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Sung HP, Chen WC. Rate of graft retear is higher in over-the-top superior capsular reconstruction for massive posterosuperior rotator cuff tears with subscapularis tear. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39010712 DOI: 10.1002/ksa.12365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE To compare side-to-side superior capsular reconstruction (SCR) with over-the-top SCR in terms of functional outcomes, pain relief and allograft survival rates. METHODS Patients who had undergone arthroscopic dermal allograft SCR for massive irreparable rotator cuff tears and clinical follow-up for ≥2 years were recruited. All patients underwent postoperative assessment with routine radiographic analysis for acromiohumeral distances, ultrasound imaging 1 and 3 months after SCR and magnetic resonance imaging (MRI) at least 12 months after SCR. The outcome measures were visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES), Constant and Single Assessment Numeric Evaluation (SANE) scores. RESULTS SCR was performed in 56 patients including side-to-side SCR in 32 and over-the-top SCR in 24. Postoperative MRI showed that the grafts were intact in 46 patients (82.1%; 26 who underwent side-to-side SCR and 20 who underwent over-the-top SCR). The proportion of nonhealing grafts in the over-the-top group was significantly higher with concomitant subscapularis tears (60% vs. 5.3%; p = 0.02). VAS scores and functional outcomes improved postoperatively in both groups and postoperative VAS (1.4 vs. 1.7; n.s.), Constant (74.8 vs. 76.0; n.s.), mean ASES (87.4 vs. 89.1; n.s.) and mean SANE (81.7 vs. 84.3; n.s.) scores did not differ significantly. CONCLUSION For massive rotator cuff tears, over-the-top and side-to-side SCR achieve similar pain relief and functional improvement, and the rate of healing allografts is high. However, over-the-top SCR is not recommended for massive posterosuperior rotator cuff tears with repairable subscapularis tendon tears due to a higher nonhealing rate. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Hsin-Pei Sung
- Department of Orthopedic Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Wei-Cheng Chen
- Department of Orthopedic Surgery, Mackay Memorial Hospital, Taipei, Taiwan
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Funakoshi T, Takahashi T, Murayama T, Miyamoto A, Koga R, Kusano H, Yamamoto Y. Arthroscopic superior capsule reconstruction augmentation using a semitendinosus autograft in massive reparable rotator cuff tears. JSES Int 2024; 8:32-40. [PMID: 38312265 PMCID: PMC10837716 DOI: 10.1016/j.jseint.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Background Arthroscopic superior capsule reconstruction (SCR) augmentation is a viable treatment option for massive reparable cuff tears. This study aimed to retrospectively compare clinical and imaging outcomes of patients with reparable massive rotator cuff tears after arthroscopic rotator cuff repair (ARCR) with those after SCR augmentation using a semitendinosus autograft. Methods We retrospectively compared 50 patients with massive reparable rotator cuff tears who underwent ARCR and SCR augmentation (n = 25 each). Patients were clinically followed up for at least 2 years, and the American Shoulder and Elbow index, other patient-reported outcomes, active range of motion, and radiography and magnetic resonance imaging findings were assessed. Results At the final follow-up, both patient groups showed significant improvements in forward elevation in range of motion and visual analog scale scores. Improvements in the American Shoulder and Elbow scores in the SCR augmentation group were significantly superior to those in the ARCR group (48.3 and 28.9, P < .01). There was a significant difference in the retear rate between the SCR augmentation group and ARCR group (20% and 56%, respectively; P = .009). Conclusion Our study demonstrated that patient-reported outcomes and retear rates in patients who underwent SCR augmentation with rotator cuff repair for massive rotator cuff tears significantly improved compared with those in patients who underwent ARCR without augmentation. Augmentation with semitendinosus autografting during rotator cuff repair represents a solution for patients with massive reparable rotator cuff tears.
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Affiliation(s)
- Tadanao Funakoshi
- Keiyu Shoulder Surgery Center, Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Toru Takahashi
- Keiyu Shoulder Surgery Center, Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Toshiki Murayama
- Keiyu Shoulder Surgery Center, Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Azusa Miyamoto
- Keiyu Shoulder Surgery Center, Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Ryuji Koga
- Keiyu Shoulder Surgery Center, Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Hiroshi Kusano
- Keiyu Shoulder Surgery Center, Keiyu Orthopaedic Hospital, Tatebayashi, Japan
| | - Yuzuru Yamamoto
- Keiyu Shoulder Surgery Center, Keiyu Orthopaedic Hospital, Tatebayashi, Japan
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Kizilay YO, Güneş Z, Turan K, Aktekin CN, Uysal Y, Kezer M, Camurcu Y. Volumetric Analysis of Subacromial Space After Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears. Indian J Orthop 2023; 57:967-974. [PMID: 37214362 PMCID: PMC10192490 DOI: 10.1007/s43465-023-00881-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/24/2023] [Indexed: 05/24/2023]
Abstract
Purpose Subacromial volume measurement on magnetic resonance images is relatively new. It has been shown that decreased subacromial volume increases after surgical repair of full-thickness rotator cuff tears. There is no study examining subacromial volume changes after superior capsular reconstruction (SCR). The purpose of this study was to compare subacromial volume changes on magnetic resonance images (MRI) after superior capsular reconstruction performed for primary irreparable rotator cuff tears. Methods Patients who underwent an SCR procedure between 2017 and 2019 with a minimum 2-year postoperative follow-up were included in this retrospective study. Subacromial volume was measured on MRI using software. The preoperative and postoperative acromiohumeral distance, Constant Scores, graft thickness, and Hamada grades of the patients were evaluated. Results A total of 18 patients with a mean age of 59.7 years (range: 49-74 years) underwent an SCR for massive irreparable cuff tear. The mean preoperative subacromial volume was 3.54 ± 0.39 cm3 (range 2.88-4.36 cm3), which increased to 4.46 ± 0.39 cm3 (range 3.75-5.32 cm3) postoperatively (p = < 0.001). The increase in subacromial volume and acromiohumeral distance did not correlate with Constant scores and graft thickness. We observed a significantly higher subacromial volume increase among Hamada grade 1 patients, compared to those with Hamada grade 2 (p = 0.011). Conclusions We observed that subacromial volume significantly increased after superior capsular reconstruction. However, the increase in subacromial volume did not correlate with clinical scores, acromiohumeral distance changes, or graft thickness.Level of evidence: Level III - Retrospective Cohort Study.
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Affiliation(s)
- Yusuf Onur Kizilay
- Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul Atlas University, Anadolu Caddesi 40, Kagithane, 34408 Istanbul, Turkey
| | - Zafer Güneş
- Ankara, Turkey Department of Orthopedics and Traumatology, Ankara Training and Research Hospital
| | - Kayhan Turan
- Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul Atlas University, Istanbul, Turkey
| | - Cem Nuri Aktekin
- Ankara, Turkey Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara Yıldırım Beyazıt University
| | - Yunus Uysal
- Department of Orthopedics and Traumatology, Bursa Osmangazi Aritmi Hospital, Bursa, Turkey
| | - Murat Kezer
- Department of Orthopedics and Traumatology, Bursa Osmangazi Aritmi Hospital, Bursa, Turkey
| | - Yalkin Camurcu
- Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul Atlas University, Istanbul, Turkey
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Shin SJ, Lee S, Hwang JY, Lee W, Koh KH. Superior Capsular Reconstruction Using Acellular Dermal Allograft Combined With Remaining Rotator Cuff Augmentation Improved Shoulder Pain and Function at 1 Year After The Surgery. Arthroscopy 2022; 38:1089-1098. [PMID: 34767952 DOI: 10.1016/j.arthro.2021.10.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/21/2021] [Accepted: 10/21/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study is to report structural integrity and clinical outcomes of superior capsular reconstruction (SCR) using a 4- to 5-mm acellular dermal allograft combined with augmentation of the remaining rotator cuff to the graft. METHODS We prospectively recruited 21 patients with symptomatic irreparable rotator cuff tear who required SCR. At least 6 months after the SCR, we evaluated each patient's graft healing by magnetic resonance imaging (MRI). We also assessed the range of motion (ROM), strength for forward flexion and external rotation, visual analog scale for pain (PVAS), American Shoulder and Elbow Surgeon (ASES) score, and Constant score. At minimum of 1 year after the surgery, we evaluated the number of patients with minimal clinically important differences (MCIDs) for each score to compare patients with healed and unhealed grafts. RESULTS Postoperative MRI showed the grafts intact in 14 patients (66.7%). Among 7 patients with unhealed grafts, tears were observed in 3 patients (42.9%) on the glenoid side, 3 (42.9%) on the humeral side, and 1 (14.3%) on both sides. PVAS, ASES score, and the Constant score improved after surgery (4.0 to 0.7 for PVAS [P < .001], 55.5 to 87.0 for ASES score [P < .001], and 56.0 to 65.9 for Constant score [P = .007]). However, there were no differences in postoperative ROM and muscle strength compared to preoperative measurements. MCIDs were reached in 90.5% of patients (n = 19) for the PVAS and in 71.4% of patients (n = 15) for the ASES score. Only 33.3% of patients (n = 7) obtained MCIDs for the Constant score, and none of the patients with a graft tear obtained MCIDs in the Constant score (P = .047). CONCLUSION The graft complete healing rate was 66.7%, although pain relief and functional improvement were satisfactory regardless of graft structural integrity. However, muscle strength recovery was not optimal until 1 year after surgery. LEVEL OF EVIDENCE Level IV; case series.
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Affiliation(s)
- Sang-Jin Shin
- Department of Orthopaedic Surgery, College of Medicine, Ewha Womens University Seoul Hospital, Seoul, Republic of Korea
| | - Sanghyeon Lee
- Department of Orthopaedic Surgery, Seoul Metropolitan City Seonam Hospital, Seoul, Republic of Korea
| | - Ji Young Hwang
- Department of Radiology, College of Medicine, Ewha Womens University Seoul Hospital, Seoul, Republic of Korea
| | - Wonsun Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Rhee SM, Youn SM, Park JH, Rhee YG. Biceps Rerouting for Semirigid Large-to-Massive Rotator Cuff Tears. Arthroscopy 2021; 37:2769-2779. [PMID: 33892075 DOI: 10.1016/j.arthro.2021.04.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare clinical and radiographic results of arthroscopic rotator cuff repair (ARCR) with biceps rerouting (BR) and those of conventional repair for semirigid, large-to-massive rotator cuff tear. METHODS We prospectively collected data of 111 patients who underwent either ARCR + BR (n = 59, group 1) or only ARCR (n = 52, group 2) for semirigid, large-to-massive rotator cuff tear between January 2016 and December 2018. We comparatively analyzed both groups with respect to preoperative factors including concomitant lesions of the long head of the biceps tendon (LHBT). Univariate logistic regression analysis was performed to identify predictive variables for occurrence of retear after ARCR + BR. RESULTS Mean age of groups 1 and 2 were 62.8 and 63.7 years, respectively (P = .484). Mean follow-up period in groups 1 and 2 were 15.1 and 25.1 months, respectively (P = .102). Mean range of motion and functional scores improved significantly (P < .05) and comparably (P > .05) in both groups. In total, 11 (18.6%) and 25 (48.1%) patients from groups 1 and 2, respectively, showed retear of the repaired rotator cuff at final follow-up (P < .01). Of 45 group 1 patients who showed less than 50% partial tearing of the LHBT preoperatively, 6 (13.3%) experienced retear. Comparatively, of 14 patients with partial tearing involving more than 50% of the LHBT, 5 (35.7%) suffered postoperative retear. If the patients had partial tear involving more than 50% of LHBT preoperatively, the odds ratio (OR) to have retear was 4.222 (P = .037). Wider (OR, 1.445, P = .047) and thinner (OR, 0.166, P = .019) LHBT were the prognostic factors to have retear. Three (5.1%) group 1 patients showed the Popeye deformity at final follow-up. CONCLUSIONS ARCR + BR for semirigid, large-to-massive rotator cuff tears effectively improved clinical and structural outcomes as also shown in the conventional repairs. However, the retear rate was significantly lower in patients who underwent ARCR + BR than those treated conventionally. Partial tearing involving more than 50% of the LHBT and wide and/or thin tendon morphology were significant risk factors for postoperative occurrence of retear. LEVEL OF EVIDENCE Level III, retrospective therapeutic comparative trial.
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Affiliation(s)
- Sung-Min Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Seung-Min Youn
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Myongji Hospital, Goyang-si, Korea
| | - Joon Hong Park
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Myongji Hospital, Goyang-si, Korea.
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Gao I, Sochacki KR, Freehill MT, Sherman SL, Abrams GD. Superior Capsular Reconstruction: A Systematic Review of Surgical Techniques and Clinical Outcomes. Arthroscopy 2021; 37:720-746. [PMID: 33227320 DOI: 10.1016/j.arthro.2020.09.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 09/06/2020] [Accepted: 09/10/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate surgical techniques and clinical outcomes of arthroscopic superior capsular reconstruction (SCR) for the treatment of massive irreparable rotator cuff tears. METHODS A systematic review was registered with PROSPERO and performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The PubMed, Scopus, and Cochrane databases were searched. Studies investigating SCR with reported surgical techniques were included. Animal studies, cadaveric studies, review studies, and letters to the editor were excluded. The technical aspects of the surgical techniques for SCR were analyzed in each article, which included graft type, glenoid fixation method, greater tuberosity fixation method, graft passage technique, suture management, margin convergence, concomitant procedures, and postoperative rehabilitation protocol. Clinical outcomes, when available, were also analyzed. RESULTS We screened 365 articles, of which 29 described surgical techniques for SCR. According to the Modified Coleman Methodology Score, 24 articles were rated as poor (score < 55), 4 were rated as fair (score between 55 and 69), and 1 was rated as good (score between 70 and 84), with an average score of 25.8 ± 20.9. The most commonly performed technique for SCR used the following: an acellular dermal allograft, 2 biocomposite suture anchors for glenoid fixation, transosseous-equivalent double-row suture anchor fixation for greater tuberosity fixation with 2 biocomposite medial-row anchors and 2 biocomposite lateral-row anchors, the double-pulley technique combined with an arthroscopic grasper and/or pull suture to pass the graft into the shoulder, the performance of both anterior and posterior margin convergence, and a native rotator cuff repair when possible. Only 8 studies reported clinical outcomes, and they showed that SCR provides significant improvement in patient-reported outcomes, significant improvement in shoulder range of motion, variable graft failure rates, low complication rates, and variable reoperation rates. There were no studies comparing outcomes among the various surgical techniques. CONCLUSIONS Many surgical techniques exist for arthroscopic SCR. However, no superior technique was shown because there were no studies comparing clinical outcomes among these various techniques. LEVEL OF EVIDENCE Level V, systematic review of Level III, IV, and V studies.
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Affiliation(s)
- Ian Gao
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, U.S.A..
| | - Kyle R Sochacki
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, U.S.A
| | - Michael T Freehill
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, U.S.A
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, U.S.A
| | - Geoffrey D Abrams
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, U.S.A
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Zheng X, Tang K. [Research progress of treatment for 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; 35:8-13. [PMID: 33448192 DOI: 10.7507/1002-1892.202004056] [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 treatment for massive rotator cuff tears. Methods The domestic and foreign literature about the treatment of massive rotator cuff tears was reviewed. The methods and effectiveness were extensively summarized. Results The treatment of massive rotator cuff tears still needs long-term research to promote its continuous improvement. The main goal of treatment is to relieve the symptoms and improve the shoulder joint function. With the development of arthroscopic technique, arthroscopic repair of rotator cuff tears has become a mature surgical protocol. Among these techniques, superior capsule reconstruction and patch augmentation for massive rotator cuff tears acquire more attention in recent years. As for rotator cuff arthropathy, reverse shoulder arthroplasty is considered to be a final choice. Conclusion Surgical treatment is the main choice for massive rotator cuff tears. Patients' age and muscle condition should be taken into consideration to decide the surgical technique.
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Affiliation(s)
- Xiaolong Zheng
- Department of Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
| | - Kanglai Tang
- Department of Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
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Hallock JD, Parsell DE, Field LD. Partial Rotator Cuff Repair for Massive Tears Rarely Require Revision Surgery. Arthrosc Sports Med Rehabil 2020; 3:e121-e126. [PMID: 33615256 PMCID: PMC7879165 DOI: 10.1016/j.asmr.2020.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/18/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the significance of initial and residual rotator cuff tear defect size on the need for revision surgery or additional nonsurgical therapy, in a consecutive group of patients undergoing partial repair of massive rotator cuff tears. Methods A retrospective chart review was carried out for all arthroscopic rotator cuff repairs performed by a single surgeon between January of 2013 and December of 2016. All patients with massive rotator cuff tears (>30 cm2) who underwent partial repair were included in the study. Outcomes for the surgical procedure were measured based on the necessity for revision surgery or adjunct therapy, including steroid injections or additional physical therapy after initial release from care. Results In total, 1954 patients who underwent arthroscopic rotator cuff repair were identified. Thirty-eight of these met the inclusion criteria. Those patients undergoing revision surgery represented 5.2% (2/38) of the series and had an average initial/residual tear defect area of 45.0/7.0 cm2. Patients requiring adjunct therapy represented 7.9% (3/38) of the series and possessed an average initial/residual tear defect size of 40.0/16.0 cm2. The remaining 33 (86.9%) patients did not require revision surgery or adjunct therapy at a minimum follow-up of 2 years. There was no significance between initial and/or residual rotator cuff tear defect size and the need for revision surgery. However, there was a significant difference in the mean residual defect size in the patients requiring additional nonoperative treatment after initial release from care (P = .012). Conclusions There was no relationship between residual defect size after partial repair and the need for revision surgery. Patients who returned for additional nonoperative treatment after being released from care were noted to have a statistically larger residual defect size at the time of index surgical intervention. Only 5% of patients underwent subsequent surgery at an average of more than 4 years’ follow-up, suggesting that partial repair of massive rotator cuff tears can provide a durable, joint-preserving intervention. Level of Evidence Level IV, Therapeutic Case Series
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Affiliation(s)
| | | | - Larry D. Field
- Address correspondence to Larry D. Field, M.D., 1325 East Fortification St., Jackson, MS 39202.
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Hirahara AM, Andersen WJ, Dooney T. Arthroscopic Knotless Rotator Cuff Repair With Decellularized Dermal Allograft Augmentation: The "Canopy" Technique. Arthrosc Tech 2020; 9:e1797-e1803. [PMID: 33294343 PMCID: PMC7695626 DOI: 10.1016/j.eats.2020.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/05/2020] [Indexed: 02/03/2023] Open
Abstract
Repairability and clinical outcomes of full-thickness rotator cuff tears rely on tendon mobility, tissue quality, and subsequent tension on a repair. While repair of rotator cuff tears tend to yield excellent clinical results, poor tissue quality has been an important factor that has hampered successful outcomes. This Technical Note describes a double-row rotator cuff repair using a SpeedBridge configuration with dermal allograft "canopy" augmentation to bolster the repairable but thinned rotator cuff tissue. This technique employs a unique graft fixation strategy to simplify the procedure. This approach could provide surgeons with a great option when faced with mobile but thinned rotator cuff tissue.
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Affiliation(s)
- Alan M. Hirahara
- Private Practice Sacramento, California, U.S.A.,Address correspondence to Alan M. Hirahara, M.D., FR.C.S.C., 2801 K St., #330, Sacramento, CA 95816.
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Alike Y, Hou JY, Tang YY, Yu ML, Long Y, Li FQ, Ali M, Yuan H, Yang R. Arthroscopic Superior Capsule Reconstruction and Rotator Cuff Repair to Restore Static and Dynamic Stability of the Shoulder. Orthop Surg 2020; 12:1503-1510. [PMID: 32851772 PMCID: PMC7670152 DOI: 10.1111/os.12768] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/09/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Treatment of massive irreparable rotator cuff tears (RCT) has shown limited clinical success and a variety of subsequent complications. Superior capsule reconstruction (SCR) has been proved to reestablish superior stability but does not restore the dynamic force or shoulder kinematics. There are numerous reports of the short-term failure of SCR grafts at the glenoid side, which relate to the non-biological healing of grafts. To restore both dynamic and static stability and to provide biologic augmentation, an integrated procedure for massive irreparable RCT using an Achilles tendon-bone allograft (ATBA) was developed. METHOD This was a retrospect study completed between October 2019 and April 2020. A 71-year-old woman with massive and irreparable rotator cuff tears was enrolled in our study. The ATBA was folded into a double-layer structure. The superior layer (proximal portion) served as a bridge patch to dynamic the glenohumeral joint, while the inferior layer (distal portion) served as the superior capsule to restore static stability of glenohumeral joint. To enhance biologic healing on the glenoid side, we fixed the calcaneus of the graft on the superior-posterior side of the superior glenoid rim. The recovery of shoulder function (including strength, range of motion, acromiohumeral interval, and fatty infiltration) was assessed at 6 months postoperation. RESULT At 6-month follow-up, the patient's strength had improved significantly (from abduction of grade 3 preoperatively to grade 4 at 6 months). Radiographic analysis showed an increase in the acromiohumeral interval from 3 to 7 mm. Magnetic resonance imaging revealed an intact graft, with the thickness of the ligament part maintained (at 6-7 mm). Most importantly, recovery of atrophy and fatty infiltration of the supraspinatus were observed. No graft tears were observed on the glenoid side. CONCLUSION This technique could provide a preferable treatment option by restoring shoulder kinematics and augmentating biological healing for patients with massive irreparable RCT.
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Affiliation(s)
- Yamuhanmode Alike
- Department of Emergency, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing-Yi Hou
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi-Yong Tang
- Department of Orthopaedic Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Meng-Lei Yu
- Department of Emergency, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi Long
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fang-Qi Li
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - MaslahIdiris Ali
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hao Yuan
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Yang
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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