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Polacek M, Nyegaard CP. Superior Capsular Reconstruction Using 3-layered Fascia Lata Autograft Reinforced with a Nonresorbable Suture Mesh. Arthrosc Sports Med Rehabil 2020; 2:e489-e497. [PMID: 33134985 PMCID: PMC7588631 DOI: 10.1016/j.asmr.2020.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/18/2020] [Indexed: 01/29/2023] Open
Abstract
Purpose The purpose of this study was to evaluate the short-term clinical outcomes and the complications related to arthroscopic superior capsular reconstruction (SCR) using a 3-layered fascia lata autograft (FLA) reinforced with a nonresorbable suture mesh, in the treatment of irreparable massive rotator cuff tears (MRCTs). Methods Consecutive patients with irreparable MRCTs (Goutallier 4, Hamada grade 1-2, Bateman 3-4) who were treated with arthroscopic SCR using reinforced FLA in 2018 were included. Patients with an irreparable subscapularis/infraspinatus, serious cardiovascular condition, systemic infection, rheumatic disease, and known alcohol/drug abuse were excluded from the study. Range of motion and Shoulder Pain and Disability Index (SPADI) scores were assessed preoperatively, at 6 months, and at 12 months postoperatively. A simple t test was used to compare the outcomes. P values <.05 were considered significant. Complications and revision surgeries were registered. Results A total of 24 consecutive patients (15 males, 9 females) with a mean age of 61 years (range, 41-76) were enrolled. Twenty (83%) patients achieved minimal clinically important difference in the SPADI score (>18) and 14 (58%) experienced substantial clinical benefit in SPADI (>45). The mean SPADI score improved from 59.0 to 9.7 (P < .0001) at 1-year follow-up. Active abduction improved from 59.5° to 154.3° (P < .0001) and active forward flexion improved from 67.0° to 160.3° (P < .0001) at 1-year follow-up. Eighteen (75%) patients achieved substantial clinical benefit in active abduction (>28.5°) and active forward flexion (>35.4°). Complications included progression of osteoarthritis in 2 cases, tear of the graft in 1 case, and pullout of the anchor in another. Two patients experienced donor site morbidity after harvesting the fascia lata autograft. Conclusions Eighty-three percent of the patients achieved minimal clinically important difference and were successfully treated with arthroscopic SCR using a FLA reinforced with a suture mesh. The procedure had a complication rate of 17% and 8.5% of the patients experienced donor site morbidity. All complications occurred in patients who were previously treated with an attempted rotator cuff repair. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Martin Polacek
- Orthopedic Department, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
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102
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Burkhart SS. Shoulder arthroscopy: a bridge from the past to the future. J Shoulder Elbow Surg 2020; 29:e287-e296. [PMID: 32713469 DOI: 10.1016/j.jse.2020.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/02/2020] [Indexed: 02/01/2023]
Abstract
This article constitutes the text of the Codman Lecture, delivered by the author to the attendees of the International Congress of Shoulder and Elbow Surgeons on September 19, 2019, in Buenos Aires, Argentina.
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Affiliation(s)
- Stephen S Burkhart
- The San Antonio Orthopaedic Group, Burkhart Research Institute for Orthopaedics (BRIO), San Antonio, TX, USA.
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103
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Osti L, Milani L, Gerace E, Padovani S, Massari L, Maffulli N. Arthroscopic superior capsular reconstruction versus latissimus dorsi transfer for irreparable rotator cuff lesions: a systematic review. Br Med Bull 2020; 134:85-96. [PMID: 32507891 DOI: 10.1093/bmb/ldaa014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The present systematic review compared arthroscopic superior capsular reconstruction (ASCR) and latissimus dorsi transfer (ALDT) for the management of massive irreparable rotator cuff lesions. SOURCES OF DATA We performed a systematic review searching the literature on Medline, Cochrane and Scopus databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. AREAS OF AGREEMENT We included a total of 20 articles, 10 on ASCR and 10 on ALDT (12 retrospective and 8 prospective studies), all published between 2013 and 2019. AREAS OF CONTROVERSY ASCR and ALDT are technical demanding procedures. When compared to each other, they do not produce significantly different improvements in clinical outcome. GROWING POINTS Both ASCR and ALDT are valid options for surgical management of MIRCLs. Although ALDT has shown a greater complication rate and a less improvement in acromion-humeral distance, its clinical outcomes overlap those obtained with ASCR. AREAS TIMELY FOR DEVELOPING RESEARCH Further comparative prospective and retrospective studies with longer follow-up could confirm which surgical procedure can lead to better outcomes with a lower complication rate.
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Affiliation(s)
- Leonardo Osti
- Department of Orthopaedic Surgery, Arthroscopy and Sport Medicine, Hesperia Hospital, Arqua' Street, 41125 Modena, Italy
| | - Lorenzo Milani
- Department of Biomedical and Speciality Surgical Sciences, Unit of Orthopaedic and Traumatology, S. Anna Hospital, Aldo Moro Street, 8, 41121 Ferrara, Italy
| | - Emanuele Gerace
- Department of Biomedical and Speciality Surgical Sciences, Unit of Orthopaedic and Traumatology, S. Anna Hospital, Aldo Moro Street, 8, 41121 Ferrara, Italy
| | - Sara Padovani
- Department of Biomedical and Speciality Surgical Sciences, Unit of Orthopaedic and Traumatology, S. Anna Hospital, Aldo Moro Street, 8, 41121 Ferrara, Italy
| | - Leo Massari
- Department of Biomedical and Speciality Surgical Sciences, Unit of Orthopaedic and Traumatology, S. Anna Hospital, Aldo Moro Street, 8, 41121 Ferrara, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno, 84081 Salerno, Italy.,Institute of Science and Technology in Medicine, Keele University School of Medicine, Stoke on Trent ST4 7QB, UK.,Centre for Sport and Exercise Medicine, Barts and the London School of Medicine, Queen Mary University of London, London E1 4NS, UK
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104
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Takayama K, Yamada S, Kobori Y, Shiode H. Association Between the Postoperative Condition of the Subscapularis Tendon and Clinical Outcomes After Superior Capsular Reconstruction Using Autologous Tensor Fascia Lata in Patients With Pseudoparalytic Shoulder. Am J Sports Med 2020; 48:1812-1817. [PMID: 32412850 DOI: 10.1177/0363546520919956] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Superior capsular reconstruction (SCR) has been performed for irreparable rotator cuff tear and pseudoparalytic shoulder (PPS); however, poor clinical outcomes have occasionally been reported. Previous studies have shown that the cause of poor clinical results was mainly graft rupture; however, poor clinical outcomes have also been observed in some cases even though the graft was not ruptured. HYPOTHESIS/PURPOSE We hypothesized that the subscapularis (SSC) tendon would be an important factor affecting clinical outcomes after SCR. The purpose was to clarify the correlation between the condition of the SSC tendon and clinical outcomes after SCR in patients with PPS. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This retrospective cohort study included 27 patients who had undergone SCR for PPS performed by 1 surgeon between June 2014 and July 2017. The 27 patients were divided into 3 groups for evaluation: group A (n = 12), irreparable supraspinatus (SSP) and infraspinatus (ISP) tears but intact SSC tendon; group B (n = 11), irreparable SSP and ISP tears and repairable SSC tear; and group C (n = 4), irreparable SSP, ISP, and SSC tears. We evaluated the preoperative and postoperative ranges of motion (ROMs; active flexion, abduction, external rotation, and internal rotation), the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, and graft condition on magnetic resonance imaging at 12 months postoperatively. All data were analyzed using the Mann-Whitney U, Wilcoxon signed-rank test, and Fisher exact tests, and P < .05 was considered significant. RESULTS Postoperative flexion, abduction, and internal rotation ROMs were significantly lower in group C than in groups A and B (flexion: 70.0° ± 17.8° vs 153.3° ± 14.3° and 154.5° ± 14.3°, P = .003 and P = .003, respectively; abduction: 67.5° ± 15° vs 148.3° ± 22.5° and 140° ± 29.3°, P = .003 and P = .004, respectively; internal rotation: L4 vs Th10 and Th11, P = .005 and P = .008, respectively). All 23 patients in groups A and B were able to recover from PPS; however, no patient recovered from PPS in group C. CONCLUSION The present study suggests that the SSC tendon is the important factor for achieving good clinical outcomes after SCR in patients with PPS. When the SSC tendon was irreparable, SCR was not an effective treatment for patients with PPS.
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Affiliation(s)
- Kazumasa Takayama
- Department of Orthopaedics, Kurashiki Central Hospital, Kurashiki, Japan
| | - Shunsuke Yamada
- Department of Orthopaedics, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yuu Kobori
- Department of Orthopaedics, Kurashiki Central Hospital, Kurashiki, Japan
| | - Hayao Shiode
- Department of Orthopaedics, Kurashiki Central Hospital, Kurashiki, Japan
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105
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Azevedo CIDC, Catarina Leiria Pires Gago Ângelo A, Campos-Correia D, Delgado L, Ferreira N, Sevivas N. Clinical Importance of Graft Integrity in Arthroscopic Superior Capsular Reconstruction Using a Minimally Invasively Harvested Midthigh Fascia Lata Autograft: 3-Year Clinical and Magnetic Resonance Imaging Outcomes. Am J Sports Med 2020; 48:2115-2128. [PMID: 32667265 DOI: 10.1177/0363546520928649] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The clinical importance of graft type and integrity in arthroscopic superior capsular reconstruction (ASCR) remains controversial. PURPOSE To assess 3-year clinical and magnetic resonance imaging (MRI) outcomes of ASCR using a minimally invasively harvested fascia lata autograft (FLA) for irreparable rotator cuff tears (IRCTs) and to determine the clinical importance of graft integrity and whether the results change from year 2 to 3. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 22 consecutive patients who underwent ASCR with a minimally invasively harvested FLA were enrolled in a prospective single-arm study. At 3 years, the patients answered a satisfaction questionnaire and underwent a clinical examination and MRI. The MRI scans were independently reviewed by 3 raters to determine the graft integrity, acromiohumeral interval, supraspinatus atrophy, and fatty degeneration of the rotator cuff muscles. Reliability statistics were calculated, and the outcomes were compared across subgroups of patients with and without complete graft tears. RESULTS Overall, 21 patients (95.5%) answered the questionnaire, 20/21 (95.2%) were satisfied, 4/20 (20.0%) reported donor site pain, and 19 patients (86.4%) underwent examinations. From preoperatively to 3 years, the mean improvement was 73.68° in elevation (95% CI, 47.59°-99.77°), 89.21° in abduction (95% CI, 66.56°-111.86°), 24.74° in external rotation (95% CI, 4.72°-34.75°), 3.00 in internal rotation (95% CI, 2.36-3.64), 2.61 kg in abduction strength (95% CI, 1.76-3.45 kg), 50.79 on the Constant score (CS; 95% CI, 41.99-59.58), 7.47 on the Simple Shoulder Test (SST; 95% CI, 5.19-9.75), and 36.05% on the subjective shoulder value (SSV; 95% CI, 23.19%-48.92%), which were all significant (P < .05). From 2 to 3 years, the mean improvement in abduction was 20.26° (95% CI, 5.44°-35.09°), which was significant (P = .010). At 3 years, the raters perfectly agreed (kappa = 1; P = .000013) that 4 patients (21.1%) had complete graft tears; this subgroup of patients had decreased external rotation strength at 90° of abduction (1.77 ± 0.17 vs 4.45 ± 2.55 kg, respectively; P = .027) and increased grades of infraspinatus (3.50 ± 0.58 vs 2.20 ± 1.01, respectively; P = .030) and teres minor fatty degeneration (3.25 ± 0.96 vs 1.53 ± 0.64, respectively; P = .005) compared with those without a complete graft tear, but the mean CS, SST, and SSV scores did not differ from those of the overall group (69.50 ± 5.20 vs 69.63 ± 18.25; 9.00 ± 2.31 vs 9.74 ± 4.73; and 72.50 ± 15.00 vs 71.58 ± 26.70, respectively). CONCLUSION The 3-year clinical outcomes of ASCR using a minimally invasively harvested FLA for IRCTs were good, despite donor site morbidity. Active abduction improved significantly from 2 to 3 years. Complete graft tears were correlated with significantly decreased external rotation strength at 90° of shoulder abduction and increased grades of infraspinatus and teres minor fatty degeneration. REGISTRATION NCT03663036 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Clara Isabel de Campos Azevedo
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.,Hospital dos SAMS de Lisboa, Lisbon, Portugal.,Clínica GIGA Saúde, Lisbon, Portugal
| | | | | | - Lara Delgado
- Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Nuno Ferreira
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Grupo Trofa Saúde, Vila do Conde, Portugal.,Hospital Santa Maria Maior, Barcelos, Portugal
| | - Nuno Sevivas
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,Grupo Trofa Saúde, Vila do Conde, Portugal.,Clínica do Dragão, Espregueira-Mendes Sports Centre, Porto, Portugal
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106
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Systematic review of reversing pseudoparalysis of the shoulder due to massive, irreparable rotator cuff tears. J Shoulder Elbow Surg 2020; 29:S87-S91. [PMID: 32643613 DOI: 10.1016/j.jse.2020.04.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Correcting pseudoparalysis of the shoulder due to massive rotator cuff tear is challenging. The most reliable treatment for restoring active shoulder elevation is debatable. Therefore, the purpose of this systematic review was to evaluate the success of various treatment options for reversing pseudoparalysis due to massive rotator cuff tear. METHODS A search was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of the MEDLINE database, Cochrane database, Sportdiscus, and Google Scholar database for articles evaluating shoulder pseudoparalysis due to massive rotator cuff tears. RESULTS Nine articles evaluating reverse total shoulder arthroplasty (RTSA), superior capsular reconstruction (SCR), and rehabilitation programs were included in the study. Though there was variability, the definition of pseudoparalysis was active forward elevation (AFE) less than 90° with preserved passive range of motion (ROM). Reversal of pseudoparalysis was defined as restoration of AFE greater than 90°. The overall rate of reversal of pseudoparalysis across studies was similar for RTSA (96% ± 17%) and SCR (94% ± 3%). However, there was a difference in average improvement in AFE for RTSA (56° ± 11°) and SCR (106° ± 20°). A progressive rehabilitation program described improvements in a single study with 82% reversal of pseudoparalysis. CONCLUSION The available Level IV evidence suggests that RTSA and SCR reliably reverse pseudoparalysis in most patients with massive, irreparable rotator cuff tears. However, the dissimilar improvements in ROM suggest that a more consistent definition of pseudoparalysis is warranted. Future randomized controlled trials are needed to determine the best treatment approach for patients with massive irreparable rotator cuff tears.
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107
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Muench LN, Kia C, Jerliu A, Williams AA, Berthold DP, Cote MP, McCarthy MB, Arciero RA, Mazzocca AD. Clinical Outcomes Following Biologically Enhanced Patch Augmentation Repair as a Salvage Procedure for Revision Massive Rotator Cuff Tears. Arthroscopy 2020; 36:1542-1551. [PMID: 32241704 DOI: 10.1016/j.arthro.2020.02.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/30/2020] [Accepted: 02/01/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the clinical outcomes of patients who underwent biologically enhanced patch augmentation repair for the treatment of revision massive rotator cuff tears. METHODS Twenty-two patients who underwent arthroscopic and mini-open rotator cuff repair using a patch augmented with platelet-rich plasma and concentrated bone marrow aspirate (cBMA) for revision massive (≥2 tendons) rotator cuff tears from 2009 to 2014, with a minimum 1-year follow-up, were included in the study. In this procedure the medial side of the graft is secured to the rotator cuff tendon remaining medially. American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test, and postoperative Single Assessment Numerical Evaluation scores were evaluated. To determine the clinical relevance of ASES scores, the minimal clinically important difference, substantial clinical benefit (SCB), and the patient-acceptable symptomatic state (PASS) thresholds were used. Clinical success or failure was defined based on whether the patient reached the SCB threshold. In the laboratory, cellular counting along with the concentration of connective tissue progenitor cells were performed on patch samples from the day of surgery. Scaffolds were processed histologically at days 0, 7,14, and 21 of culture. RESULTS Patients had significant improvement in the Simple Shoulder Test (2.6 ± 3.0pre vs 5.2 ± 4.2post, P = .01), whereas improvement in pain scores was found to be nonsignificant (5.6 ± 2.5pre vs 4.2 ± 3.4post,P = .11) at final follow-up. Mean ASES improved by Δ14.6 ± 33.4 points; however, this did not reach statistical significance (40.2 ± 21.6pre vs 53.9 ± 31.4post,P = .10). With regards to ASES score, 45% of patients achieved the minimal clinically important difference, 41% the SCB, and 32% reached or exceeded the PASS criteria. At 21 days, there was a significantly greater cell count in scaffolds from patients who had clinical success than those who were failures (P = .02). CONCLUSIONS Only 41% of patients undergoing biologically enhanced patch augmentation repair reached substantial clinical benefit, whereas 32% reached or exceeded the PASS criteria. LEVEL OF EVIDENCE Case Series: Level IV.
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Affiliation(s)
- Lukas N Muench
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A.; Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany.
| | - Cameron Kia
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| | - Aulon Jerliu
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| | - Ariel A Williams
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Daniel P Berthold
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A.; Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany
| | - Mark P Cote
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| | - Mary Beth McCarthy
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| | - Robert A Arciero
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A
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Barth J, Olmos MI, Swan J, Barthelemy R, Delsol P, Boutsiadis A. Superior Capsular Reconstruction With the Long Head of the Biceps Autograft Prevents Infraspinatus Retear in Massive Posterosuperior Retracted Rotator Cuff Tears. Am J Sports Med 2020; 48:1430-1438. [PMID: 32267730 DOI: 10.1177/0363546520912220] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Materials and patches with increased biomechanical and biological properties and superior capsular reconstruction may change the natural history of massive rotator cuff tears (RCTs). PURPOSE To compare structural and clinical outcomes among 3 surgical techniques for the treatment of massive posterosuperior RCTs: double-row (DR) technique, transosseous-equivalent (TOE) technique with absorbable patch reinforcement, and superior capsular reconstruction (SCR) with the long head of the biceps tendon (LHBT) autograft. STUDY DESIGN Cohort study; Level of evidence 3. METHODS We retrospectively analyzed the 3 techniques in patients who underwent repair of massive posterosuperior RCTs between January 2007 and March 2017. All patients completed preoperative and 24-month postoperative evaluations: range of motion, subjective shoulder value, Simple Shoulder Test, American Shoulder and Elbow Surgeons (ASES) score, visual analog scale for pain, and Constant score. Tendon integrity was assessed with ultrasound 1 year postoperatively. RESULTS A total of 82 patients completed the final evaluation (28 patients, DR; 30 patients, TOE + patch; 24 patients, SCR with LHBT). Groups were statistically comparable preoperatively, except for active forward elevation and tendon retraction, which were significantly worse in the SCR group (P = .008 and P = .001, respectively). After 24 months, the mean ± SD scores for the respective groups were as follows: 76 ± 10, 72 ± 15, and 77 ± 10 for the Constant score (P = .35); 84 ± 10, 84 ± 15, and 80 ± 15 for the ASES (P = .61); 9 ± 2, 9 ± 3, and 8 ± 3 for the Simple Shoulder Test (P = .23); 82 ± 15, 80 ± 18, and 75 ± 18 for the subjective shoulder value (P = .29); and 1.4 ± 1.7, 1.8 ± 2, and 1.4 ± 1.4 for the visual analog scale (P = .65). The strength of the operated shoulder was 4 ± 3 kg, 4.7 ± 3 kg, and 6.4 ± 1.6 kg for the DR, TOE + patch, and SCR groups, respectively (P = .006). At 12 months postoperatively, 60.7% (17 of 28) of the DR group, 56.7% (17 of 30) of the TOE + patch group, and 91.7% (22 of 24) of the SCR group remained healed on ultrasound. The infraspinatus tendon remained healed in 75% of the DR group, 76.5% of the TOE + patch group, and 100% of the SCR with the LHBT group (P = .006). CONCLUSION In cases of massive posterosuperior RCTs, SCR with the LHBT should be considered a reliable, cost-effective treatment option that protects infraspinatus integrity.
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Affiliation(s)
- Johannes Barth
- Department of Orthopedic Surgery, Centre Osteoarticulaire des Cèdres, Echirolles, Grenoble, France
| | - Manuel Ignacio Olmos
- Department of Orthopedic Surgery, Centre Osteoarticulaire des Cèdres, Echirolles, Grenoble, France
| | - John Swan
- Department of Orthopedic Surgery, Centre Osteoarticulaire des Cèdres, Echirolles, Grenoble, France
| | | | - Philippe Delsol
- Department of Orthopedic Surgery, Centre Osteoarticulaire des Cèdres, Echirolles, Grenoble, France
| | - Achilleas Boutsiadis
- Department of Orthopedic Surgery, 401 Military Hospital of Athens, Athens, Greece
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109
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Kim DM, Shin MJ, Kim H, Park D, Jeon IH, Kholinne E, Koh KH. Comparison Between Autografts and Allografts in Superior Capsular Reconstruction: A Systematic Review of Outcomes. Orthop J Sports Med 2020; 8:2325967120904937. [PMID: 32181265 PMCID: PMC7059236 DOI: 10.1177/2325967120904937] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 11/19/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The treatment of irreparable rotator cuff tears (IRCTs) is a significant challenge, and various treatment options have emerged. Superior capsular reconstruction (SCR) is a promising procedure for patients with IRCTs. PURPOSE To investigate the clinical outcomes of SCR and compare allografts with autografts. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A search for relevant articles was carried out using the PubMed, Cochrane Library, Embase, Scopus, and Google Scholar databases. We used medical subject heading (MeSH) terms and natural keywords (superior AND (capsule OR capsular) AND reconstruction). Also, we filtered for high-quality articles using the Methodological Index for Non-Randomized Studies (MINORS). We summarized the characteristic data and commonly used outcome measures of each included study and performed a descriptive analysis using an evidence-based tendency concept as proposed by Huisstede et al (2013). RESULTS A total of 10 articles (374 shoulders) with a mean follow-up of 27.2 months were selected and analyzed. There were 4 articles on SCR with an autograft, 4 on SCR with an allograft, and 2 on SCR with both an autograft and allograft. For autografts and allografts, respectively, the mean gain in forward elevation (FE) was 48.7° and 33.3°, the visual analog scale for pain score improved by 3.5 and 3.3, the American Shoulder and Elbow Surgeons (ASES) score increased by 47.3 and 31.9, and the acromiohumeral distance increased by 1.2 and 1.8 mm. In addition, the number of graft tears was 16 (10.0%) and 17 (12.9%), the number of other complications was 12 (7.5%) and 6 (3.9%), and the number of reoperations was 5 (3.1%) and 14 (8.2%) for autografts and allografts, respectively. CONCLUSION Both autografts and allografts improved clinical outcomes. Although the graft tear rate appeared similar between the autograft and allograft groups, the autograft group had no cases of conversion to reverse total shoulder arthroplasty. In addition, we found 3 evidence-based tendencies: (1) a tendency for both autografts and allografts to have significantly improved FE and clinical scores, (2) a tendency that autografts improved internal rotation and allografts improved abduction, and (3) a weak tendency that autografts improved abduction and allografts improved internal and external rotation. Although it was not possible to compare the groups statistically, the differences in ASES scores might be clinically important and will need to be explored in future comparative studies.
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Affiliation(s)
- Dong Min Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of
Ulsan College of Medicine, Seoul, Republic of Korea
| | - Myung Jin Shin
- Department of Orthopedic Surgery, Asan Medical Center, University of
Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyojune Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of
Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dongjun Park
- Department of Orthopedic Surgery, Asan Medical Center, University of
Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, University of
Ulsan College of Medicine, Seoul, Republic of Korea
| | - Erica Kholinne
- Department of Orthopedic Surgery, Asan Medical Center, University of
Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Orthopedic Surgery, St Carolus Hospital, Jakarta,
Indonesia
| | - Kyoung Hwan Koh
- Department of Orthopedic Surgery, Asan Medical Center, University of
Ulsan College of Medicine, Seoul, Republic of Korea
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Makovicka JL, Chung AS, Patel KA, Deckey DG, Hassebrock JD, Tokish JM. Superior capsule reconstruction for irreparable rotator cuff tears: a systematic review of biomechanical and clinical outcomes by graft type. J Shoulder Elbow Surg 2020; 29:392-401. [PMID: 31522915 DOI: 10.1016/j.jse.2019.07.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/25/2019] [Accepted: 07/01/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Superior capsular reconstruction (SCR) has recently been proposed as a surgical solution to the irreparable rotator cuff tear and has gained popularity because of promising early results. Therefore, the purpose of this study is to review the biomechanical and clinical outcomes in shoulders with this condition treated with SCR. METHODS A systematic review was conducted following PRISMA guidelines using PubMed, EMBASE, and Cochrane databases. Studies were included if they reported biomechanical, radiographic, or clinical outcomes data after undergoing SCR in shoulders with irreparable rotator cuff tears. Studies were broken down into 3 categories: cadaveric biomechanical studies, autograft clinical outcome studies, and allograft clinical outcome studies. Biomechanical, radiographic, patient-reported, and functional outcomes data were recorded for each study. RESULTS Eight cadaveric biomechanical studies, 5 autograft clinical studies, and 4 allograft clinical studies met inclusion criteria. In biomechanical studies, subacromial contact pressure and superior humeral translation were decreased in most tested scenarios. An increase in American Shoulder and Elbow Surgeons (ASES) scores, forward elevation and external rotation values, and acromiohumeral distance (AHD) were found in all autograft clinical studies reporting. Allograft clinical studies reported increases in ASES scores, forward elevation values, and AHD but decreases in visual analog scale scores in all studies reporting. CONCLUSIONS SCR is emerging as a viable surgical option to address the irreparable rotator cuff tear. Biomechanical studies suggest that the humeral head-stabilizing effect of SCR appears to translate into improved clinical outcomes. Future research should focus on further defining the indications, limitations, and optimal technique.
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Affiliation(s)
| | - Andrew S Chung
- Department of Orthopedics, Mayo Clinic, Phoenix, AZ, USA
| | - Karan A Patel
- Department of Orthopedics, Mayo Clinic, Phoenix, AZ, USA
| | - David G Deckey
- Department of Orthopedics, Mayo Clinic, Phoenix, AZ, USA
| | | | - John M Tokish
- Department of Orthopedics, Mayo Clinic, Phoenix, AZ, USA.
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111
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de Campos Azevedo CI, Andrade R, Leiria Pires Gago Ângelo AC, Espregueira-Mendes J, Ferreira N, Sevivas N. Fascia Lata Autograft Versus Human Dermal Allograft in Arthroscopic Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears: A Systematic Review of Clinical Outcomes. Arthroscopy 2020; 36:579-591.e2. [PMID: 31839214 DOI: 10.1016/j.arthro.2019.08.033] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 08/07/2019] [Accepted: 08/14/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the clinical outcomes of arthroscopic superior capsular reconstruction (ASCR) using either fascia lata autograft or human dermal allograft for irreparable rotator cuff tears (IRCTs). METHODS A systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines by searching the MEDLINE, Embase, and Cochrane Library databases through January 31, 2019. The inclusion criteria were as follows: 5 or more consecutive patients who underwent ASCR for IRCTs; clinical outcome measures reported at a minimum follow-up of 12 months; and magnetic resonance imaging assessment at a minimum follow-up of 6 months. The methodologic quality was evaluated using the Methodological Index for Non-randomized Studies (MINORS). A narrative synthesis of data was performed. Mean outcome improvements were compared with minimal clinically important differences. RESULTS We identified 7 eligible studies that included 344 shoulders in 338 patients who underwent ASCR for IRCTs (all Level IV studies). The mean MINORS score was 12.3 ± 1.60. Of the 7 studies, 5 had a high risk of bias (MINORS score ≤12): 2 studies using only fascia lata autograft and 3 studies using only human dermal allograft. The mean age of patients ranged from 59.4 to 66.9 years. The mean follow-up time ranged from 12 to 48 months. All studies reported statistically significant and clinically important mean improvements in active elevation (range of means, 28°-56°), the Constant score (range of means, 12-47.1 points), or the American Shoulder and Elbow Surgeons score (range of means, 29.3-56 points). In total, 218 shoulders underwent postoperative magnetic resonance imaging. The graft tear rate reported in studies using fascia lata autograft (181 shoulders) ranged from 5% to 32%, whereas the values reported in studies using human dermal allograft (37 shoulders) ranged from 20% to 75%. CONCLUSIONS ASCR using either fascia lata autograft or human dermal allograft leads to significant and clinically important improvements in clinical outcomes in IRCT patients at 12 months or later. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Affiliation(s)
- Clara Isabel de Campos Azevedo
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães; Centro Hospitalar de Lisboa Ocidental, Lisbon; Hospital dos SAMS de Lisboa, Lisbon; Clínica GIGA Saúde, Lisbon.
| | - Renato Andrade
- Clínica do Dragão, Espregueira-Mendes Sports Centre-FIFA Medical Centre of Excellence, Porto; Dom Henrique Research Centre, Porto; Faculty of Sports, University of Porto, Porto
| | | | - João Espregueira-Mendes
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães; Clínica do Dragão, Espregueira-Mendes Sports Centre-FIFA Medical Centre of Excellence, Porto
| | - Nuno Ferreira
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães; Grupo Trofa Saúde, Portugal; Hospital de Santa Maria Maior, Barcelos, Portugal
| | - Nuno Sevivas
- Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães; Clínica do Dragão, Espregueira-Mendes Sports Centre-FIFA Medical Centre of Excellence, Porto; Grupo Trofa Saúde, Portugal
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112
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Scheiderer B, Kia C, Obopilwe E, Johnson JD, Cote MP, Imhoff FB, Dyrna F, Beitzel K, Imhoff AB, Adams CR, Mazzocca AD, Morikawa D. Biomechanical Effect of Superior Capsule Reconstruction Using a 3-mm and 6-mm Thick Acellular Dermal Allograft in a Dynamic Shoulder Model. Arthroscopy 2020; 36:355-364. [PMID: 31791890 DOI: 10.1016/j.arthro.2019.08.026] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 08/01/2019] [Accepted: 08/09/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To biomechanically compare the effect of superior capsule reconstruction (SCR) using a 3- and 6-mm thick acellular dermal allograft for the treatment of irreparable rotator cuff tears. METHODS Eight fresh-frozen cadaveric shoulders were tested using a dynamic shoulder model. Maximum abduction angle (MAA), glenohumeral superior translation (ghST), subacromial peak contact pressure (sPCP), and cumulative deltoid force (cDF) were compared among 4 conditions: (1) intact shoulder, (2) simulated irreparable rotator cuff tear (RCT), (3) SCR using a 3-mm-thick acellular dermal allograft, (4) SCR using a 6-mm-thick acellular dermal allograft. RESULTS Compared with the intact state, simulated irreparable RCTs significantly decreased MAA (P < .001), while significantly increasing ghST (P = .001), sPCP (P < .001), and cDF (P < .001). SCR with a 3-mm-thick graft significantly increased MAA (P = .01) and decreased ghST (P = .01) compared with the RCT state, however, showed similar sPCP and cDF. Compared with the torn state, SCR with a 6-mm-thick graft significantly increased MAA (P < .001) and significantly decreased ghST (P < .001), sPCP (P < .001), and cDF (P = .001). Using a 6-mm-thick graft demonstrated similar MAA, ghST, sPCP, and cDF compared with the intact state. When comparing the 3-mm to the 6-mm thick graft, significant differences were found in ghST (P = .03), sPCP (P < .001), and cDF (P = .02). CONCLUSIONS SCR with a 6-mm-thick acellular dermal allograft better restored normal glenohumeral joint position and forces compared with a 3-mm-thick graft for the treatment of irreparable RCTs. CLINICAL RELEVANCE Graft thickness may affect the clinical success following SCR with commercially available dermal allografts. Using a thicker (>3 mm) graft was able to biomechanically better restore native glenohumeral joint properties.
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Affiliation(s)
- Bastian Scheiderer
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.; Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.
| | - Cameron Kia
- 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
| | - Jeremiah D Johnson
- 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
| | - Florian B Imhoff
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.; Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Felix Dyrna
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Knut Beitzel
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Christopher R Adams
- Department of Orthopaedic Surgery, Naples Community Hospital, Naples, Florida, U.S.A
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Daichi Morikawa
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A.; Department of Orthopaedic Surgery, Juntendo University, Tokyo, Japan
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113
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Superior Capsular Reconstruction for the Operatively Irreparable Rotator Cuff Tear: Clinical Outcomes Are Maintained 2 Years After Surgery. Arthroscopy 2020; 36:373-380. [PMID: 31864817 DOI: 10.1016/j.arthro.2019.08.035] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the results of arthroscopic superior capsular reconstruction (SCR) after 2-year minimum follow-up and to compare the results with those seen in a previously studied group of patients at 1 year postoperatively. METHODS The retrospective study period was October 2014 through September 2016. Inclusion criteria were arthroscopic dermal allograft SCR performed for operatively irreparable posterosuperior rotator cuff tear with intact or repairable subscapularis tendon, failure of nonoperative treatment, and clinical follow-up at 1 and minimum 2 years postoperatively. Patients lost to follow-up or undergoing revision of the SCR were excluded from the analysis. The primary outcome measure was American Shoulder and Elbow Surgeons (ASES) score (mean, [95% confidence interval], P value). Secondary outcomes included visual analog pain rating (0-10), subjective shoulder value, and active forward elevation and external rotation (degrees). Radiographic analysis included acromiohumeral interval (millimeters) and graft integrity 1-year postoperation. Complications and reoperations were reviewed from the medical record. RESULTS Forty-one patients met inclusion criteria at mean 34 months postoperatively, and 8 were excluded. ASES score improved from 52 (46-57) preoperative to 90 (87-92; P < .0001) and 89 (86-92; P < .0001) at 1-year postoperation and at final follow-up without diminishing in the interim (P = .9). All secondary clinical outcomes improved from preoperative to final follow-up. Subjective shoulder value diminished 5% between 1 year and final follow-up (P = .03), whereas active external rotation improved 11° during this time (P = .02). In total, 85% of grafts were fully healed, with acromiohumeral interval improved from 7 (6-8) mm to 8 mm (7-9; P = .04). There were 2 (5%) revisions and 6 (14%) failures to reach the minimally clinically important improvement in ASES score: a 19% rate of unsatisfactory outcomes. There was an additional 1 reoperation (2%) and 1 (2%) medical complication. CONCLUSIONS Arthroscopic joint preservation surgery for massive, operatively irreparable posterosuperior rotator cuff tears with dermal allograft SCR and associated procedures results in improved clinical outcomes that are durable between 1 and minimum 2-year follow-up. LEVEL OF EVIDENCE IV retrospective case series.
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114
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Jordan RW, Sharma N, Daggett M, Saithna A. The role of Superior Capsule Reconstruction in the irreparable rotator cuff tear - A systematic review. Orthop Traumatol Surg Res 2019; 105:1535-1542. [PMID: 31727588 DOI: 10.1016/j.otsr.2019.07.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 06/30/2019] [Accepted: 07/19/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Irreparable rotator cuff tears in active patients provide a significant challenge and a consensus on the gold standard treatment is currently lacking. Superior capsule reconstruction (SCR) has recently been advocated and functions by providing a passive biological constraint to superior humeral head migration. The aim of this study is to systematically review the literature to evaluate the role of SCR in terms of functional outcome scores and failure rates. PATIENTS AND METHODS A review of the online databases Medline and EMBASE was conducted in accordance with the PRISMA guidelines on the 28th January 2019. Clinical studies reporting SCR using any type of graft or surgical technique were included if reporting either functional outcome scores or rate of secondary surgery. The studies were appraised using the Methodological index for non-randomised studies tool. RESULTS The search strategy identified nine studies eligible for inclusion; five reported on fascia lata autografts and four studies reported on dermal allografts. All nine studies reported significant improvement in functional scores after SCR. Rates of secondary surgery were only provided in the dermal allograft studies at short-term follow-up (mean 10.9 to 32.4months) and ranged from 0 to 18.6%. Radiological assessment revealed graft failure in 5.5 to 55% of dermal allografts and 4.2 to 36.1% of fascia lata autografts. CONCLUSION This review demonstrates that SCR is a useful treatment modality for patients with irreparable rotator cuff tears. SCR was associated with significantly improved functional outcome scores in all studies. All studies reported a preserved or increased mean AHD. The radiological graft failure rate ranged from 4.2 to 55% and the short duration of follow-up in most studies means that this remains an important concern that requires longer-term evaluation. LEVEL OF EVIDENCE IV, systematic review.
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Affiliation(s)
| | | | - Matt Daggett
- Kansas City University of Medicine and Biosciences, Missouri, USA; Sano Orthopedic Clinic, Overland Park, Kansas, USA
| | - Adnan Saithna
- Kansas City University of Medicine and Biosciences, Missouri, USA; Sano Orthopedic Clinic, Overland Park, Kansas, USA; School of Science and Technology, Nottingham Trent University, Nottingham, UK
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115
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Hirahara AM, Andersen WJ, Panero AJ. Ultrasound Assessment of the Superior Capsular Reconstruction With Dermal Allograft: An Evaluation of Graft Thickness and Vascularity. Arthroscopy 2019; 35:3194-3202. [PMID: 31785745 DOI: 10.1016/j.arthro.2019.06.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/18/2019] [Accepted: 06/22/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess postoperative changes in the thickness of the dermal allograft of the superior capsular reconstruction (SCR) and to evaluate the graft for the presence of intrasubstance pulsatile vessels. METHODS A retrospective chart review was conducted to identify SCR patients who had ultrasound evaluations between May 2014 and February 2019. Data were collected and stratified based on time from surgery into 2 groups: 0 to 12 months and past the 12-month follow-up. The primary outcome measure was graft thickness at the articular margin-greater tuberosity interface (tuberosity measurement). Secondary measures included midsubstance graft thicknesses 0.5, 1.0, and 1.5 cm medial to the tuberosity measurement; status of lateral graft fixation; presence of pulsatile vessels; and American Shoulder and Elbow Society and visual analog scale scores. RESULTS Eighteen patients were included for analysis. The tuberosity measurement at final follow-up (mean 25 months, range 12-40 months) was (mean ± standard error [95% confidence interval (CI)]) 4.4 ± 0.2 mm (95% CI 4.0-4.8). This differed significantly from the midsubstance measurements: 0.5 cm: 3.6 ± 0.2 mm (95% CI 3.3-4.0, P = .008); 1.0 cm: 3.1 ± 0.2 mm (95% CI 2.7-3.4, P < .001); and 1.5 cm: 2.9 ± 0.2 mm (95% CI 2.6-3.2, P < .001). Ten constructs (56%) showed signs of pulsatile vessels in the first 12 months and all constructs were intact. ASES scores improved from 49.3 ± 4.0 (95% CI 41.6-57.1) preoperatively to 85.1 ± 2.9 (95% CI 79.4-90.8) (P < .001), and VAS scores decreased from 5.3 ± 0.6 (95% CI 4.2-6.5) preoperatively to 0.9 ± 0.3 (95% CI 0.3-1.5) at final follow-up (P < .001). CONCLUSIONS The SCR dermal allograft significantly thickens at its lateral aspect, presents with evidence of vasculature in most patients in the first year of implantation, and is not resorbed by the body. LEVEL OF EVIDENCE Level IV - therapeutic case series.
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116
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Mihata T, Lee TQ, Hasegawa A, Fukunishi K, Kawakami T, Fujisawa Y, Ohue M, Neo M. Five-Year Follow-up of Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears. J Bone Joint Surg Am 2019; 101:1921-1930. [PMID: 31567675 DOI: 10.2106/jbjs.19.00135] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arthroscopic superior capsule reconstruction was developed to restore superior stability, muscle balance, and function in the shoulder joint after an irreparable rotator cuff tear. Our objective was to assess the functional and radiographic results of superior capsule reconstruction after 5 years of follow-up. METHODS Thirty patients who underwent arthroscopic superior capsule reconstruction using fascia lata autograft were enrolled in this study. The inclusion criteria were an irreparable rotator cuff tear confirmed by shoulder arthroscopy and 5 years of postoperative follow-up. Shoulder range of motion, American Shoulder and Elbow Surgeons (ASES) and Japanese Orthopaedic Association (JOA) scores, rates of return to sport and physical work, acromiohumeral distance, Goutallier grade of all rotator cuff muscles, graft healing and thickness, and postoperative cuff tear arthropathy were investigated. RESULTS Compared with preoperative values, ASES and JOA scores, active elevation, and acromiohumeral distance increased postoperatively at both 1 year (p < 0.001) and 5 years (p < 0.001); the 1-year values increased by 54.0 points for the ASES score, 34.4 points for the JOA score, 53° for active elevation, and 5.7 mm for acromiohumeral distance, and the 5-year values increased by 63.3 points for the ASES score, 39.9 points for the JOA score, 66° for active elevation, and 4.7 mm for acromiohumeral distance. The ASES score was greater at 5 years postoperatively than it was at 1 year postoperatively (mean difference, 9.3 points; p = 0.03). At 5 years postoperatively, 11 of 12 patients returned to physical work, a rate of 92% (95% confidence interval [CI], 73% to 100%), and 8 of 8 patients returned to sports, a rate of 100% (95% CI, 79% to 100%). None of the 27 patients who had graft healing showed progression of cuff tear arthropathy, but all 3 patients with a graft tear (10% [95% CI, 0% to 22%]) had severe cuff tear arthropathy at 5 years postoperatively. In the 27 patients whose grafts remained intact, the graft thicknesses at 3 months, 1 year, and 5 years postoperatively did not differ (p = 0.67). CONCLUSIONS In this 5-year follow-up study, healed arthroscopic superior capsule reconstruction restored shoulder function and resulted in high rates of return to recreational sport and work. In patients with postoperative graft failure, severe cuff tear arthropathy was present at 5 years. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan.,Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California.,First Towakai Hospital, Takatsuki, Japan.,Katsuragi Hospital, Kishiwada, Japan
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California
| | - Akihiko Hasegawa
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Kunimoto Fukunishi
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | | | - Yukitaka Fujisawa
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | | | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
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Hartzler RU, Softic D, Qin X, Dorfman A, Adams CR, Burkhart SS. The Histology of a Healed Superior Capsular Reconstruction Dermal Allograft: A Case Report. Arthroscopy 2019; 35:2950-2958. [PMID: 31604517 DOI: 10.1016/j.arthro.2019.06.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/09/2019] [Accepted: 06/16/2019] [Indexed: 02/02/2023]
Abstract
Acellular human dermal allograft commonly is used in the surgical treatment of complex rotator cuff tears, but little information is known about the biological fate of these grafts in human subjects. In this case report, the authors describe a patient who presented with a radiographically healed acellular human dermal allograft superior capsular reconstruction but had humeral head avascular necrosis. The healed superior capsular reconstruction, including graft-bone interfaces, was explanted after 7 months and sent for histologic analysis. A successful biological reconstruction of the superior capsule was found. The graft demonstrated gross and microscopic incorporation with the host, including a tendon-like structure, aligned collagen fibers, fibroblast-like cells, and no clear graft-host distinction. Cellular infiltration ranged from 5% to 14% (central graft) to 65% to 92% (sutured attachment points). Neovascularization and active graft remodeling were confirmed histologically. LEVEL OF EVIDENCE: V, case report.
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Affiliation(s)
- Robert U Hartzler
- TSAOG Orthopaedics and Baylor College of Medicine, San Antonio, Texas, U.S.A..
| | | | - Xiaofei Qin
- LifeNet Health, Virginia Beach, Virginia, U.S.A
| | - Amy Dorfman
- LifeNet Health, Virginia Beach, Virginia, U.S.A
| | | | - Stephen S Burkhart
- TSAOG Orthopaedics and Baylor College of Medicine, San Antonio, Texas, U.S.A
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Ding S, Ge Y, Zheng M, Ding W, Jin W, Li J, Chen S. Arthroscopic Superior Capsular Reconstruction Using "Sandwich" Patch Technique for Irreparable Rotator Cuff Tears. Arthrosc Tech 2019; 8:e953-e959. [PMID: 31687326 PMCID: PMC6819740 DOI: 10.1016/j.eats.2019.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 05/03/2019] [Indexed: 02/03/2023] Open
Abstract
The technique of superior capsular reconstruction (SCR) using fascia lata autograft, described by Mihata et al. in 2012, has been an acceptable and effective method for treating irreparable massive rotator cuff tears, especially in cases with severe fatty infiltration and tendon retraction. After the SCR procedure of Mihata et al., it was found that some graft failure occurred with thinning and elongation during the follow-up time, which was called graft "creep." To avoid graft creep and reduce graft failure rates after SCR, we created an arthroscopic SCR technique with a "sandwich" patch augmented with polyethylene terephthalate scaffold interspaced between 2 folded layers of fascia lata autograft.
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Affiliation(s)
- Shaohua Ding
- Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Yunshen Ge
- Huashan Hospital, Fudan University, Shanghai, China
| | - Minzhe Zheng
- Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Wei Ding
- Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Wenhe Jin
- Huashan Hospital, Fudan University, Shanghai, China
| | - Jin Li
- Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Shiyi Chen
- Huashan Hospital, Fudan University, Shanghai, China,Address correspondence to Shiyi Chen, M.D., Ph.D., Huashan Hospital, Fudan University, Shanghai, China.
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119
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Editorial Commentary: Superior Capsule Reconstruction: Grafts for Superior Capsular Reconstruction Must Be Thick and Stiff. Arthroscopy 2019; 35:2535-2536. [PMID: 31395197 DOI: 10.1016/j.arthro.2019.04.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 02/02/2023]
Abstract
To achieve a good functional outcome, including minimal graft tear, after superior capsule reconstruction, surgeons should carefully compare the biomechanical properties of all graft materials under consideration. In particular, graft stiffness affects postoperative stability in the glenohumeral joint, acromiohumeral distance, and graft healing. In my experience, a sufficiently stiff fascia lata graft is 6- to 8-mm thick and includes suture reinforcement and/or an augmentation patch. I believe that augmenting acellular dermal allografts in a similar way will decrease the incidence of graft elongation, persistent superior migration of the humoral head, and other complications after superior capsule reconstruction.
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120
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Hu Q, Ding Z, Zhang H, He Y. Author Reply to "Regarding 'The Superior Glenohumeral Joint Capsule Alone Does Not Prevent Superior Translation of the Humeral Head: An In Vitro Biomechanical Study'". Arthroscopy 2019; 35:1301-1303.e1. [PMID: 31054708 DOI: 10.1016/j.arthro.2019.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/04/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Qingxiang Hu
- Department of Sports Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zhenyu Ding
- Department of Sports Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Haoyu Zhang
- Department of Sports Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yaohua He
- Department of Sports Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
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121
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"Regarding 'The Superior Glenohumeral Joint Capsule Alone Does Not Prevent Superior Translation of the Humeral Head: An In Vitro Biomechanical Study'". Arthroscopy 2019; 35:1300-1301. [PMID: 31054707 DOI: 10.1016/j.arthro.2019.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 03/04/2019] [Indexed: 02/02/2023]
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Matsen FA, Whitson A, Jackins SE, Hsu JE. Significant improvement in patient self-assessed comfort and function at six weeks after the smooth and move procedure for shoulders with irreparable rotator cuff tears and retained active elevation. INTERNATIONAL ORTHOPAEDICS 2019; 43:1659-1667. [PMID: 30903255 DOI: 10.1007/s00264-019-04310-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/12/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND It has been documented that the smooth and move procedure-smoothing the proximal humeral surface while maintaining the coracoacromial arch-can provide clinically significant long-term improvement in function for patients having irreparable rotator cuff tears with retained active elevation. This study sought to demonstrate that clinically significant gains in comfort, function, and active motion can be realized as early as 6 weeks after this procedure. METHODS We conducted a prospective cohort study of the 6-week clinical outcomes for 48 patients enrolled prior to a smooth and move procedure for irreparable rotator cuff tears. Prior rotator cuff repair had been attempted in 28 (70%). RESULTS In 40 patients with preoperative and 6-week postoperative measurements, the Simple Shoulder Test scores improved from an average of 3.4 ± 2.8 preoperatively to 5.7 ± 3.5 at 6 weeks (p < 0.001), an improvement that exceeded the published values for the minimal clinically important difference (MCID). The clinical outcomes were not worse for the 18 shoulders with irreparable tears of both the supraspinatus and infraspinatus. In 30 patients with preoperative and 6-week postoperative objective measurements of active motion, the average abduction improved from 93(± 43) to 123(± 47)° (p = 0.005) and the average flexion improved from 102(± 46) to 126(± 44)° (p = 0.023). CONCLUSIONS In addition to its previously documented long-term effectiveness for shoulders with irreparable rotator cuff tears and retained active elevation, this study demonstrates that the smooth and move procedure provides clinically significant improvement as early as 6 weeks after surgery.
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Affiliation(s)
- Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA.
| | - Anastasia Whitson
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA
| | - Sarah E Jackins
- Department of Rehabilitation, University of Washington, 1959 NE Pacific St., Box 354745, Seattle, WA, 98195, USA
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA
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Mihata T. Editorial Commentary: Superior Capsular Reconstruction-Improved Superior Stability and Functional Deltoid Reverse Pseudoparalysis in Patients With Irreparable Rotator Cuff Tears. Arthroscopy 2019; 35:29-31. [PMID: 30611360 DOI: 10.1016/j.arthro.2018.08.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 08/28/2018] [Indexed: 02/02/2023]
Abstract
Since I reported clinical and biomechanical improvement after superior capsular reconstruction (SCR) for irreparable rotator cuff tears in 2012 and 2013, many shoulder surgeons around the world have started to perform SCR. However, most of these surgeons are still on the learning curve, and their clinical results are not consistent because clinical outcomes after SCR are correlated with graft healing, which is affected by the surgeon's skill. In cases in which the graft does heal, active shoulder elevation increases after SCR even in patients with pseudoparalysis before surgery. These patients can elevate the arm using the deltoid muscle when superior shoulder stability is restored after SCR. When patients whose grafts have healed cannot elevate the arm even after SCR, they may have concomitant cervical radiculopathy, which causes real paralysis.
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