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Jenkins TL, Sarmiento Huertas PA, Umemori K, Guilak F, Little D. Tendon-derived matrix crosslinking techniques for electrospun multi-layered scaffolds. J Biomed Mater Res A 2023; 111:1875-1887. [PMID: 37489733 PMCID: PMC10592356 DOI: 10.1002/jbm.a.37588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/19/2023] [Accepted: 06/23/2023] [Indexed: 07/26/2023]
Abstract
Tendon tears are common and healing often occurs incompletely and by fibrosis. Tissue engineering seeks to improve repair, and one approach under investigation uses cell-seeded scaffolds containing biomimetic factors. Retention of biomimetic factors on the scaffolds is likely critical to maximize their benefit, while minimizing the risk of adverse effects, and without losing the beneficial effects of the biomimetic factors. The aim of the current study was to evaluate cross-linking methods to enhance the retention of tendon-derived matrix (TDM) on electrospun poly(ε-caprolactone) (PCL) scaffolds. We tested the effects of ultraviolet (UV) or carbodiimide (EDC:NHS:COOH) crosslinking methods to better retain TDM to the scaffolds and stimulate tendon-like matrix synthesis. Initially, we tested various crosslinking configurations of carbodiimide (2.5:1:1, 5:2:1, and 10:4:1 EDC:NHS:COOH ratios) and UV (30 s 1 J/cm2 , 60 s 1 J/cm2 , and 60 s 4 J/cm2 ) on PCL films compared to un-crosslinked TDM. We found that no crosslinking tested retained more TDM than coating alone (Kruskal-Wallis: p > .05), but that human adipose stem cells (hASCs) spread most on the 60 s 1 J/cm2 UV- and 2.5:1:1 EDC-crosslinked films (Kruskal-Wallis: p < .05). Next, we compared the effects of 60 s 1 J/cm2 UV- and 2.5:1:1 EDC-crosslinked to TDM-coated and untreated PCL scaffolds on hASC-induced tendon-like differentiation. UV-crosslinked scaffolds had greater modulus and stiffness than PCL or TDM scaffolds, and hASCs spread more on UV-crosslinked scaffolds (ANOVA: p < .05). Fourier transform infrared spectra revealed that UV- or EDC-crosslinking TDM did not affect the peaks at wavenumbers characteristic of tendon. Crosslinking TDM to electrospun scaffolds improves tendon-like matrix synthesis, providing a viable strategy for improving retention of TDM on electrospun PCL scaffolds.
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Affiliation(s)
- Thomas L. Jenkins
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
| | | | - Kentaro Umemori
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
| | - Farshid Guilak
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO
- Shriners Hospitals for Children – St. Louis, St. Louis, MO
| | - Dianne Little
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN
- Department of Basic Medical Sciences, Purdue University, West Lafayette, IN
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López-Chicón P, Pérez ML, Castells-Sala C, Piteira AR, Fariñas O, Tabera J, Vilarrodona A. Quality by Design: Development of Safe and Efficacious Full-Thickness Acellular Dermal Matrix Based on EuroGTPII Methodologies. Ther Clin Risk Manag 2023; 19:567-578. [PMID: 37425344 PMCID: PMC10325720 DOI: 10.2147/tcrm.s410574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Background The activities of tissue establishments are constantly and rapidly evolving. The development of a new type of allograft, full-thickness acellular dermal matrix, with high mechanical properties to be used in tendon repair surgeries and abdominal wall reconstruction, has determined the need for quality by design process in order to assess evidence of quality, safety and efficacy. The EuroGTPII methodologies were specifically tailored to perform the risk assessment, identify and suggest tests in order to mitigate the potential risk consequences of a novel tissue preparation implementation. Methods The new allograft and associated preparation processes were assessed using the EuroGTP methodologies and characterized to properly evaluate the novelty (Step 1), identify and quantify the potential risks and risk consequences (Step 2), and define the extent of pre-clinical and clinical assessments required to mitigate the risks identified in the assessment (Step 3). Results Four risk consequences associated with the preparation process were identified: (i) implant failure related with tissue procurement and the reagents used during the decellularization protocol; (ii) unwanted immunogenicity related with the processing; (iii) disease transmission linked with the processing, reagents used, reduction in the reliability of microbiology testing and the storage conditions; and (iv) toxicity related to the reagents used and handling of the tissue during clinical application. The outcome of the risk assessment was a low level of risk. Nevertheless, it determined the need for a series of risk mitigation strategies proposed to reduce each individual risk and to provide additional evidence of the safety and efficacy of full-thickness acellular dermal matrix grafts. Conclusion EuroGTPII methodologies allow us to identify the risks and ensure the correct definition of pre-clinical assessments required to address and mitigate the potential risk consequences, before proceeding with clinical use of the new allografts in patients.
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Affiliation(s)
- Patricia López-Chicón
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Spain
- Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Maria Luisa Pérez
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Spain
- Vall Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Cristina Castells-Sala
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Spain
- Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Ana Rita Piteira
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Spain
- Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Oscar Fariñas
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Spain
- Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Jaime Tabera
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Spain
- Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - Anna Vilarrodona
- Barcelona Tissue Bank (BTB), Banc de Sang i Teixits (BST), Barcelona, Spain
- Vall Hebron Institute of Research (VHIR), Barcelona, Spain
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Castells-Sala C, Pérez ML, López-Chicón P, Lopez-Puerto L, Martinez JIR, Ruiz-Ponsell L, Sastre S, Madariaga SE, Aiti A, Fariñas O, Vilarrodona A. Development of a full-thickness acellular dermal graft from human skin: Case report of first patient rotator cuff patch augmentation repair. Transpl Immunol 2023; 78:101825. [PMID: 36934900 DOI: 10.1016/j.trim.2023.101825] [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: 11/25/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 03/19/2023]
Abstract
The processing and initial testing of a new human tissue preparation is described. Full-thickness Acellular Dermal Matrix (ftADM) is the extracellular matrix (ECM) obtained by decellularization of full-thickness human skin from cadaveric donors. The safety, stability and usability of the graft are discussed with respect to the results of the residual cellular content, maintenance of ECM components, and biomechanical properties. Quantitative and qualitative analysis of the ECM demonstrated the absence of cell debris, while the native structure of human dermis was maintained. Biomechanical testing showed stiffness values comparable to other commercial products used for tendon reinforcement, suggesting that our ftADM could be successfully used not only in soft tissue regeneration surgeries, but also in tendon reinforcement. First case of ftADM in rotator cuff augmentation is described. Technical management of the patch during surgery and clinical outcomes are discussed.
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Affiliation(s)
- C Castells-Sala
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain.
| | - M L Pérez
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain.
| | - P López-Chicón
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - L Lopez-Puerto
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - J I Rodríguez Martinez
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - L Ruiz-Ponsell
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - S Sastre
- Arthroscopy Unit, Department of Orthopaedics, Hospital Clinic de Barcelona, Barcelona, Spain
| | - S E Madariaga
- Arthroscopy Unit, Department of Orthopaedics, Hospital Clinic de Barcelona, Barcelona, Spain
| | - A Aiti
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain
| | - O Fariñas
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
| | - A Vilarrodona
- Barcelona Tissue Bank, Banc de Sang i Teixits (BST), Barcelona, Spain; Biomedical Research Institute (IIB-Sant Pau; SGR1113), Barcelona, Spain
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Avanzi P, Cardoni G, Zorzi C. Arthroscopic Superior Capsular Reconstruction (ASCR): All Soft Anchors Technique. Arthrosc Tech 2023; 12:e343-e348. [PMID: 37013018 PMCID: PMC10066339 DOI: 10.1016/j.eats.2022.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/05/2022] [Indexed: 04/05/2023] Open
Abstract
Rotator cuff tears are among the most common orthopaedic injuries. If not treated, they can result in a massive irreparable tear because of tendon retraction and muscle atrophy. Mihata et al. in 2012 described the technique of superior capsular reconstruction (SCR) using fascia lata autograft. This has been considered an acceptable and effective method for treating irreparable massive rotator cuff tears. We describe an arthroscopically assisted superior capsular reconstruction (ASCR) technique using all soft anchors to preserve the bone stock and reduce possible hardware complications. Moreover, knotless anchors for the lateral fixation make the technique easier to reproduce.
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Affiliation(s)
| | - Gaia Cardoni
- Address correspondence to Gaia Cardoni, M.D., Department of Orthopaedics, Sacro Cuore–Don Calabria Hospital, Via Don Angelo Sempreboni 5, 37024 Verona, Italy.
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Xu J, Han K, Ye Z, Wu C, Wu X, Li Z, Zhang T, Xu C, Su W, Zhao J. Biomechanical and Histological Results of Dual-Suspensory Reconstruction Using Banded Tendon Graft to Bridge Massive Rotator Cuff Tears in a Chronic Rabbit Model. Am J Sports Med 2022; 50:2767-2781. [PMID: 35853168 DOI: 10.1177/03635465221102744] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bridging rotator cuff tendon defects with a patch is a reasonable treatment for massive rotator cuff tears (MRCTs). However, the poor outcomes associated with routine patch repair have prompted exploration into superior bridging techniques and graft structures. PURPOSE To detect whether dual-suspensory reconstruction using a banded graft would be superior to routine bridging using a patch graft to treat MRCTs and to detect the comparative effectiveness of patellar tendon (PT) and fascia lata (FL) grafts in dual-suspensory reconstruction. STUDY DESIGN Controlled laboratory study. METHODS Unilateral chronic MRCTs were created in 72 mature male New Zealand White rabbits, which were randomly divided into 3 groups: (1) patch bridging repair using rectangular FL autograft (PR-FL), (2) dual-suspensory bridging reconstruction using banded FL autograft (DSR-FL), and (3) dual-suspensory bridging reconstruction using banded PT autograft (DSR-PT). In each group, the mean failure load and stiffness of the cuff-graft-humerus (C-G-H) complexes of 6-week and 12-week specimens were recorded, with the failure modes and sites noted. Moreover, cuff-to-graft and graft-to-bone interface healing and graft substance remodeling of the complexes were histologically evaluated (via hematoxylin and eosin, Picrosirius red, Masson trichrome, and Safranin O/fast green staining) at 6 and 12 weeks to assess integrations between the bridging constructs and the native bone or rotator cuff tendons. RESULTS The DSR-PT group had the greatest mean failure loads and stiffness of the C-G-H complexes at 6 and 12 weeks (41.81 ± 7.00 N, 10.34 ± 2.68 N/mm; 87.62 ± 9.20 N, 17.98 ± 1.57 N/mm, respectively), followed by the DSR-FL group (32.04 ± 5.49 N, 8.20 ± 2.27 N/mm; 75.30 ± 7.31 N, 14.39 ± 3.29 N/mm, respectively). In the DSR-PT and DSR-FL groups, fewer specimens failed at the graft-to-bone junction and more failed at the cuff-to-graft junction, but both groups had higher median failure loads at 6 and 12 weeks (DSR-PT: cuff-to-graft junction, 37.80 and 83.76 N; graft-to-bone junction, 45.46 and 95.86 N) (DSR-FL: cuff-to-graft junction, 28.52 and 67.68 N; graft-to-bone junction, 37.92 and 82.18 N) compared with PR-FL (cuff-to-graft junction, 27.17 and 60.04 N; graft-to-bone junction, 30.12 and 55.95 N). At 12 weeks, the DSR-FL group had higher median failure loads at graft substance (72.26 N) than the PR-FL group (61.27 N). Moreover, the PR-FL group showed more inflammatory responses at the 2 healing interfaces and the graft substance in the 6-week specimens and subsequently displayed poorer interface healing (assessed via collagen organization, collagen maturity, and fibrocartilage regeneration) and graft substance remodeling (assessed via collagen organization and maturity) in 12-week specimens compared with the DSR-PT and DSR-FL groups. Superior interface healing and substance remodeling processes were observed in the DSR-PT group compared with the DSR-FL group. CONCLUSION When compared with routine patch repair, the dual-suspensory reconstructions optimized biomechanical properties and improved interface healing and graft substance remodeling for bridging MRCTs. Furthermore, the dual-suspensory technique using the PT graft presented superior histological and biomechanical characteristics than that using FL. CLINICAL RELEVANCE The dual-suspensory reconstruction technique using banded tendon grafts may enhance bridging constructs for MRCTs in humans, warranting further investigations of clinical outcomes.
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Affiliation(s)
- Junjie Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Kang Han
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zipeng Ye
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Chenliang Wu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiulin Wu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ziyun Li
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tianlun Zhang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Wei Su
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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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: 3] [Impact Index Per Article: 1.5] [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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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: 0.5] [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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8
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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: 6] [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: 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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Li H, Ma L, Li Y, Tao X, Liao Y, Yang A, Zhou B, Tang K. [The short-term effectiveness of superior capsular reconstruction using autologous fascia lata graft for 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 2021; 35:1427-1433. [PMID: 34779169 DOI: 10.7507/1002-1892.202104003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To observe and evaluate the short-term effectiveness of superior capsular reconstruction using autologous fascia lata graft for irreparable massive rotator cuff tears. Methods The clinical data of 9 patients with irreparable massive rotator cuff tears treated with arthroscopic superior capsular reconstruction by using autologous fascia lata graft between September 2019 and April 2020 were retrospectively analysed. There were 4 males and 5 females with a median age of 66 years (range, 55-70 years). The disease duration was 6-60 months with an average of 19.1 months. According to Hamada classification, the patients were classified as grade 1 in 2 cases, grade 2 in 2 cases, grade 3 in 2 cases, and grade 4 in 3 cases. Before and after operation, the visual analogue scale (VAS) score was used to evaluate the improvement of shoulder joint pain, the American Shoulder and Elbow Surgeons (ASES) score, Constant score, and the University of California Los Angeles (UCLA) shoulder function score were used to evaluate the improvement of shoulder joint function. The active range of motion of shoulder joint was recorded, including forward flexion, abduction, lateral external rotation, and internal rotation. The changes of subacromial space were recorded by anteroposterior X-ray film of shoulder joint. Sugaya classification was used to judge the integrity of rotator cuff immediately after operation and at last follow-up. Results The operation time was 210-380 minutes, with an average of 302.3 minutes. All incisions healed by first intention after operation, and there was no complication such as infection and nonunion of incisions. Two patients had numbness of the upper limbs on the surgical side after operation, and the numbness completely relieved at 6 weeks after operation; 5 cases with preoperative pseudoparalysis symptoms recovered after operation. Nine patients were followed up 12-17 months, with an average of 14.1 months. At last follow-up, the patient's active range of motion of shoulder joint (forward flexion, abduction, lateral external rotation, and internal rotation), subacromial space distance, VAS score, ASES score, Constant score, and UCLA score significantly improved when compared with preoperative ones ( P<0.05). There was no significant difference in the Sugaya classification between at last follow-up and immediately after operation ( Z=-1.633, P=0.102). Conclusion Superior capsular reconstruction using autologous fascia lata graft can restore the superior stability and achieve a good short-term effectiveness for irreparable massive rotator cuff tears.
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Affiliation(s)
- Huaisheng Li
- Department of Orthopedics/Sports Medicine Center, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 400038, P.R.China
| | | | - Yan Li
- Department of Orthopedics/Sports Medicine Center, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 400038, P.R.China
| | - Xu Tao
- Department of Orthopedics/Sports Medicine Center, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 400038, P.R.China
| | - Yatao Liao
- Department of Orthopedics/Sports Medicine Center, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 400038, P.R.China
| | - Aining Yang
- Department of Orthopedics/Sports Medicine Center, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 400038, P.R.China
| | - Binghua Zhou
- Department of Orthopedics/Sports Medicine Center, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 400038, P.R.China
| | - Kanglai Tang
- Department of Orthopedics/Sports Medicine Center, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 400038, P.R.China
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10
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Li H, Zhou B, Tang K. Advancement in Arthroscopic Superior Capsular Reconstruction for Irreparable Massive Rotator Cuff Tear. Orthop Surg 2021; 13:1951-1959. [PMID: 34585538 PMCID: PMC8528972 DOI: 10.1111/os.12976] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/28/2020] [Accepted: 02/01/2021] [Indexed: 11/28/2022] Open
Abstract
Irreparable massive rotator cuff tear (IMRCT) was one of the causes of shoulder dysfunction, despite technical improvement, the failure rate of IMRCT was still demonstrated to be high. Traditional treatments like non-surgical treatments, partial rotator cuff repair, and tendon transfers could only achieve a slight improvement. A potential cause for high failure rate was the fact that traditional treatments cannot restore the superior stability of glenohumeral joint, and thus restricted the movement of shoulder joint severely. Superior capsular reconstruction (SCR) using a variety of grafts (autograft, allograft, xenograft, or synthetic grafts) provided a promising option for IMRCT. In surgery, graft was fixed medially to superior glenoid and laterally to the footprint of humeral greater tuberosity. SCR could increase the stability of the superior glenohumeral joint, decrease the subacromial pressure and acromiohumeral distance. This review summarized the relevant literature regarding the alternative grafts, surgery indications, operative techniques and clinical outcomes of SCR. we compared the different grafts, key surgical steps, the advantages and disadvantages of different surgical methods to provide clinicians with new surgical insights into the treatments of IMRCT. In conclusion, IMRCT without severe glenohumeral arthritis was the best suitable indication for SCR. The clinical outcomes were positive in the short-term and middle-term following-up. More studies were necessary to determine long-term results of this surgical procedure.
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Affiliation(s)
- Huaisheng Li
- 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
| | - Kanglai Tang
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
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Baek S, Shin MH, Kim TM, Im JM, Oh KS, Chung SW. Clinical Outcomes of Interposition Graft Versus Superior Capsular Reconstruction in Patients With Irreparable Rotator Cuff Tears: A Systematic Review and Meta-analysis. Orthop J Sports Med 2021; 9:23259671211022241. [PMID: 34527751 PMCID: PMC8435932 DOI: 10.1177/23259671211022241] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/24/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Interposition grafting (IG), also called bridging grafting, and superior capsular reconstruction (SCR) are the most commonly used joint-preserving surgical methods for irreparable rotator cuff tears (RCTs). Purpose: To compare the effectiveness of IG versus SCR to treat patients with irreparable RCTs. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search was performed in MEDLINE, Embase, and Scopus. Included in this review were clinical studies evaluating the effect of IG or SCR in patients with irreparable RCTs with a minimum follow-up of 1 year. Various clinical results from the studies were extracted and compared between IG and SCR, and among them, the results of the American Shoulder and Elbow Surgeons score, graft retear rate, and complication rate were included in the meta-analysis. Results: Of 1638 identified articles, 17 (10 studies of IG involving 321 patients and 7 studies of SCR involving 357 patients) were selected. Both surgical methods showed significantly improved clinical outcomes in all but 1 study; however, the IG group had lower pain visual analog scale score, higher Constant score, and bigger active forward flexion and internal rotation compared with the SCR group (all P < .001). The meta-analysis showed no difference in the American Shoulder and Elbow Surgeons score between groups (P = .44), but showed a significantly lower complication rate in the IG group compared with the SCR group (1.12% vs 8.37%, respectively; P < .001). The graft retear rate was not significantly different between groups (IG = 10.64% vs SCR = 12.67%; P = .79). The meta-analysis of graft type indicated no difference between groups in retear rate (autograft: 95% CI, 0.045-0.601; I2 = 93.28 [IG], 91.27 [SCR]; P = .22; allograft: 95% CI, 0.041-0.216; I2 = 80.39 [IG], 69.12 [SCR]; P = .64) or complication rate (autograft: 95% CI, 0.009-0.150; I2 = 0 [IG], 65.89 [SCR]; P = .25; allograft: 95% CI, 0.012-0.081; I2 = 0 [IG], 30.62 [SCR]; P = .09). Conclusion: Both IG and SCR techniques resulted in improvement in patients with irreparable RCTs. Meta-analysis showed a lower complication rate in the IG group; however, the lack of randomized studies limited our conclusions.
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Affiliation(s)
- Samuel Baek
- Department of Orthopaedic Surgery, Seoul Red Cross Hospital, Seoul, Republic of Korea
| | - Myung Ho Shin
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Tae Min Kim
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Je Min Im
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Kyung-Soo Oh
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
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Li H, Yang M, Li Y, Zhou B, Tang K. [Research progress of indication and treatment of graft in shoulder superior capsular reconstruction for rotator cuff tear]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:252-257. [PMID: 33624483 DOI: 10.7507/1002-1892.202006015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the research progress of indication and treatment of graft in shoulder superior capsular reconstruction (SCR) for rotator cuff tear (RCT). Methods The literature related to shoulder SCR in recent years was extensively reviewed, and the anatomy, biomechanics, surgical indications, and treatment of graft in SCR were summarized. Results Superior capsule plays a role as a functional complex with rotator cuff, ligament, and whole capsule. SCR can effectively restore the superior stability of the shoulder. The indications of SCR include the irreparable massive RCT, massive RCT combined with pseudoparalysis shoulder, medium/large RCT with severe degenerative rotator cuff tissue, and dual-layer RCT. In order to achieve a better healing of tendon-bone in graft and decrease the rate of long-term graft retearing, it is essential to select an appropriate thickness graft, fix the graft in right intensity, and get a better capsular continuity. Conclusion The technique of SCR advanced to SCR for reinforcement and it is indicated from substantial massive RCT to severe degeneration of rotator cuff tissue. Graft treatment is the key step for a successful SCR.
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Affiliation(s)
- Huaisheng Li
- Department of Sports Medicine, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 400038, P.R.China
| | - Mingyu Yang
- Department of Sports Medicine, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 400038, P.R.China
| | - Yan Li
- Department of Sports Medicine, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 400038, P.R.China
| | - Binghua Zhou
- Department of Sports Medicine, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 400038, P.R.China
| | - Kanglai Tang
- Department of Sports Medicine, the First Affiliated Hospital of the Army Military Medical University, Chongqing, 400038, P.R.China
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Gilat R, Haunschild ED, Williams BT, Fu MC, Garrigues GE, Romeo AA, Verma NN, Cole BJ. Patient Factors Associated With Clinical Failure Following Arthroscopic Superior Capsular Reconstruction. Arthroscopy 2021; 37:460-467. [PMID: 32998042 DOI: 10.1016/j.arthro.2020.09.038] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 09/19/2020] [Accepted: 09/19/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify demographic, clinical, and radiographic factors associated with failure after superior capsular reconstruction (SCR). METHODS Prospectively collected data were analyzed from patients who underwent SCR using a decellularized dermal allograft for an irreparable rotator cuff tear. Demographic characteristics, radiographic findings, concomitant procedures, and patient-reported outcomes (PROs) were recorded. Failure was defined by ≥1 of the following criteria: (1) conversion to reverse total shoulder arthroplasty (RTSA), (2) a decrease in 1-year postoperative shoulder-specific PROs compared with preoperative scores, or (3) patient reports at final follow-up that the shoulder was in a worse condition than before surgery. Preoperative variables were compared between patients meeting the criteria for clinical failure and those who did not. RESULTS Fifty-four patients (mean age 56.3 ± 5.8 years, range 45 to 70) who underwent SCR, with minimum 1-year follow-up, were included in the analysis. Mean follow-up after surgery was 24 months (range 12 to 53). Eleven patients (20.4%) met criteria for clinical failure. Of the 11, 8 reported decreased American Shoulder and Elbow Surgeons (ASES) or Constant scores or indicated that the operative shoulder was in a worse condition than before surgery. Three patients underwent RTSA in the 6 to 12 months after SCR. Female sex and the presence of a subscapularis tear were associated with failure (P = .023 and P = .029, respectively). A trend toward greater body mass index (BMI), lower preoperative forward flexion, and lower preoperative acromiohumeral distance (AHD) was found in patients with clinical failure (P = .075, P = .088, and P = .081, respectively). No other variable included in the analysis was significantly associated with failure. CONCLUSION The proportions of female patients and those with subscapularis tear were greater among patients with clinical failure after SCR. Greater BMI, lower preoperative forward flexion, and lower preoperative AHD trended toward association with clinical failure of SCR. LEVEL OF EVIDENCE 4, case series.
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Affiliation(s)
- Ron Gilat
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, U.S.A.; Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - Eric D Haunschild
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, U.S.A
| | - Brady T Williams
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, U.S.A
| | - Michael C Fu
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, U.S.A
| | - Grant E Garrigues
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, U.S.A
| | - Anthony A Romeo
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, U.S.A
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, U.S.A
| | - Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, U.S.A..
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Selim NM, Badawy ER. Consider Long Head of Biceps Tendon for Reconstruction of Massive, Irreparable Rotator Cuff Tear. Arthrosc Tech 2021; 10:e457-e467. [PMID: 33680779 PMCID: PMC7917143 DOI: 10.1016/j.eats.2020.10.024] [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: 06/14/2020] [Accepted: 10/18/2020] [Indexed: 02/03/2023] Open
Abstract
Despite the different treatment options for irreparable and massive rotator cuff tears (RCTs), there is no optimal treatment. Thirty percent of total RCTs can be classified as irreparable because of the massive tear size and severe muscle atrophy. The reported treatment failure rate is approximately 40% for massive RCTs. RCTs may be treated conservatively or surgically depending on pain, disability, and functional demands. The surgical treatment options are many, but decision making is a challenge; the real challenge is to apply the correct procedure for the correct indication in each patient. The long head of the biceps tendon (LHBT) was used for augmentation to bridge the gap in immobile, massive RCTs. An arthroscopic biceps-incorporating technique was used for repair of large and massive RCTs, avoiding undue tension on the rotator cuff (RC). Recently, the LHBT was used for superior capsular reconstruction. This article describes the use of the LHBT for reconstruction of massive and irreparable RCTs through the following steps: (1) open exposure of the RCT, (2) debridement and subacromial decompression, (3) biceps tenotomy at the LHBT's origin on the glenoid, (4) LHBT and RC cuff mobilization, (5) passage of the LHBT through the mobilized RC and reflection onto itself, (6) tuberoplasty, and (7) fixation of the RC complex at the RC footprint.
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Affiliation(s)
- Naser M. Selim
- Knee Surgery–Arthroscopy and Sports Injuries Unit, Orthopedic Department, Mansoura University, Mansoura, Egypt
| | - Ehab R. Badawy
- Knee Surgery–Arthroscopy and Sports Injuries Unit, Orthopedic Department, Mansoura University, Mansoura, Egypt
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Dede Eren A, Sinha R, Eren ED, Huipin Y, Gulce-Iz S, Valster H, Moroni L, Foolen J, de Boer J. Decellularized Porcine Achilles Tendon Induces Anti-inflammatory Macrophage Phenotype In Vitro and Tendon Repair In Vivo. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.regen.2020.100027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Kim JW, Nam DJ. Arthroscopic Superior Capsular Reconstruction by the Mini-Open Modified Keyhole Technique Using an Achilles Tendon-Bone Allograft. Arthrosc Tech 2020; 9:e275-e281. [PMID: 32099782 PMCID: PMC7029195 DOI: 10.1016/j.eats.2019.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/13/2019] [Indexed: 02/06/2023] Open
Abstract
The treatment of massive and irreparable rotator cuff tears remains a challenge for shoulder surgeons. When treating patients with chronic rotator cuff tears, especially those with severe fatty degeneration, severe tendon retraction, or muscle atrophy, the risk of re-tear and persistent severe pain persists. Therefore, surgeons can choose from numerous options. Superior capsular reconstruction (SCR) was introduced as a technique to maintain the stability of the upper shoulder and stabilize the muscles without repairing the supraspinatus and infraspinatus. Various autograft and allograft techniques have been developed. SCR performed using an autograft has the disadvantage of requiring harvesting the tensor fascia lata. Although allografts reduce harvest time, they also increase donor-site morbidity and the time required for healing. To solve the healing problem, we have introduced an SCR technique through grafting with the Achilles tendon-bone. Although this is an unproven technique for patients with chronic irreparable rotator cuff tears, our short-term outcomes seem promising. Further studies and follow-ups are needed to determine the success of this technique.
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Affiliation(s)
- Jeong Woo Kim
- Address correspondence to Jeong Woo Kim, Department of Orthopedic Surgery, Wonkwang University Hospital, 344-2 Shinyong-dong, Iksan, Jeollabuk-do, Korea.
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Revision of a Failed Latissimus Dorsi Transfer for a Massive Rotator Cuff Tear With Arthroscopic Anatomic Bridging Reconstruction Using an Acellular Human Dermal Matrix Allograft. Arthrosc Tech 2019; 8:e1171-e1179. [PMID: 31921592 PMCID: PMC6950775 DOI: 10.1016/j.eats.2019.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/08/2019] [Indexed: 02/03/2023] Open
Abstract
Latissimus dorsi tendon transfer is a nonanatomic tendon transfer that is often considered a salvage procedure for failed repairs of massive rotator cuff tears. A rupture of the transferred latissimus tendon is an uncommon complication and there is limited literature on its management, especially in the young, active population without cuff arthropathy. In this article, we present a technique of managing a failed latissimus dorsi tendon transfer for a massive rotator cuff tear with an arthroscopic, anatomic bridging reconstruction using an acellular human dermal matrix allograft.
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18
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Zastrow RK, London DA, Parsons BO, Cagle PJ. Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears: A Systematic Review. Arthroscopy 2019; 35:2525-2534.e1. [PMID: 31395196 DOI: 10.1016/j.arthro.2019.02.053] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/10/2019] [Accepted: 02/24/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the preliminary clinical outcomes and complications of superior capsule reconstruction (SCR) for irreparable rotator cuff tears. METHODS A systematic review of PubMed, MEDLINE, EMBASE, and Cochrane databases was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting clinical outcomes of irreparable rotator cuff tears managed by SCR were included. Clinical outcome analyses of pre- and postoperative range of motion, American Shoulder and Elbow Surgeons scores, visual analog scale pain scores, and acromiohumeral intervals (AHIs) were performed and reported as range or frequency. RESULTS Five studies (285 patients, 291 shoulders) of level III-IV evidence were included, with a weighted mean (± standard deviation) follow-up of 27.7 ± 17.3 months. Forward flexion improved from 91°-130° preoperatively to 147°-160° postoperatively, external rotation from 26°-41° to 41°-45°, and internal rotation from L4-L1 to L1. American Shoulder and Elbow Surgeons scores increased from 36-52.2 to 77.5-92, and visual analog scale pain scores decreased from 4.0-6.3 to 0.4-1.7. Radiographically, AHIs with acellular dermal allograft ranged from 4.5 to 7.1 mm preoperatively, improving to 7.6-10.8 mm immediately postoperation before decreasing to 6.7-9.7 mm by final follow-up. Complication and graft failure rates were 17.2% and 11.7%, respectively. CONCLUSIONS Preliminary results of SCR show consistent improvement in shoulder functionality and pain reduction. However, a decrease in postoperative AHIs indicates dermal allograft elongation and persistent superior migration of the humerus, potentially contributing to later graft failure. Studies with longer follow-up will be essential to evaluate the long-term utility of SCR in the treatment of irreparable rotator cuff tears. LEVEL OF EVIDENCE Level IV, systematic review of level III-IV studies.
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Affiliation(s)
- Ryley K Zastrow
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, U.S.A..
| | - Daniel A London
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, U.S.A
| | - Bradford O Parsons
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, U.S.A
| | - Paul J Cagle
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, U.S.A
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Novi M, Kumar A, Paladini P, Porcellini G, Merolla G. Irreparable rotator cuff tears: challenges and solutions. Orthop Res Rev 2018; 10:93-103. [PMID: 30774464 PMCID: PMC6376460 DOI: 10.2147/orr.s151259] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Irreparable rotator cuff tears are common conditions seen by shoulder surgeons, characterized by a torn and retracted tendon associated with muscle atrophy and impaired mobility. Direct fixation of the torn tendon is not possible due to the retracted tendon and lack of healing potential which result in poor outcome. Several treatment options are viable but correct indication is mandatory for a good result, pain improvement, and restoration of shoulder function. Patient can be treated either with a conservative program or surgically when necessary, by different available modalities like arthroscopic debridement, partial reconstruction, subacromial spacer, tendon transfer, and shoulder replacement with reverse prosthesis. The aim of this study was to review literature to give an overview of the available possible solutions, with indications and expected outcomes.
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Affiliation(s)
- Michele Novi
- Orthopaedic and Trauma Unit, University Hospital of Pisa, Pisa, Italy
| | - Avinash Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, Patna, India
| | - Paolo Paladini
- Shoulder and Elbow Unit, "D. Cervesi" Hospital, AUSL della Romagna, Ambito Territoriale di Rimini, Rimini, Italy,
| | - Giuseppe Porcellini
- Orthopaedic and Trauma Unit, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Giovanni Merolla
- Shoulder and Elbow Unit, "D. Cervesi" Hospital, AUSL della Romagna, Ambito Territoriale di Rimini, Rimini, Italy, .,"Marco Simoncelli" Biomechanics Laboratory, "D. Cervesi" Hospital, AUSL della Romagna, Ambito Territoriale di Rimini, Rimini, Italy,
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de Campos Azevedo CI, Ângelo ACLPG, Vinga S. Arthroscopic Superior Capsular Reconstruction With a Minimally Invasive Harvested Fascia Lata Autograft Produces Good Clinical Results. Orthop J Sports Med 2018; 6:2325967118808242. [PMID: 30505873 PMCID: PMC6259077 DOI: 10.1177/2325967118808242] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Painful dysfunctional shoulders with irreparable rotator cuff tears (IRCTs)
in active patients are a challenge. Arthroscopic superior capsular
reconstruction (ASCR) is a new treatment option originally described using a
fascia lata autograft harvested through an open approach. However, concerns
about donor site morbidity have discouraged surgeons from using this type of
graft. Hypothesis: ASCR using a minimally invasive harvested fascia lata autograft produces good
6-month and 2-year shoulder outcomes in IRCTs, with low-impact thigh
morbidity at 2 years. Study Design: Case series; Level of evidence, 4. Methods: From 2015 to 2016, a total of 22 consecutive patients (mean age, 64.8 ± 8.6
years) with chronic IRCTs (Hamada grade 1-2; Goutallier cumulative grade ≥3;
Patte stage 1: 2 patients; Patte stage 2: 6 patients; Patte stage 3: 14
patients) underwent ASCR using a minimally invasive harvested fascia lata
autograft. All patients completed preoperative and 6-month evaluations
consisting of the Simple Shoulder Test (SST), subjective shoulder value
(SSV), Constant score (CS), range of motion (ROM), acromiohumeral interval
(AHI), and magnetic resonance imaging. Twenty-one patients completed the
2-year shoulder and donor site morbidity assessments. Results: The mean active ROMs improved significantly (P < .001):
elevation, from 74.8° ± 55.5° to 104.5° ± 41.9° (6 months) and 143.8° ±
31.7° (2 years); abduction, from 53.2° ± 43.3° to 86.6° ± 32.9° (6 months)
and 120.7° ± 37.7° (2 years); external rotation, from 13.2° ± 18.4° to 27.0°
± 16.1° (6 months) and 35.6° ± 17.3° (2 years); and internal rotation, from
1.2 ± 1.5 points to 2.6 ± 1.5 points (6 months) and 3.8 ± 1.2 points (2
years). The mean functional shoulder scores improved significantly
(P < .001): SST, from 2.1 ± 2.9 to 6.8 ± 3.5 (6
months) and 8.6 ± 3.5 (2 years); SSV, from 33.0% ± 17.4% to 55.7% ± 25.6% (6
months) and 70.0% ± 23.0% (2 years); CS, from 17.5 ± 13.4 to 42.5 ± 14.9 (6
months) and 64.9 ± 18.0 (2 years). The mean shoulder abduction strength
improved significantly (P < .001) from 0.0 to 1.1 ± 1.4
kg (6 months) and 2.8 ± 2.6 kg (2 years). The mean AHI improved from 6.4 ±
3.3 mm to 8.0 ± 2.5 mm (6 months) and decreased to 7.1 ± 2.5 mm (2 years).
This 0.7 ± 1.5–mm overall decrease was statistically significant
(P = .042). At 6 months, 20 of 22 patients (90.9%) had
no graft tears. At 2 years, 12 of 21 patients (57.1%) were bothered by their
harvested thigh, 16 (76.2%) noticed donor site changes, 16 (76.2%)
considered that the shoulder surgery’s end result compensated for the
thigh’s changes, and 18 (85.7%) would undergo the same surgery again. Conclusion: ASCR using a minimally invasive harvested fascia lata autograft produced good
6-month and 2-year shoulder outcomes in IRCTs, with low-impact thigh
morbidity at 2 years.
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Affiliation(s)
- Clara Isabel de Campos Azevedo
- Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.,Hospital dos SAMS, Lisbon, Portugal.,Clínica GIGA Saúde, Lisbon, Portugal
| | | | - Susana Vinga
- Instituto de Engenharia de Sistemas e Computadores-Investigação e Desenvolvimento, Lisbon, Portugal.,INESC - ID, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
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Azevedo C, Ângelo AC. Arthroscopic Superior Capsular Reconstruction or Reverse Total Shoulder Arthroplasty for Irreparable Bilateral Rotator Cuff Tear: A Case Report. JBJS Case Connect 2018; 8:e96. [PMID: 30489380 DOI: 10.2106/jbjs.cc.18.00138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
CASE An active elderly patient with bilateral chronic rotator cuff tear underwent a reverse total shoulder arthroplasty (RTSA) on the right shoulder and an arthroscopic superior capsular reconstruction (ASCR) with a fascia lata autograft on the left shoulder. To our knowledge, this is the first reported case that compares these 2 techniques for irreparable rotator cuff tears in the same patient. CONCLUSION The patient had very good midterm (2 and 8 years of follow-up) functional outcomes with both treatment options. However, the ASCR was found to have superior clinical outcome measures, and it is a valid alternative to RTSA for irreparable rotator cuff tears in the appropriate setting.
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Affiliation(s)
- Clara Azevedo
- Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal
- Hospital dos SAMS, Lisbon, Portugal
| | - Ana Catarina Ângelo
- Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal
- Hospital dos SAMS, Lisbon, Portugal
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