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Open Anterior Capsular Reconstruction With a Dermal Allograft Is a Viable Nonarthroplasty Salvage Procedure for Irreparable Subscapularis Tears at a Minimum 2-Year Follow-up. Arthrosc Sports Med Rehabil 2022; 4:e1291-e1297. [PMID: 36033201 PMCID: PMC9402413 DOI: 10.1016/j.asmr.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/11/2022] [Indexed: 11/24/2022] Open
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Clavert P, Bruyere A, Ollivier I, Nourrissat G, Lädermann A. An anatomical study of the fetal superior capsule of the glenohumeral joint. Orthop Traumatol Surg Res 2021; 107:103073. [PMID: 34562650 DOI: 10.1016/j.otsr.2021.103073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The superior part of the glenohumeral joint capsule has an intimate relationship with the tendons of the rotator cuff and the tendon of the long head of the biceps. One of the strategies currently proposed in the event of a massive cuff rupture is to reconstruct this superior capsule. The main objective of this anatomical study was to describe the superior joint capsule of the embryonic glenohumeral joint and its relationship to the tendons of the rotator cuff. HYPOTHESIS The hypothesis was that this structure was an anatomical entity, morphologically identifiable from the embryogenesis of the joint (more pronounced tissue boundaries in the fetus). MATERIAL AND METHODS In total, 101 continuous fetal anatomical sections (4 fetuses of 336mm), in the frontal plane, made it possible to identify and measure: diameters of the humeral head and glenoid, dimensions of the joint capsule insertion zone at the level of the greater tubercle, as well as the different thicknesses of this insertion zone. The ratios above the head of the biceps and against the superior labrum were also measured. RESULTS At the level of its distal insertion on the greater tuberosity, the thickness of the superior joint capsule varies on average between 0.8mm laterally and 1.2mm next to the tendons of the supraspinatus and infraspinatus; the thickness is 0.9mm next to the middle part of the supraspinatus tendon (the "rotator cable" zone). For its insertion at the level of the glenoid labrum, the superior capsule measures 0.6mm thick on average. The capsule around the tendon of the long head of the biceps is 1.5mm thick on average. DISCUSSION Here, we confirm the existence of this superior joint capsule, which can potentially be reconstructed. It is inserted on the greater tubercle covering 30 to 60% of its surface with variations in thickness. The joint capsule is fused to the supraspinatus tendon at the rotator cuff insertion area, preventing independent reinsertion of the tendon. LEVEL OF EVIDENCE IV; anatomical study.
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Affiliation(s)
- Philippe Clavert
- Faculté de médecine, institut d'anatomie, 4, rue Kirschleger, 67085 Strasbourg cedex, France.
| | - Alexandra Bruyere
- Faculté de médecine, institut d'anatomie, 4, rue Kirschleger, 67085 Strasbourg cedex, France
| | - Irène Ollivier
- Faculté de médecine, institut d'anatomie, 4, rue Kirschleger, 67085 Strasbourg cedex, France
| | | | - Alexandre Lädermann
- Service d'orthopédie et traumatologie, hôpital de la Tour, avenue J.-D.-Maillard 3, 1217 Meyrin, Switzerland; Faculté de médecine medicine, université de Genève, rue Michel-Servet 1, 1206 Geneva, Switzerland; Service d'orthopédie et traumatologie, Department de Chirurgie, rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
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- 15, rue Ampère, 92500 Rueil Malmaison, France
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Ferrando A, Kingston R, Delaney RA. Superior capsular reconstruction using a porcine dermal xenograft for irreparable rotator cuff tears: outcomes at minimum two-year follow-up. J Shoulder Elbow Surg 2021; 30:1053-1059. [PMID: 32890682 DOI: 10.1016/j.jse.2020.08.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE To evaluate midterm outcomes of arthroscopic superior capsular reconstruction (SCR) using a decellularized porcine dermal xenograft in patients with massive, irreparable rotator cuff tears and to determine the influence of concomitant, repairable subscapularis tears. METHODS This is a retrospective study of 56 patients with a minimum 2-year follow-up. Preoperative and postoperative range of motion, American Shoulder and Elbow Surgeons score, Subjective Shoulder Value, and visual analog score for pain were measured. Postoperative data were collected at 3, 6, 12, 24, and 36 months. RESULTS Of the 56 patients who underwent arthroscopic SCR, there were 39 men and 17 women. The mean age at operation was 65 ± 9 years, and the mean follow-up was 34 ± 8 months. The mean preoperative American Shoulder and Elbow Surgeons improved from 41 ± 19 to 78 ± 18 at 24 weeks, to 86± 16 at 12 months, and to 90±9 at 24 months, P < .0001. Similarly, the mean preoperative Subjective Shoulder Value improved from 39 ± 17 to 74 ± 18 at 24 weeks, to 80 ± 18 at 12 months, and to 80 ± 11 at 24 months, P < .0001. The mean preoperative visual analog score improved from 6.5 ± 2.1 to 1.4 ± 2.2 at 24 weeks, to 0.7± 1.1 at 12 months, and to 0.2 ± 0.4 at 24 months, P < .0001. There were no differences in outcome scores between patients with intact vs. repaired subscapularis. Similarly, no statistically significant differences were found in forward flexion or external rotation after SCR between patients with an intact vs. repaired subscapularis. Failure of the SCR graft was observed on magnetic resonance imaging in 14 patients, 4 of whom opted for revision to reverse shoulder arthroplasty. Eleven patients were truly pseudoparalytic before surgery; in 5 cases, pseudoparalysis was reversed after SCR. CONCLUSIONS SCR can alleviate pain and disability from irreparable rotator cuff tears and provide significant improvements in shoulder function; however, the xenograft technique resulted in inconsistent reversal of true pseudoparalysis. No difference was found between patients who required concomitant subscapularis repair vs. those who did not.
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Affiliation(s)
- Albert Ferrando
- Departamento de Traumatología y Cirugía Ortopédica, Hospital Universitari Sant Joan de Reus, Reus, Spain.
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Okamura K, Abe M, Yamada Y, Makihara T, Yoshimizu T, Sakaki Y, Suzumori Y, Mihata T. Arthroscopic superior capsule reconstruction with Teflon felt synthetic graft for irreparable massive rotator cuff tears: clinical and radiographic results at minimum 2-year follow-up. J Shoulder Elbow Surg 2021; 30:625-634. [PMID: 32650075 DOI: 10.1016/j.jse.2020.06.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Superior capsule reconstruction (SCR) was developed to improve shoulder function and relieve pain in patients with irreparable rotator cuff tears. Here, we investigated the clinical and radiographic outcomes and postoperative complications of SCR using a Teflon graft for reconstruction. METHODS Thirty-five consecutive patients with irreparable rotator cuff tears underwent SCR with Teflon grafts. The American Shoulder and Elbow Surgeons score, active shoulder elevation, shoulder muscle strength, visual analog scale pain scores, acromiohumeral distance, and postoperative complications were investigated. Data obtained before and after surgery were compared by using a paired t-test, χ2 test, and 1-way analysis of variance, and data from 1-layer-graft SCR (15 patients; mean age, 75.1 years) and 3-layer-graft SCR (20 patients; mean age, 76.6 years) were compared by using an unpaired t-test. The average time to final follow-up was 42 months (range, 24-69 months). RESULTS SCR using Teflon grafts of either 1 or 3 layers significantly improved the American Shoulder and Elbow Surgeons score (by 20.8, P = .001 for a 1-layer graft; and by 31.1, P < .0001 for a 3-layer graft), visual analog scale score for motion pain (by 3.2, P = .001; and by 3.0, P < .0001), and muscle strength in shoulder abduction (by 11.9 N, P = .02; and by 10.9 N, P = .008). Active elevation at final follow-up was significantly greater in the 3-layer-graft group (142° ± 27°) than in the 1-layer-graft group (107° ± 42°) (P = .006). One year after SCR, acromiohumeral distance in the 3-layer-graft group was significantly greater than preoperatively (P = .04), whereas in the 1-layer-graft group, it was not. On postoperative magnetic resonance imaging, none of the patients in the 3-layer-graft group had graft tears, whereas 2 patients had graft tears and 1 patient had severe synovitis after 1-layer-graft SCR. CONCLUSION SCR using a Teflon graft-especially a 3-layer graft-significantly improved shoulder function and shoulder abduction strength, with pain relief and a low rate of postoperative complications. SCR using a Teflon graft can be a viable option for irreparable rotator cuff tears, especially when an autograft or allograft is not available.
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Affiliation(s)
- Kenji Okamura
- Department of Orthopedic Surgery, Hitsujigaoka Hospital, Sapporo, Hokkaido, Japan
| | - Masayuki Abe
- Department of Orthopedic Surgery, Hitsujigaoka Hospital, Sapporo, Hokkaido, Japan
| | - Yuichiro Yamada
- Department of Orthopedic Surgery, Hitsujigaoka Hospital, Sapporo, Hokkaido, Japan
| | - Takeshi Makihara
- Department of Orthopedic Surgery, Hitsujigaoka Hospital, Sapporo, Hokkaido, Japan
| | - Takaki Yoshimizu
- Department of Orthopedic Surgery, Hitsujigaoka Hospital, Sapporo, Hokkaido, Japan
| | - Yoshinari Sakaki
- Department of Orthopedic Surgery, Hitsujigaoka Hospital, Sapporo, Hokkaido, Japan
| | - Yuki Suzumori
- Department of Orthopedic Surgery, Hitsujigaoka Hospital, Sapporo, Hokkaido, Japan
| | - Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan.
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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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Mihata T, Lee TQ, Hasegawa A, Fukunishi K, Kawakami T, Fujisawa Y, Ohue M, Doi M, Neo M. Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears: Comparison of Clinical Outcomes With and Without Subscapularis Tear. Am J Sports Med 2020; 48:3429-3438. [PMID: 33104385 DOI: 10.1177/0363546520965993] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic superior capsule reconstruction (SCR) was developed to restore shoulder superior stability, muscle balance, and function in patients with irreparable posterior-superior rotator cuff tears. PURPOSE To assess the effects of concomitant subscapularis tendon tear, which may reduce glenohumeral stability and force coupling, on clinical outcomes of SCR for irreparable posterior-superior rotator cuff tears. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS In total, 193 patients with irreparable posterior-superior rotator cuff tears underwent arthroscopic SCR using fascia lata autograft between 2007 and 2015. They were allocated to 3 groups: group 1, no subscapularis tear (160 patients); group 2, reparable subscapularis tear, which underwent arthroscopic repair (26 patients); and group 3, irreparable subscapularis tear (7 patients). American Shoulder and Elbow Surgeons (ASES) and Japanese Orthopaedic Association (JOA) scores, visual analog scale (VAS) score for pain, active shoulder range of motion (ROM), muscle strength (manual muscle test), and acromiohumeral distance were evaluated before surgery and at final follow-up (mean, 3 years, 7 months; range, 2-11 years). Postoperative complications were assessed. RESULTS In groups 1 and 2, ASES, JOA, and VAS scores and shoulder ROM and muscle strength improved significantly after SCR with subscapularis repair (P < .001). SCR in group 3 significantly improved ASES, JOA, and VAS scores (P < .001), whereas shoulder ROM and muscle strength did not increase significantly. Postoperative acromiohumeral distance was significantly smaller in group 3 (5.7 ± 2.9 mm [mean ± SD]) than group 2 (9.1 ± 2.3 mm) (P = .002). Group 3 had a significantly higher rate of graft tear (P < .001) and postoperative infection (P < .001) than group 1. CONCLUSION The presence of subscapularis tendon tear affects clinical outcomes and complication rates after SCR. The reparability of the subscapularis affects superior glenohumeral stability; therefore, an intact subscapularis or reparable subscapularis tendon tear is the best indication for arthroscopic SCR in patients with irreparable posterior-superior rotator cuff tendon tears.
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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, USA
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
| | - Akihiko Hasegawa
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Kunimoto Fukunishi
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Takeshi Kawakami
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Yukitaka Fujisawa
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | | | - Munekazu Doi
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
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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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Shin JJ, Woodmass JM. Editorial Commentary: Anterior Capsular Reconstruction for Subscapularis Deficiency: The Definitive Treatment or a Helpful Adjunct? Arthroscopy 2019; 35:3009-3010. [PMID: 31699251 DOI: 10.1016/j.arthro.2019.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/02/2019] [Indexed: 02/02/2023]
Abstract
Anterior glenohumeral instability in the setting of irreparable subscapularis deficiency represents a difficult clinical scenario for the treating shoulder surgeon. Anterior capsular reconstruction with humeral dermal allograft improved glenohumeral translation stability and range of motion to near-normal values whereas pectoralis major tendon transfer was unable to do so. However, placement of a static spacer does not restore the dynamic force couple or shoulder kinematics. Further research is needed to evaluate the functional outcomes using this reconstruction technique.
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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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