.49° ± 11.42°) was significantly improved after operation (P < 0.05). The VAS score was notably decreased after operation (8.46 ± 0.80 vs. 1.55 ± 0.70), but the UCLA score was markedly increased (15.27 ± 2.89 vs. 31.17 ± 2.36). MRI imaging showed that 15 patients had good tissue healing, with a healing rate of 83.3% (15/18).
Conclusion
Arthroscopy of the biceps long head tendon transposition can significantly relieve pain in patients with large rotator cuff tears, improve joint mobility, and restore joint function.
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Li HS, Zhou M, Huang P, Liu J, Tang H, Zhang CK, Wang YJ, Shi YX, Liao YT, Jin BY, Tang KL, Zhou B. Histologic and biomechanical evaluation of the thoracolumbar fascia graft for massive rotator cuff tears in a rat model. J Shoulder Elbow Surg 2022; 31:699-710. [PMID: 34775038 DOI: 10.1016/j.jse.2021.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 09/30/2021] [Accepted: 10/14/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fascial autografts, which are easily available grafts, have provided a promising option in patients with massive rotator cuff tears. However, no fascial autografts other than the fascia lata have been reported, and the exact healing process of the fascia-to-bone interface is not well understood. The objective of this study is to histologically and biomechanically evaluate the effect of the thoracolumbar fascia (TLF) on fascia-to-bone healing. METHODS A total of 88 rats were used in this study. Eight rats were killed at the beginning to form an intact control group, and the other rats were divided randomly into 2 groups (40 rats per group): the TLF augmentation group (TLF group) and the repair group (R group). The right supraspinatus was detached, and a 3 × 5 mm defect of the supraspinatus was created. The TLF was used to augment the torn supraspinatus in the TLF group, whereas in the R group, the torn supraspinatus was repaired in only a transosseous manner. Histology and biomechanics were assessed at 1, 2, 4, 8, and 16 weeks postoperatively. RESULTS The modified tendon maturation score of the TLF group was higher than that of the R group at 8 weeks (23.00 ± 0.71 vs. 24.40 ± 0.89, P = .025) and 16 weeks (24.60 ± 0.55 vs. 26.40 ± 0.55, P ≤ .001). The TLF group showed a rapid vascular reaction, and the peak value appeared at 1 week. Later, the capillary density decreased, and almost no angiogenesis was observed at 8 weeks postoperatively. Immunohistochemistry results demonstrated a significantly higher percentage of collagen I in the TLF group at 4, 8, and 16 weeks (24.78% ± 2.76% vs. 20.67% ± 2.11% at 4 weeks, P = .046; 25.46% ± 1.77% vs. 21.49% ± 2.33% at 8 weeks, P = .026; 34.77% ± 2.25% vs. 30.01% ± 3.17% at 16 weeks, P = .040) postoperatively. Biomechanical tests revealed that the ultimate failure force in the TLF group was significantly higher than that in the R group at the final evaluation (29.13 ± 2.49 N vs. 23.10 ± 3.47 N, P = .022). CONCLUSIONS The TLF autograft can promote a faster biological healing process and a better fixation strength. It could be used as an alternative reinforcement or bridging patch when the fascia lata is not appropriate or available for superior capsule reconstruction (SCR).
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Affiliation(s)
- Huai-Sheng Li
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Mei Zhou
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Pan Huang
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Juan Liu
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Hong Tang
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Chen-Ke Zhang
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Yun-Jiao Wang
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - You-Xing Shi
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Ya-Tao Liao
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Bao-Yong Jin
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Kang-Lai Tang
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China.
| | - Binghua Zhou
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China.
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Kawashima K, Terabayashi N, Asano H, Akiyama H. Arthroscopic Long Head of the Biceps Transposition for Superior Capsular Augmentation Results in Comparable Clinical Outcomes to Arthroscopic Partial Repair for Irreparable Rotator Cuff Tears. Arthrosc Sports Med Rehabil 2022; 4:e425-e434. [PMID: 35494304 PMCID: PMC9042770 DOI: 10.1016/j.asmr.2021.10.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/24/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose To describe a modified arthroscopic technique of long head of biceps transposition (LHBT) for superior capsular augmentation; to investigate the outcomes and effectiveness of LHBT in patients with irreparable rotator cuff tears; and to compare the results with those of arthroscopic partial repair (APR) after a 2-year minimum follow-up. Methods We retrospectively reviewed patients who underwent arthroscopic repair of large to massive superior rotator cuff tears. The inclusion criteria were an irreparable rotator cuff with inability of the tendon to reach the original footprint and postoperative follow-up for a minimum of 2 years. We investigated 22 patients followed up for 30.7 months (mean); 10 patients underwent isolated partial repair and 12 patients underwent LHBT combined with partial repair. The acromiohumeral interval (AHI) was measured using anteroposterior radiographs. Cuff integrity was defined using Sugaya’s classification 2 years postoperatively. Clinical outcomes were assessed preoperatively and during postoperative follow-up (minimum 2 years) using the American Shoulder and Elbow Surgeons and University of California, Los Angeles shoulder rating scales. Results Postoperative functional scores significantly improved in both groups. In the LHBT group, both American Shoulder and Elbow Surgeons and University of California, Los Angeles scores significantly improved postoperatively from 52.0 ± 14.6 to 89.3 ± 10.4 points (P = .002) and 15.2 ± 2.2 to 32.5 ± 2.6 points (P = .002), respectively. In addition, the AHI at the final follow-up was significantly greater in the LHBT group (7.5 ± 2.0 mm) than in the APR group (5.8 ± 1.9 mm) (P = .032). The retear rate, forward flexion, and postoperative functional scores at the final follow-up were better in the LHBT group; however, the intergroup differences were not statistically significant. Conclusions Arthroscopic LHBT for irreparable rotator cuff tears showed comparable clinical outcomes and improvement in postoperative AHI compared with APR after a minimum 2-year follow-up. Level of Evidence Level III, retrospective comparative trial.
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Superior Capsule Reconstruction Is a Viable Option for Patients with Symptomatic, Isolated, and Irreparable Supraspinatus Tears. Arthrosc Sports Med Rehabil 2022; 4:e591-e597. [PMID: 35494274 PMCID: PMC9042762 DOI: 10.1016/j.asmr.2021.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 11/22/2021] [Indexed: 11/22/2022] Open
Abstract
Purpose Methods Results Conclusions Level of Evidence
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46
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Denard PJ, Park MC, McGarry MH, Adamson G, Lee TQ. Biomechanical Assessment of a V-Shaped Semitendinosus Allograft Anterior Cable Reconstruction for Irreparable Rotator Cuff Tears. Arthroscopy 2022; 38:719-728. [PMID: 34352334 DOI: 10.1016/j.arthro.2021.07.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to biomechanically assess superior stability, subacromial contact pressures, and glenohumeral kinematics of a V-shaped anterior cable reconstruction with semitendinosus allograft (VST) in a massive rotator cuff tear (MCT) model. METHODS Eight cadaveric shoulders (mean age, 66 years; range, 48 to 72 years) were tested with a custom testing system used to evaluate superior translation, subacromial contact pressure, and glenohumeral kinematics at 0°, 20°, and 40° glenohumeral abduction and 0°, 30°, 60°, and 90° of external rotation (ER). Conditions tested included (1) native state, (2) MCT (complete supraspinatus and ½ infraspinatus), a (3) VST. The VST was secured medially on the glenoid with 1 anchor and on the greater tuberosity with a double-row configuration using 4 anchors. RESULTS The VST significantly decreased superior translation compared to the MCT at 0° and 20° glenohumeral abduction for 0°, 30°, and 60° humeral rotation and at 40° abduction and 0° degrees humeral rotation (P < .05). Superior translation following the VST remained significantly greater than the intact state at 0° abduction and 60° and 90° ER (P = .039 and 0.007, respectively) and 20° abduction and 30°, 60°, and 90° ER (P = .048, .003, and .004, respectively). The VST restored peak subacromial contact pressure to intact levels for all positions except 40° abduction and 60° ER. The VST did not statistically affect humeral head kinematics compared to the intact condition. CONCLUSIONS In a biomechanical model, a VST anterior cable reconstruction partially restores superior stability and reduces peak subacromial contact pressure associated with an MCT, without affecting glenohumeral kinematics. The technique may be a consideration in the treatment of an irreparable MCT with isolated anterior cable disruption. CLINICAL RELEVANCE The VST may provide an option for treatment of irreparable MCTs with anterior rotator cable disruption.
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Affiliation(s)
| | - Maxwell C Park
- Southern California Permanente Group, Woodland Hills, California, U.S.A
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | - Gregory Adamson
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
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Ângelo ACLPG, de Campos Azevedo CI. Donor-Site Morbidity After Autologous Fascia Lata Harvest for Arthroscopic Superior Capsular Reconstruction: A Midterm Follow-up Evaluation. Orthop J Sports Med 2022; 10:23259671211073133. [PMID: 35141340 PMCID: PMC8819761 DOI: 10.1177/23259671211073133] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Autologous fascia lata (AFL) graft use in arthroscopic superior capsular reconstruction (ASCR) is effective for the treatment of irreparable rotator cuff tears (RCTs). Although donor-site morbidity (DSM) is a recurrent argument against AFL graft use, scientific evidence for this argument is lacking. Purpose: To report the midterm clinical follow-up evaluation of DSM in ASCR using minimally invasively harvested AFL grafts and compare thigh function and patient satisfaction with those of an unharvested control group. Study Design: Cohort study; Level of evidence, 3. Methods: Of 66 consecutive patients who underwent ASCR using a minimally invasively harvested AFL graft, 39 patients with a minimum follow-up of 24 months were retrospectively evaluated (ASCR group) and compared with 39 randomly selected patients who underwent arthroscopic RCT repair by the same surgeons (control group). The functional outcomes of both thighs were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Patient satisfaction was evaluated using the Patient Scar Assessment Questionnaire (PSAQ) and a subjective questionnaire. Pain was quantified using a visual analog scale (VAS). Results: The ASCR group had a mean age of 65 years (range, 51-77 years) and a mean follow-up of 47 months (range, 24-66 months). The WOMAC score in the harvested thigh differed by 0.8% from that in the contralateral thigh ( P = .002). The mean PSAQ score differed by 6 points from the minimum PSAQ score ( P < .001). Overall, 95% of the patients indicated that they would undergo the same surgery again and that the shoulder outcome compensated for the thigh symptoms. There was no significant association between the presence of residual thigh symptoms and the willingness to undergo the same surgery again ( P = .354). The mean VAS score in the harvested thigh was 0.6 (range, 0-5). There was no significant difference in the average WOMAC score or VAS score between groups ( P = .684 and P = .148, respectively). Conclusion: Despite the proportion of residual symptoms, the associated functional effects were small and not clinically significant, and the vast majority of patients were accepting of the harvest symptoms given the improvement in shoulder function.
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Affiliation(s)
| | - Clara Isabel de Campos Azevedo
- Hospital dos SAMS de Lisboa, Lisbon, Portugal
- Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Hospital CUF Tejo, Lisbon, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal
- ICVS/3B’s–Instituto de Investigação em Ciências da Vida e Saúde/Biomaterials, Biodegradables and Biomimetics PT Government Associate Laboratory, Braga/Guimarães, Portugal
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[Research progress of arthroscopic long head of biceps tendon transposition in treatment of irreparable massive rotator cuff tears]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:249-253. [PMID: 35172414 PMCID: PMC8863521 DOI: 10.7507/1002-1892.202108120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To review the research progress of arthroscopic long head of biceps tendon (LHBT) transposition in treatment of irreparable massive rotator cuff tears. METHODS The domestic and foreign related literature in recent years on the treatment of irreparable massive rotator cuff tears with different LHBT transposition methods under arthroscopy was reviewed and analyzed. RESULTS Arthroscopic LHBT transposition is an effective method for irreparable massive rotator cuff tears, which mainly includes "proximal cut", "both two cuts", "distal cut", and "no cut". Different methods of LHBT transposition can achieve good effectiveness, but its long-term effectiveness needs further follow-up. CONCLUSION Arthroscopic LHBT transposition in treatment of irreparable massive rotator cuff tears is simple and effective. The patients can recover quickly after operation with less injury. But the technique has higher requirements for surgeons, and the indications must be strictly controlled.
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Berthold DP, Ravenscroft M, Bell R, Obopilwe E, Cote MP, Kane Z, Morgan BW, Mühlenfeld N, Mazzocca AD, Muench LN. Bursal Acromial Reconstruction (BAR) Using an Acellular Dermal Allograft for Massive, Irreparable Posterosuperior Rotator Cuff Tears: A Dynamic Biomechanical Investigation. Arthroscopy 2022; 38:297-306.e2. [PMID: 34329702 DOI: 10.1016/j.arthro.2021.07.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the effect of bursal acromial reconstruction (BAR) using an acellular dermal allograft on glenohumeral joint kinematics including maximum abduction angle, glenohumeral superior translation, cumulative deltoid force, and subacromial contact pressure. METHODS In this dynamic biomechanical cadaveric shoulder study, 8 fresh-frozen cadaveric shoulders (age 53.4 ± 14.2 years, mean ± standard deviation) were tested using a dynamic shoulder testing system. Maximum abduction angle (MAA), glenohumeral superior translation (ghST), maximum cumulative deltoid force (cDF), and subacromial peak contact pressure (sCP) were compared across 3 conditions: (1) intact shoulder; (2) massive retracted irreparable posterosuperior rotator cuff tear (psRCT) according to Patte III; and (3) BAR. Additionally, humeral head containment was measured using contact pressure. RESULTS Compared with the simulated psRCT, BAR significantly increased mean MAA and significantly decreased ghST (P < .001, respectively) and cDF (P = .017) Additionally, BAR was found to significantly decrease sCP compared with psRCT (P = .024). CONCLUSION In a dynamic biomechanical cadaveric shoulder simulator, resurfacing the undersurface of the acromion using the BAR technique leads to significantly improved ghST, MAA, cDF, and sCP compared with the irreparable rotator cuff tear. CLINICAL RELEVANCE With the BAR technique, native humeral containment may be restored, which can potentially delay progressive subacromial and glenoidal abrasive wear and improve overall shoulder function. As such, the proposed BAR technique can be considered as a technically feasible and potentially cost- and timesaving procedure, as no bone anchors are needed, glenoidal or humeral side graft ruptures can be avoided, and postoperative rehabilitation can be started immediately. However, future clinical studies are needed.
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Affiliation(s)
- Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A..
| | | | | | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Zenon Kane
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | | | - Nils Mühlenfeld
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Lukas N Muench
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany; Orthoteam Centre, Manchester, UK
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[Arthroscopic augmentation techniques for superior capsule reconstruction]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2022; 34:21-33. [PMID: 35037092 DOI: 10.1007/s00064-021-00757-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/14/2021] [Accepted: 09/14/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Reconstruction of the superior capsule for treatment of irreparable supraspinatus tendon tears. INDICATIONS Irreparable supraspinatus tendon tear; centered humeral head; largely intact cartilage; largely intact transversal "force-couple". CONTRAINDICATIONS Decentered humeral head; osteoarthritis of the glenohumeral joint/cuff tear arthropathy; irreparable anterosuperior and posterosuperior cuff tears. SURGICAL TECHNIQUE Arthroscopic superior capsule reconstruction (SCR) is performed in beach-chair position. At first the bone bed of the glenoid and the insertion of the supraspinatus tendon are prepared using a bone burr. Now, depending on the integrity of the long biceps tendon, two options are possible. Option 1: In the case of an existing long biceps tendon, a biceps tendon tenodesis to the greater tubercle is performed. Therefore, the long head of the biceps is fixed central to the former insertion of the supraspinatus tendon, using a suture anchor. Option 2: In the case of a nonexisting or degeneratively modified long biceps tendon, a PushLock® anchor (Arthrex, Inc. Naples, FL, USA) loaded with a FiberTape® (Arthrex, Inc. Naples, FL, USA) is placed centrally onto the glenoid. Now, the actual superior capsule reconstruction is completed. Two suture anchors are placed at the glenoid and two SwiveLock® anchors, each loaded with a FiberTape®, (Arthrex, Inc. Naples, FL, USA) are placed at the footprint of the supraspinatus tendon at the greater tubercle. The tapes are shuttled extra-articularly and the graft size is evaluated by measuring the distance between the anchors. The graft is customized to that size and armed with the tapes. Using the tapes of the glenoidal anchors, as tension ropes, the graft is placed intra-articularly. Medially the sutures are tied and laterally the graft is fixed in a knotless lateral row manner. The tails of the tape, of the glenoidal PushLock® (Arthrex, Inc. Naples, FL, USA) anchor are fixed within the lateral row and are tensioned above the graft. Afterwards side-to-side sutures to the infraspinatus and a subacromial decompression are completed. POSTOPERATIVE MANAGEMENT The arm is placed in a sling for 6 weeks, afterwards active physiotherapy begins. Passive-assisted physiotherapy is started on postoperative day 1. RESULTS Between 2017 and 2019, 11 patients were treated with SCR. As the combined procedure is our new treatment algorithm, case studies will be presented. For this study, 9 patients treated with singular SCR, with a mean follow-up of 18 months, were recruited. A statistically significant reduction of pain (VAS 6.3 → VAS 2), a good postoperative forward flexion (mean 138°; 56 standard deviation [SD]), and external rotation (mean 37°; 21 SD) were measured. A mean ASES of 76.5 (18 SD) a mean DASH of 17.8 (14 SD) and a mean Constant score of 64.6 (25 SD) were achieved.
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