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Baek CH, Kim BT, Kim JG, Kim SJ. Mid-Term Outcome of Superior Capsular Reconstruction Using Fascia Lata Autograft (At Least 6 mm in Thickness) Results in High Retear Rate and No Improvement in Muscle Strength. Arthroscopy 2024; 40:1961-1971. [PMID: 38311262 DOI: 10.1016/j.arthro.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To report and evaluate clinical and radiologic outcomes of superior capsular reconstruction (SCR) using fascia lata autograft in patients with irreparable rotator cuff tears (IRCTs) over a mid-term duration and to assess the overall survival rate of the graft. METHODS We retrospectively reviewed patients who underwent SCR with fascia lata autograft between June 2017 and August 2018. The graft, folded 3 or 4 times, achieved a minimum thickness of 6 mm during the surgical procedure. The inclusion criteria encompassed patients with isolated supraspinatus IRCTs or posterosuperior IRCTs exhibiting poor muscle quality (Goutallier grade ≥3) and without arthritis (Hamada grade ≤ 2). The exclusion criteria included lack of follow-up data or magnetic resonance imaging. Clinical assessments included the visual analog scale score, Constant score, and American Shoulder and Elbow Surgeons (ASES) score; active range of motion; and strength. Radiographic analysis included the acromiohumeral distance, Hamada grade, and graft integrity at final follow-up. A Kaplan-Meier curve was generated to depict SCR graft survivorship. RESULTS In total, 45 patients (mean age, 64.8 ± 5.7 years) were included, and the average follow-up duration was 63.2 ± 5.9 months (range, 50-79 months). There was significant improvement in pain (visual analog scale score of 4.4 ± 1.3 preoperatively vs 1.4 ± 0.4 at final follow-up, P < .001). Yet, 18 patients (40.0%) and 17 patients (37.7%) achieved the minimal clinically important difference in the ASES score and Constant score, respectively. Active forward elevation increased from 119° ± 23° to 137° ± 23° (P < .001), and external rotation at the side improved from 29° ± 11° to 36° ± 12° (P = .002). However, strength did not exhibit improvement in any direction. The acromiohumeral distance decreased from 8.5 ± 1.7 mm to 6.5 ± 1.9 mm (P < .001), and the Hamada grade increased from 1.1 ± 0.3 to 1.8 ± 1.1 (P < .001). Finally, the infection rate was 13.3% (n = 6). CONCLUSIONS Despite a substantial graft retear rate of 62.2%, SCR led to a significant improvement in pain. Nonetheless, 18 patients (40.0%) and 17 patients (37.7%) achieved the minimal clinically important difference in the ASES score and Constant score, respectively. Forward elevation and external rotation at the side showed significant improvement, but no improvement in muscle strength was observed. Finally, significant arthritis progression was observed. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Chang Hee Baek
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea.
| | - Bo Taek Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
| | - Jung Gon Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
| | - Seung Jin Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
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Browning RB, Fenn TW, Allahabadi S, Vogel MJ, Chapman RS, Beals C, Chan J, Nho SJ. Open and Endoscopic Gluteus Medius and/or Minimus Repair Achieves Clinical Success Regardless of Tear Grade: High-Grade Fatty Infiltration Portends Worse Outcomes. Arthroscopy 2024:S0749-8063(24)00398-0. [PMID: 38844013 DOI: 10.1016/j.arthro.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 05/04/2024] [Accepted: 05/12/2024] [Indexed: 07/22/2024]
Abstract
PURPOSE To evaluate minimum 2-year gluteus medius and/or minimus repair clinical success rates stratified by the 3-grade magnetic resonance imaging (MRI)-based classification (MRI grade) and to evaluate clinical success rates by the surgical approach used at each MRI grade and by the Goutallier-Fuchs (GF) classification. METHODS A retrospective review identified patients who underwent primary endoscopic or open gluteus medius and/or minimus repair from 2012 to 2021 performed by a single surgeon. Preoperative MRI scans were classified using the MRI grade and GF classification. Patient-reported outcomes were collected preoperatively and at minimum 2-year follow-up. Cohort-specific minimal clinically important difference and patient acceptable symptom state achievement was recorded. Rates of clinical success, defined as achievement of the 2-year minimal clinically important difference or patient acceptable symptom state with avoidance of revision surgery, were compared by MRI grade, by surgical approach at each MRI grade, and by GF classification. RESULTS A total of 112 patients (71 with MRI grade 1, 19 with grade 2, and 22 with grade 3) were included. MRI grade 1 patients underwent endoscopic repair (P < .001) more often than the other groups. The overall clinical success rate was 90%. Clinical success rates by MRI grade were 93% for grade 1, 95% for grade 2, and 77% for grade 3 (P = .087). Clinical success rates by the endoscopic and open surgical approaches used at each MRI grade were 93% versus 90% for grade 1 (P = .543), 91% versus 100% for grade 2 (P > .999), and 60% versus 92% for grade 3 (P = .135). GF grade 1 tears achieved a higher rate of clinical success than GF grade 4 tears (100% vs 71%, P = .030). CONCLUSIONS Primary repair of gluteus medius and/or minimus tears resulted in clinical success in most patients irrespective of MRI grade and irrespective of the surgical approach used at each MRI grade, yet GF grade 1 tears showed a significantly higher clinical success rate than GF grade 4 tears. LEVEL OF EVIDENCE Level IV, prognostic retrospective case series.
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Affiliation(s)
- Robert B Browning
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Thomas W Fenn
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Sachin Allahabadi
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Michael J Vogel
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Reagan S Chapman
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Corey Beals
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jimmy Chan
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Shane J Nho
- Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College of Rush University, Rush University Medical Center, Chicago, Illinois, U.S.A
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Baek CH, Kim BT, Kim JG, Kim SJ. Joint-preserving treatment for global irreparable rotator cuff tears: combined anterior Latissimus dorsi and Teres major tendon transfer. Arch Orthop Trauma Surg 2024; 144:1473-1483. [PMID: 38285220 DOI: 10.1007/s00402-023-05196-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 12/19/2023] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Treating global irreparable rotator cuff tears (GIRCTs) that involve both antero-and postero-superior cuff tendon tears could be a challenging problem. There has been limited joint-preserving treatment options in high-demand patients with minimal glenohumeral arthritis. The study aims to assess the clinical outcome of combined anterior latissimus dorsi and teres major tendon (aLDTM) transfer for patients with both GIRCTs and minimal glenohumeral arthritis. MATERIALS AND METHODS This retrospective study included patients who underwent combined aLDTM transfer for GIRCTs between 2018 May and 2020 October. Clinical outcomes include pain VAS, Constant, American Shoulder and Elbow Society (ASES), University of California Los Angeles (UCLA), activities of daily living requiring active internal rotation (ADLIR) score, active range of motion (aROM), strength, rates of pseudoparalysis or pseudoparesis reversal and return to work. Radiographic assessment included the acromiohumeral distance (AHD), Hamada grade, and transferred tendon integrity at final follow-up. RESULTS 23 patients (mean age: 64.7 ± 5.9 years [55-74]) were included and the mean follow-up period was 28.2 ± 4.3 [24‒36] months. Postoperatively, VAS, Constant, ASES, UCLA, and ADLIR scores significantly improved at final follow-up (P < .001). Postoperative aROM was significantly improved in forward elevation (FE) to 129° ± 29°, abduction (ABD) to 105° ± t3°, and internal rotation (IR) at back to 5.9 ± 2.5. Strength of both FE and IR were also significantly improved (P < .001). Patients with preoperative pseudoparalysis (2 of 4 patients) and pseudoparesis (6 of 6 patients) experienced a reversal. No significant change in AHD and hamada grade was confirmed at final follow-up. 3 patients experienced partial tear of the transferred tendon. CONCLUSIONS In this study, we found significant improvement in clinical outcomes with no significant progression of arthritis by final follow-up. The aLDTM transfer could be an alternative choice of joint-preserving treatment option for young and active patients with GIRCTs and minimal glenohumeral arthritis. However, large and long-term studies should be conducted to establish its adequacy. STUDY DESIGN Case series. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Chang Hee Baek
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-ro, Yeosu-si, Jeollanam-do, 59709, Republic of Korea.
| | - Bo Taek Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-ro, Yeosu-si, Jeollanam-do, 59709, Republic of Korea
| | - Jung Gon Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-ro, Yeosu-si, Jeollanam-do, 59709, Republic of Korea
| | - Seung Jin Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-ro, Yeosu-si, Jeollanam-do, 59709, Republic of Korea
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Lee S, Shin SJ. Postoperative Graft Volume Reduction Is Associated With Inferior Clinical Outcomes of Superior Capsule Reconstruction Using an Acellular Dermal Matrix Allograft. Arthroscopy 2024; 40:229-239. [PMID: 37394150 DOI: 10.1016/j.arthro.2023.06.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/10/2023] [Accepted: 06/16/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE To evaluate whether postoperative graft volume reduction is associated with clinical outcomes after superior capsule reconstruction (SCR) and to identify factors related to graft volume change. METHODS Between May 2018 and June 2021, patients who underwent SCR with acellular dermal matrix allograft for irreparable rotator cuff tear with a minimum 1-year follow-up and who had intact graft continuity in postoperative 6-month magnetic resonance imaging were retrospectively reviewed. The lateral half to the medial half of the graft volume ratio was defined as lateral half graft volume ratio. The difference between the preoperative and postoperative lateral half graft volume ratio was defined as lateral half graft volume change. Patients were divided into 2 groups: those with preserved graft volume (group I) and those with reduced graft volume (group II). Intergroup differences in clinical and radiological characteristics were analyzed. RESULTS A total of 81 patients were included, with 47 (58.0%) in group I and 34 (42.0%) in group II. Group I showed significantly lower lateral half graft volume change (0.018 ± 0.064 vs 0.370 ± 0.177; P < .001) than group II. Group II showed significantly greater preoperative Hamada grade (1.3 ± 0.5 vs 2.2 ± 0.6, P < .001), an anteroposterior distance of the graft at the greater tuberosity (APGT) (30.3 ± 4.8 vs 35.2 ± 3.8, P < .001), and fatty infiltration of infraspinatus (2.3 ± 0.9 vs 3.1 ± 0.8, P < .001) and subscapularis (0.9 ± 0.9 vs 1.6 ± 1.3, P = .009) than group I. Group II had a significantly lower proportion of patients achieving MIC in Constant score than group I (70.2% vs 47.1%, P = .035). The Hamada grade, APGT, and fatty infiltration of infraspinatus and subscapularis were independent factors of graft volume change. CONCLUSIONS Although SCR improved pain and shoulder function, postoperative graft volume reduction was related to a lower rate of minimal important change achievement in the Constant score compared with preserved graft volume. The preoperative Hamada grade, APGT, and fatty infiltration of infraspinatus and subscapularis were associated with graft volume reduction. LEVEL OF EVIDENCE Level III, retrospective case-control study.
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Affiliation(s)
- Sanghyeon Lee
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Sang-Jin Shin
- Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea.
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Lee JB, Kholinne E, Ben H, So SP, Alsaqri H, Koh KH, Jeon IH. Superior Capsular Reconstruction Combined With Lower Trapezius Tendon Transfer Improves the Biomechanics in Posterosuperior Massive Rotator Cuff Tears. Am J Sports Med 2023; 51:3817-3824. [PMID: 37975524 DOI: 10.1177/03635465231207834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Surgical treatments for chronic posterosuperior massive rotator cuff tear (MRCT) are still controversial. Superior capsular reconstruction (SCR), which provides a static stabilizer to decrease superior humeral head translation, and lower trapezius tendon transfer (LTTT) with centralization of the humeral head, which prevents superior humeral head migration, are potential surgical options. To date, SCR combined with LTTT has not been fully investigated. HYPOTHESIS Restoration of static stabilizer and dynamic stabilizer together would effectively improve shoulder kinematics in posterosuperior MRCT. STUDY DESIGN Controlled laboratory study. METHODS A custom-made shoulder mechanics testing system was used to test 8 fresh-frozen cadaveric shoulders. The testing conditions were as follows: (1) intact; (2) posterosuperior MRCT (supraspinatus and infraspinatus removed); (3) SCR using the fascia lata; (4) LTTT; and (5) SCR combined with LTTT. The total rotational range of motion (ROM), superior translation, anteroposterior translation, and peak subacromial contact pressure were evaluated at 0°, 30°, and 60° of shoulder abduction. Repeated-measures analysis of variance and Tukey post hoc tests were performed. RESULTS The total rotational ROM, superior translation, anteroposterior translation, and peak subacromial contact pressure increased in posterosuperior MRCTs (all, P < .05). The rotational ROM, superior translation, anteroposterior translation, and peak subacromial contact pressure at 0° and 30° of shoulder abduction decreased in SCR (all, P < .05). However, there was no significant improvement in rotational ROM, superior translation, and peak subacromial contact pressure at 60° of shoulder abduction (P > .05). LTTT resulted in a significant decrease in the superior translation, anteroposterior translation, and peak subacromial contact pressure at 0°, 30°, and 60° of shoulder abduction (P < .05). SCR combined with LTTT restored the total rotational ROM, superior translation, anteroposterior translation, and peak subacromial contact pressure at 0°, 30°, and 60° of shoulder abduction (all, P < .05). CONCLUSION In the cadaveric model, SCR combined with LTTT showed improved shoulder kinematics and contact pressures in the posterosuperior MRCT model compared with SCR or LTTT alone. CLINICAL RELEVANCE SCR combined with LTTT may be regarded as an alternative surgical procedure for posterosuperior MRCTs.
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Affiliation(s)
- Jun-Bum Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Erica Kholinne
- Department of Orthopedic Surgery, Saint Carolus Hospital, Faculty of Medicine, Universitas Trisakti, Jakarta, Indonesia
| | - Hui Ben
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Pil So
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hood Alsaqri
- Department of Orthopaedic Surgery, Rustaq Hospital, Rustaq, Sultanate of Oman
| | - Kyoung-Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Lee JB, Kholinne E, Yeom JW, So SP, Ben H, Alsaqri H, Koh KH, Jeon IH. Evaluation of a New MRI-Based Classification of Graft Status After Superior Capsule Reconstruction. Orthop J Sports Med 2023; 11:23259671231193315. [PMID: 37781637 PMCID: PMC10536853 DOI: 10.1177/23259671231193315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/03/2023] [Indexed: 10/03/2023] Open
Abstract
Background A classification system for the graft state after superior capsule reconstruction (SCR) using magnetic resonance imaging (MRI) has not been described previously. Purpose To introduce a new, MRI-based classification system for graft integrity after SCR and to evaluate the system according to postoperative outcomes. Study Design Cohort study (diagnosis); Level of evidence, 3. Method Included were 62 consecutive patients who underwent SCR using autologous fascia lata graft between January 2013 and April 2021. Postoperative outcomes were assessed (American Shoulder and Elbow Surgeons [ASES] score, Constant score, pain visual analog scale [pVAS], range of motion [ROM], acromiohumeral distance [AHD], Hamada grade). Graft status was classified by 2 orthopaedic surgeons on postoperative MRI in accordance with the signal intensity and the presence or extent of the tear, as follows: type 1 (hypointense signal without tear), type 2 (hyperintense signal without tear), type 3 (partial-thickness tear), type 4 (full-thickness tear with partial continuity), and type 5 (full-thickness tear with complete discontinuity). Intra- and interobserver agreement were assessed using Cohen kappa. The correlation between postoperative outcomes (ASES score, Constant score, pVAS, ROM, AHD, and Hamada grade) and the SCR graft classification system was assessed with the Pearson correlation coefficient, and the outcomes were compared according to classification type. Results Patients were classified according to the new system as follows: type 1 (n = 15), type 2 (n = 20), type 3 (n = 7), type 4 (n = 8), and type 5 (n = 12). There was excellent interobserver agreement (κ = 0.819) and intraobserver agreement (κ = 0.937 and 0.919). The classification system showed a moderate to high correlation with the ASES score (r = -0.451; P = .001), pVAS (r = 0.359; P = .005), AHD (r = -0.642; P < .001), and Hamada grade (r = 0.414; P < .001). Patients classified as having types 1 and 2 showed better outcomes in terms of ASES score, pVAS, ROM, and AHD compared with type 5 patients (P ≤ .021 for all). Conclusion The new classification system was highly reproducible and showed clinical utility for both radiological and clinical evaluation after SCR.
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Affiliation(s)
- Jun-Bum Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Erica Kholinne
- Department of Orthopedic Surgery, St Carolus Hospital, Faculty of Medicine, Universitas Trisakti, Jakarta, Indonesia
| | - Ji Woong Yeom
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Pil So
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hui Ben
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hood Alsaqri
- 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
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Thangarajah T, Tsuchiya S, Lukenchuk J, Lo IK. Arthroscopic superior capsular reconstruction with dermal allograft for primary and recurrent rotator cuff tears. JSES Int 2023; 7:574-580. [PMID: 37426916 PMCID: PMC10328778 DOI: 10.1016/j.jseint.2023.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Background The aim of this study was to compare the clinical outcomes and retear rate of arthroscopic superior capsular reconstruction (SCR) with dermal allograft following structural failure of a previous rotator cuff repair, with a cohort of primary SCRs. Methods This was a retrospective comparative study with a study group comprising 22 patients who were followed up at a minimum of 24 (mean, 41; range, 27-65) months after SCR with dermal allograft performed for structural failure of a previous rotator cuff repair. The control group included 13 patients who previously underwent a primary SCR using dermal allograft and were followed up for 24 months. Clinical outcome measures comprised range of motion, the American Shoulder and Elbow Surgeons score, and the Western Ontario Rotator Cuff (WORC) Index. Radiological outcomes included the acromiohumeral interval and graft integrity on magnetic resonance imaging at one year. Logistic regression was used to determine whether SCR being undertaken as either a primary or revision procedure influenced functional outcomes or retear rate. Results The mean age at the time of surgery was 58 (range, 39-74) years for the study group and 60 (range, 48-70) years for the control group. Forward flexion improved from a mean of 117° (range, 7°-180°) preoperatively to 140° (range, 45°-170°) postoperatively (P = .11), and external rotation increased from a mean of 31° (range, 0°-70°) preoperatively to 36° (range, 0°-60°) postoperatively (P = .23). The American Shoulder and Elbow Surgeons score improved (P = 0) from a mean of 38 (range, 12-68) to 73 (range, 17-95), and the WORC Index improved (P = 0) from a mean of 29 (range, 7-58) to 59 (range, 30-97). Following SCR, there was no significant change in the acromiohumeral interval. The graft was intact in 42% of cases on magnetic resonance imaging and none of the retears underwent further surgery. Compared to revision SCR, primary SCR resulted in a significant improvement in forward flexion (P = .001), external rotation (P = 0), and WORC Index (P = .019). Logistic regression demonstrated that SCR performed as a revision procedure was associated with a higher retear rate (P = .006) and worse forward flexion (P = .009) and external rotation (P = .008). Conclusion SCR using human dermal allograft following structural failure of a previous rotator cuff repair can lead to an improvement in clinical outcomes but the results are inferior to primary procedures.
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Affiliation(s)
- Tanujan Thangarajah
- Corresponding author: Tanujan Thangarajah, MB ChB (hons), MSc, PhD, FRCS (Tr&Orth), MAcadMEd, Department of Trauma and Orthopaedic Surgery, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4 Canada.
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Lee JB, Kholinne E, Ben H, So SP, Alsaqri H, Lee HJ, Koh KH, Jeon IH. Clinical and Radiological Outcomes of Arthroscopic Superior Capsular Reconstruction Versus Primary Rotator Cuff Repair in Massive Rotator Cuff Tears: A Propensity Score-Matched Study. Am J Sports Med 2023; 51:1971-1978. [PMID: 37260275 DOI: 10.1177/03635465231171928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Arthroscopic superior capsular reconstruction (aSCR) has emerged as a treatment option for managing massive rotator cuff tears (MRCTs) given the unpredictable results after an arthroscopic rotator cuff repair (aRCR). Yet, few comparative studies of aSCR and aRCR have been conducted. PURPOSE To compare the clinical and radiological outcomes between aRCR and aSCR in patients with MRCT. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 163 cases of MRCT from 2010 to 2020 with follow-up ≥2 years were retrospectively reviewed. Among them, 102 had aRCR and 61 had aSCR using fascia lata autograft. Propensity score matching was used to select controls matched for age, sex, diabetes mellitus, osteoporosis, preoperative American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation score, Constant score, pain visual analog scale (pVAS) score, range of motion (ROM), tear size, global fatty degeneration index, and acromiohumeral distance (AHD). Last, 33 cases in each group were selected after propensity score matching. Radiological assessment was conducted using serial postoperative magnetic resonance imaging. Pre- and postoperative findings-including American Shoulder and Elbow Surgeons, pVAS, Single Assessment Numeric Evaluation, and Constant scores and ROM-were assessed to compare clinical outcomes. For radiological outcomes, global fatty degeneration index, AHD, and healing rate were evaluated. Healing failure was defined as Sugaya classification IV or V in the aRCR group, as compared with a full-thickness tear of the graft in the aSCR group, which corresponded to Sugaya classification IV or V. RESULTS Postoperative clinical outcomes were significantly improved at the final follow-up in both groups. In the aSCR group, postoperative forward flexion, pVAS, and AHD were significantly improved as compared with the aRCR group (mean, 161° vs 148° [P = .02]; 1.03 vs 1.64 [P = .047]; 7.00 vs 5.23 mm [P < .001], respectively). The healing rate was 20 of 33 (60.6%) for aRCR and 29 of 33 (87.9%) for aSCR (P = .022). CONCLUSION aSCR and aRCR are effective and reliable treatment options for MRCT. However, when compared with aRCR, aSCR showed improved clinical outcomes, including pVAS score, postoperative ROM, and favorable radiological findings, including AHD and a higher healing rate.
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Affiliation(s)
- Jun-Bum Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Erica Kholinne
- Department of Orthopedic Surgery, St Carolus Hospital, Faculty of Medicine, Trisakti University, Jakarta, Indonesia
| | - Hui Ben
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Pil So
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hood Alsaqri
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Orthopaedic Surgery, Rustaq Hospital, Rustaq, Sultanate of Oman
| | - Hyun June 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
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Hommen JP, Heifner JJ, Sakalian PA, Grewal G, Benito J. Irreparable Rotator Cuff Tear Treated With Combined Reconstruction of the Superior Capsule and Rotator Cuff: Technique Guidelines. Arthrosc Tech 2023; 12:e965-e973. [PMID: 37424647 PMCID: PMC10323923 DOI: 10.1016/j.eats.2023.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/23/2023] [Accepted: 02/14/2023] [Indexed: 07/11/2023] Open
Abstract
Irreparable rotator cuff tears in young patients can be challenging for the patient and orthopaedic surgeon. Interposition rotator cuff reconstruction has gained popularity in patients with retracted tears and a viable rotator cuff muscle belly. Superior capsular reconstruction is an emerging treatment option that was developed to restore native glenohumeral joint mechanics by creating a superior constraint, which provides a stable glenohumeral fulcrum. Reconstructing both the superior capsule and rotator cuff tendon in the setting of an irreparable tear may improve clinical results in younger patients with viable rotator cuff muscle belly and a maintained acceptable acromiohumeral distance.
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Affiliation(s)
- Jan Pieter Hommen
- Larkin Hospital Department of Orthopaedics, Coral Gables, Florida, U.S.A
| | - John J. Heifner
- Miami Orthopaedic Research Foundation, Miami, Florida, U.S.A
| | - Philip A. Sakalian
- Larkin Hospital Department of Orthopaedics, Coral Gables, Florida, U.S.A
| | - Gagan Grewal
- Larkin Hospital Department of Orthopaedics, Coral Gables, Florida, U.S.A
| | - Jorge Benito
- Larkin Hospital Department of Orthopaedics, Coral Gables, Florida, U.S.A
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Muench LN, Dyrna F, Otto A, Wellington I, Obopilwe E, Scheiderer B, Imhoff AB, Beitzel K, Mazzocca AD, Berthold DP. Superior Capsular Reconstruction Partially Restores Native Glenohumeral Joint Loads In A Dynamic Biomechanical Shoulder Model. Arthroscopy 2023:S0749-8063(23)00199-8. [PMID: 36868531 DOI: 10.1016/j.arthro.2023.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE To evaluate the effect of an irreparable posterosuperior rotator cuff tear (PSRCT) on glenohumeral joint loads and to quantify improvement following superior capsular reconstruction (SCR) using an acellular dermal allograft. METHODS Ten fresh-frozen cadaveric shoulders were tested using a validated dynamic shoulder simulator. A pressure mapping sensor was placed between the humeral head and glenoid surface. Each specimen underwent the following conditions: (1) native, (2) irreparable PSRCT, (3) SCR using a 3mm-thick acellular dermal allograft. Glenohumeral abduction angle (gAA) and superior humeral head migration (SM) were measured using 3D motion tracking software. Cumulative deltoid force (cDF) and glenohumeral contact mechanics, including contact area (gCA) and contact pressure (gCP), were assessed at rest,15°,30°,45°, and maximum angle of glenohumeral abduction. RESULTS The PSRCT resulted in a significant decrease of gAA along with an increase in SM, cDF, and gCP (P<.001, respectively). SCR did not restore native gAA (P<.001), however, SM was significantly reduced (P<.001). Further, SCR significantly reduced deltoid forces at 30° (P=.007) and 45° of abduction (P=.007) when compared to the PSRCT. SCR did not restore native cDF at 30°(P=.015), 45°(P<.001), and maximum angle (P<.001) of glenohumeral abduction. Compared to the PSRCT, SCR resulted in a significant decrease of gCP at 15°(P=.008), 30°(P=.002), and 45°(P=.006). However, SCR did not completely restore native gCP at 45° (P=.038) and maximum abduction angle (P=.014). CONCLUSION In this dynamic shoulder model, SCR only partially restored native glenohumeral joint loads. However, SCR significantly decreased glenohumeral contact pressure, cumulative deltoid forces, and superior migration, while increasing abduction motion, when compared to the posterosuperior rotator cuff tear. CLINICAL RELEVANCE These observations raise concerns regarding the true joint preserving potential of SCR for an irreparable posterosuperior rotator cuff tear, along with its ability to delay progression of cuff tear arthropathy and eventual conversion to reverse shoulder arthroplasty.
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Affiliation(s)
- Lukas N Muench
- Department of Sports Orthopaedics, Technical University of Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.
| | | | - Alexander Otto
- Department of Sports Orthopaedics, Technical University of Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Ian Wellington
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Bastian Scheiderer
- Department of Sports Orthopaedics, Technical University of Munich, Germany
| | - Andreas B Imhoff
- Department of Sports Orthopaedics, Technical University of Munich, Germany
| | - Knut Beitzel
- Arthroscopy and Orthopedic Sportsmedicine, ATOS Orthoparc Clinic, Cologne, Germany
| | - Augustus D Mazzocca
- Massachusetts General Hospital, Massachusetts General Brigham, Harvard Medical School, Boston, MA 02115, USA
| | - Daniel P Berthold
- Department of Sports Orthopaedics, Technical University of Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
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Ben H, Kholinne E, Zeng CH, So SP, Lee JB, Sun Y, Koh KH, Jeon IH. Early Postoperative MRI Evaluation of a Fascia Lata Autograft With and Without Polypropylene Mesh Augmentation After Superior Capsular Reconstruction. Am J Sports Med 2023; 51:912-918. [PMID: 36786289 DOI: 10.1177/03635465231151927] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND Recently, a polypropylene mesh has been introduced and reported to improve clinical outcomes after superior capsular reconstruction (SCR) using a fascia lata autograft (FLA). However, mesh-related events such as a foreign body response may trigger inflammation, which might affect graft healing and remodeling. PURPOSE/HYPOTHESIS The aim was to investigate whether the healing and remodeling of an FLA were affected by the use of a mesh by comparing the signal intensity of an FLA-alone group vs an FLA + Mesh group on postoperative magnetic resonance imaging (MRI). The hypothesis was that the use of a mesh would decrease the MRI signal intensity of FLA during the early postoperative phase. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who had undergone SCR using an FLA with or without a mesh between March 2013 and August 2021 were retrospectively analyzed. Follow-up MRI was performed at 3 months. A total of 78 patients (24 in the FLA group and 54 in the FLA + Mesh group) with intact grafts were included. Graft remodeling was evaluated by analyzing the signal-to-noise quotient (SNQ) at the humeral, mid-substance, and glenoid sites. Theoretically, lower SNQ ratios indicate higher strength and better healing of the graft. RESULTS The mean SNQ was 30.603 (range, 11.790-72.710) in the FLA group and 18.367 (range, 4.464-69.500) in the FLA + Mesh group (P < .001). Furthermore, significant differences were found between the 2 groups at the humeral and mid-substance sites (37.863 [range, 5.092-81.187] vs 15.512 [range, 1.814-80.869], P < .001; and 29.168 [range, 6.103-73.900] vs 16.878 [range, 2.454-92.416], P = .003; respectively). However, there was no difference between the 2 groups at the glenoid site (25.346 [range, 7.565-86.353] vs 20.354 [range, 3.732-88.468], P = .057). CONCLUSION At the 3-month follow-up, the FLA + Mesh group showed a lower MRI signal intensity than the FLA group. The healing and remodeling of an FLA may be enhanced when a mesh is used.
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Affiliation(s)
- Hui Ben
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Erica Kholinne
- Faculty of Medicine, Universitas Trisakti, Department of Orthopedic Surgery, St Carolus Hospital, Jakarta, Indonesia
| | - Chu Hui Zeng
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Pil So
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun-Bum Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yucheng Sun
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Kyoung-Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Early postoperative recovery comparisons of superior capsule reconstruction to tendon transfers. J Shoulder Elbow Surg 2023; 32:276-285. [PMID: 36115613 DOI: 10.1016/j.jse.2022.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/11/2022] [Accepted: 07/29/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The management of massive posterosuperior rotator cuff tears is controversial, with no gold standard. Two recently developed techniques that have shown promising initial results include arthroscopic superior capsular reconstruction (SCR) and tendon transfers (latissimus or lower trapezius). However, there remains a scarcity of studies examining each procedure's early postoperative clinical outcomes individually or in comparison to each other. The purpose of this study is to compare the early postoperative recovery outcomes of tendon transfers (TTs) to SCR. METHODS Using the surgical outcomes system global database (Arthrex Inc.), we assessed the postoperative recovery outcomes for all patients who had outcomes recorded at least 6 months after SCR or TT. The time points analyzed included preoperative and postoperative (2 weeks, 6 weeks, 3 months, 6 months, 1 year, 2 years). The outcomes analyzed included pain visual analog scale (VAS) score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, VR-12 physical, and Single Assessment Numeric Evaluation (SANE). RESULTS Overall, 163 patients underwent SCR and 24 arthroscopically assisted TT. The mean age for SCR and TT was 60 and 56 years, respectively. Postoperative recovery curves demonstrate that both procedures produced improved outcomes at each postoperative time point compared to preoperative. The pain and functional outcomes measures, including VAS, ASES, SANE, and VR-12 physical, were comparable for TT and SCRs, with similar recovery curves between the 2 techniques. Ultimately at 2 years postoperatively, there were no significant differences between the 2 techniques. CONCLUSIONS Analysis of the early outcomes associated with arthroscopic treatment of massive posterosuperior rotator cuff tears demonstrated that the arthroscopically assisted tendon transfers and arthroscopic superior capsular reconstruction had similar pain and functional outcomes throughout the 2-year postoperative recovery period. Overall, the process of recovery appears equivalent between the 2 techniques. Future studies are needed to assess the outcomes of each technique and specific indications in an attempt to delineate an algorithm for the treatment of irreparable rotator cuff tears.
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Ulstrup A, Reinhold M, Falster O. Superior capsular reconstruction with a porcine xenograft. JSES Int 2023. [DOI: 10.1016/j.jseint.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
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Hasegawa A, Mihata T, Fukunishi K, Itami Y, Uchida A, Neo M. Structural and clinical outcomes after superior capsule reconstruction using an at least 6-mm-thick fascia lata autograft including the intermuscular septum. J Shoulder Elbow Surg 2023; 32:e48-e59. [PMID: 35998778 DOI: 10.1016/j.jse.2022.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/18/2022] [Accepted: 07/07/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Superior capsule reconstruction (SCR) is a viable treatment option for irreparable rotator cuff tears. However, graft tear rate is highly variable in the previous studies, and the impact of graft tears on clinical outcomes after arthroscopic SCR remains controversial. We aimed to investigate the graft tear rate, timing of graft tear, and the impact of graft tears on clinical outcomes after arthroscopic SCR using an at least 6-mm-thick fascia lata autograft including the intermuscular septum. METHODS This retrospective multi-institutional study included 154 patients (79 women and 75 men; mean age, 69.9 yr; age range, 49-87 yr) with irreparable rotator cuff tears who underwent arthroscopic SCR using an at least 6-mm-thick fascia lata autograft including the intermuscular septum and completed a minimum 2-year follow-up. Postoperative graft integrity was evaluated by magnetic resonance imaging examinations performed at 3, 6, 12, and 24 mo after surgery. The presence of a full-thickness defect within the graft was diagnosed as a graft tear. In contrast, a graft without a full-thickness defect was diagnosed as a healed graft. We compared the following data between patients with and without graft tears: (1) baseline characteristics, (2) visual analog scale pain score, (3) Japanese Orthopaedic Association score, (4) American Shoulder and Elbow Surgeons shoulder score, and (5) active range of motion. RESULTS The overall graft tear rate was 11.7% (18 of 154 patients). Of 18 graft tears, 14 (77.8%) occurred within 6 mo after SCR. Two additional graft tears were diagnosed at 12 mo postoperatively and another 2 at 24 mo after SCR. The visual analog scale, American Shoulder and Elbow Surgeons, and Japanese Orthopaedic Association scores improved significantly after SCR in both patients with and without graft tears (all P < .0001). However, patients with graft tears showed significantly inferior postoperative visual analog scale, American Shoulder and Elbow Surgeons, and Japanese Orthopaedic Association scores (1.9, 75.2, and 77.4, respectively) than those without graft tears (0.5, 93.1, and 92.3, respectively; all P < .01). CONCLUSIONS The overall graft tear rate after arthroscopic SCR using an at least 6-mm-thick fascia lata autograft including the intermuscular septum was low (11.7%), relatively to that reported in previous studies. The majority of graft tears (77.8%) occurred within 6 mo after SCR. Graft healing was associated with more favorable clinical outcomes after SCR.
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Affiliation(s)
- Akihiko Hasegawa
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
| | - Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan; Department of Orthopedic Surgery, First Towakai Hospital, Takatsuki, Japan
| | - Kunimoto Fukunishi
- Department of Orthopedic Surgery, Rakusai Shimizu Hospital, Kyoto, Japan
| | - Yasuo Itami
- Department of Orthopedic Surgery, Takatsuki Red Cross Hospital, Takatsuki, Japan
| | - Akihiro Uchida
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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Ting RS, Rosenthal R, Al-Housni HS, Lam PH, Murrell GA. Factors influencing clinical outcomes in superior capsular reconstruction: A scoping review. J Clin Orthop Trauma 2023; 36:102081. [PMID: 36479505 PMCID: PMC9720335 DOI: 10.1016/j.jcot.2022.102081] [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: 06/24/2022] [Revised: 10/18/2022] [Accepted: 11/23/2022] [Indexed: 12/02/2022] Open
Abstract
Background It is undetermined how effective superior capsule/capsular reconstruction (SCR) is, and which factors influence clinical outcomes. Questions/purposes (1) To identify which factors influence outcomes in SCR, (2) to evaluate the effect of graft integrity on clinical outcomes, and (3) to compare SCR to other procedures for irreparable rotator cuff tears. Methods PubMed and EMBASE databases were searched for clinical SCR studies. Data on specific factors that influenced outcomes, that compared outcomes between intact/torn graft groups, or compared SCR to alternative treatments for irreparable tears were extracted by two investigators. Random-effects meta-analysis was performed to compare outcomes between intact vs torn SCR grafts. Results 394 articles were identified. 100 full-text articles were screened. 13 studies were included for scoping review. Eight studies were meta-analyzed. Better clinical scores were found in younger patients, with intact/repairable subscapularis, without acetabulization/arthritis, who played sports. In patients with irreparable tears without arthritis, SCR produced similar clinical scores at 2 years as shoulder arthroplasty and partial infraspinatus repair, and greater improvements in ASES and Constant scores than latissimus dorsi tendon transfer. Intact grafts produced better VAS (mean difference [MD] = 0.97, 95% confidence interval [-1.45-0.50], P < 0.0001, I 2 = 67%, n [patients] = 261), ASES (MD = 8.29, [2.89-13.70], P = 0.003, I 2 = 74%, n = 281), external rotation (MD = 4.49, [0.36-8.61], P = 0.03, I 2 = 0%, n = 240), and acromiohumeral distance (MD = 2.45, [0.96-3.94], P = 0.001, I 2 = 92%, n = 260) than torn grafts. Conclusions Patients who underwent SCR for irreparable rotator cuff tears were more likely to have better clinical outcomes if they were younger, had intact/repairable subscapularis, without acetabulization/arthritis, played sports and had intact grafts.
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Affiliation(s)
- Ryan S. Ting
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Ron Rosenthal
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Hilal S.A. Al-Housni
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Patrick H. Lam
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - George A.C. Murrell
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
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Does arthroscopic superior capsule reconstruction using porcine dermal xenograft represent a viable option in case of massive irreparable posterosuperior rotator cuff tear? Arch Orthop Trauma Surg 2023; 143:439-445. [PMID: 35084550 DOI: 10.1007/s00402-022-04335-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 01/03/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of the present study was to evaluate clinical and structural outcomes of patients with a massive irreparable rotator cuff tear treated with arthroscopic superior capsule reconstruction using an acellular porcine dermal xenograft. We hypothesized that this procedure would lead to improvement in clinical and functional results and that structural failure would not influence the final clinical results. MATERIALS AND METHODS A retrospective analysis on arthroscopic superior capsule reconstruction performed from October 2016 to January 2019 was conducted. The procedure was performed in patients with a massive irreparable posterosuperior rotator cuff tear without a severe glenohumeral arthropathy (Hamada I and II) and complaining a painful pseudoparalysis. Clinical evaluation and MRI study were performed before surgery and after at least 14 months. RESULTS A comprehensive group of 21 patients with 11 females and 10 males and a mean age of 57 ± 8.5 years underwent arthroscopic superior capsule reconstruction. The graft had a thickness of 1.5 mm in the first 9 cases (43%) since it was used in a single layer. The graft was thereafter doubled for technique evolution in the following 12 cases (57%) achieving a graft thickness of 3 mm. Active ROM significantly improved with a mean increase of active forward flexion from 72.8° ± 7.5° to 120.6° ± 4.5°, active abduction from 68.3° ± 10.2° to 140.2° ± 8.8° and external rotation from 38.2° ± 11.2° to 56.7° ± 6.8° at the last follow-up. The mean Constant score significantly improved from 40.4 ± 6.7 to 73.3 ± 8.2. A graft tear revealed in 52% (11/21) of overall patients was significantly more frequent in single layer graft when compared to double layer (77% vs 33%, p < 0.05). Location and type of graft tear significantly influenced final outcomes. Patients with a healed (graft continuity with bone at medial and lateral insertion) or medial graft tear showed statistically significant better outcomes when compared with patients in which the graft was completely reabsorbed or torn on humeral side (p < 0.05). CONCLUSION Arthroscopic superior capsule reconstruction using an acellular porcine dermal xenograft may be a viable alternative to treat massive posterosuperior rotator cuff tear in patients with a painful pseudoparalysis without anterosuperior escape. Structural failure may strongly influence final outcomes with significant role played by tear location.
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Lee JB, Kholinne E, Yeom JW, Ben H, AlAhmadi BM, Koh KH, Jeon IH. Effect of Fatty Infiltration of the Infraspinatus Muscle on Outcomes and Graft Failure After Arthroscopic Superior Capsule Reconstruction for Irreparable Posterosuperior Rotator Cuff Tears. Am J Sports Med 2022; 50:3907-3914. [PMID: 36341723 DOI: 10.1177/03635465221130459] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Superior capsule reconstruction (SCR) was developed as an alternative treatment for irreparable rotator cuff tears to restore superior stability of the glenohumeral joint. Although fatty infiltration (FI) of the rotator cuff muscles, especially the infraspinatus, has been implicated as a predictor of outcomes and graft integrity after rotator cuff repair, it has not been fully investigated in cases of SCR. PURPOSE To evaluate the effect of FI of the infraspinatus muscle on clinical and radiological outcomes after SCR. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 55 consecutive patients with irreparable posterosuperior rotator cuff tears who underwent SCR between January 2013 and August 2020 were included retrospectively. Preoperative and postoperative clinical and radiological findings (median follow-up of >2 years), including magnetic resonance imaging results, were thoroughly reviewed. The patients were divided into 2 groups: group 1 with mild FI of the infraspinatus (Goutallier grades 0-2) and group 2 with severe FI of the infraspinatus (Goutallier grades 3-4). The American Shoulder and Elbow Surgeons score, Constant score, visual analog scale score for pain, and range of motion were evaluated. Acromiohumeral distance and rotator cuff tear arthropathy using the Hamada classification were assessed on plain radiography. Postoperative graft integrity was evaluated by magnetic resonance imaging. Graft failure was defined as complete discontinuity. Univariate and multivariable logistic regression analyses were performed to evaluate clinical and radiological findings that might be associated with successful SCR. RESULTS Clinical and radiological outcomes significantly improved after SCR. Graft failure was noted in 15 (27.3%) patients and was more frequent in group 2 than in group 1 (50.0% vs 14.3%, respectively; P = .004). Univariate analysis indicated a significant association between severe FI in the infraspinatus (group 2) and graft failure after SCR (odds ratio, 6.00 [95% CI, 1.65-21.80]; P = .006). Multivariable analysis indicated that FI of the infraspinatus was the only factor associated with graft failure (odds ratio, 6.37 [95% CI, 1.63-24.90]; P = .008). CONCLUSION Severe FI of the infraspinatus muscle was a factor indicating a poor prognosis for graft integrity after SCR. Preoperative evaluation of FI in the rotator cuff muscles can help predict postoperative outcomes and may help guide therapeutic options.
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Affiliation(s)
- Jun-Bum Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Erica Kholinne
- Department of Orthopedic Surgery, St Carolus Hospital, Faculty of Medicine, Trisakti University, Jakarta, Indonesia
| | - Ji Woong Yeom
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hui Ben
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Basim Masoud AlAhmadi
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Department of Orthopedic Surgery, St Carolus Hospital, Faculty of Medicine, Trisakti University, Jakarta, Indonesia
| | - Kyung-Hwan Koh
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Graft Healing Is More Important Than Graft Technique: Superior Capsular Reconstruction Versus Bridging Grafts-A Prospective Randomized Controlled Trial. Arthroscopy 2022; 38:3109-3117. [PMID: 35835435 DOI: 10.1016/j.arthro.2022.06.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 06/21/2022] [Accepted: 06/25/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare superior capsular reconstruction (SCR) versus bridging graft (BG) for massive irreparable rotator cuff tears (RCTs). METHODS A prospective double-blind randomized study was conducted to compare SCR versus BG for massive irreparable RCTs. Fifty patients (mean age: 60.2 ± 6.0 years) with chronic tears (mean duration of symptoms: 5 ± 5.2 years) were intraoperatively randomized following partial repair to SCR or BG using human dermal allograft. All patients underwent standardized rehabilitation and were followed at 3, 6, 12, and 24 months clinically and radiographically. Magnetic resonance imaging were obtained at 12 months to determine graft integrity. RESULTS At 2 years, 46 patients were available for follow-up. Mean American Shoulder and Elbow Surgeons (ASES), Western Ontario Rotator Cuff (WORC), and Quick Disabilities of the Arm, Shoulder and Hand scores were 74.8 ± 23.9, 66.0 ± 28.3, and 24.7 ± 26.1 for the SCR group, and 77.9 ± 19.9, 69.5 ± 24.5, and 25.0 ± 19.1 for the BG group, respectively, with no significant difference between groups. Magnetic resonance imaging demonstrated 18 of 24 (75%) in the SCR group and 14 of 22 (64%) in the BG group were intact at 12 months (P = .53). Patients with intact grafts compared with those with retorn grafts, whether SCR or BG, had greater ASES and WORC scores at 24 months (ASES 81.0 ± 18.7 vs 65.7 ± 24.4, P = .021 and WORC 72.3 ± 24.6 vs 53.7 ± 26.7, P = .04) and greater acromiohumeral intervals on radiographs at all follow-up time points. CONCLUSIONS When performing arthroscopic reconstruction using human dermal allograft for an irreparable RCT, whether the proximal edge of the graft is attached on the glenoid bone or to the torn tendon does not significantly change short-term clinical and radiographic outcomes. LEVEL OF EVIDENCE I, therapeutic.
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Hankins AC, Griffin JW, Taliaferro JP, Werner BC, Bonner KF. The Number of Surgeons Using Superior Capsular Reconstruction for Rotator Cuff Repair Is Declining. Arthrosc Sports Med Rehabil 2022; 4:e2089-e2098. [PMID: 36579047 PMCID: PMC9791834 DOI: 10.1016/j.asmr.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 10/10/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate surgeon preferences for graft use, including biologic augmentation and superior capsular reconstruction (SCR) associated with surgical treatment of rotator cuff repair (RCR). Methods A 26-question survey was completed by arthroscopic shoulder surgeons. Surgeon demographics were evaluated. Surgeons were queried about shoulder arthroscopic graft use and rationale then responses were analyzed based on demographics. Results In total, 260 surgeons completed the survey. Fifty-one percent of surgeons reported a decrease in the volume of SCR use in the past 5 years. Less than 3% of surgeons used SCR in >90% of irreparable RCR cases, compared with 38% using SCR in <10% of irreparable cases (P < .05). Surgeons performing >100 RCR annually (42%; P < .05) and those employed in the hospital setting (44%; P < .05) reported an overall increase in the use of SCR. More international surgeons (67%) decreased their use of SCR compared with U.S. surgeons (44%; P < .05). In contrast, bioinductive graft use is generally on the rise, with 48% of surgeons reporting increased use since first use, although used in <10% of cases by 54% of surgeons. Sixty-eight percent of surgeons performing >100 RCRs annually used bioinductive grafts (P < .05). Fewer international surgeons (30%) performed biologic augmentation (P < .05). Suboptimal published outcomes (40%) and no perceived patient benefit (40%) were most cited for decreased SCR use. Surgeons reporting increased use cited improved personal patient outcomes (72%). Conclusions Arthroscopic surgeons report decrease in volume of SCR use in the past 5 years. Surgeon's personal experience of patient outcome and suboptimal published results were the strongest factors impacting decision-making. In contrast, bioinductive graft use is increasing. However, most surgeons use these grafts in a relatively small percentage of cases. Clinical Relevance Evaluation of scientific data, personal experience, and influences on surgical practice will give a comprehensive understanding of current RCR practices.
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Affiliation(s)
| | - Justin W. Griffin
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A.,Jordan-Young Institute, Virginia Beach, Virginia, U.S.A
| | | | - Brian C. Werner
- Department of Orthopedic Surgery, University of Virginia, Charlottesville, Virginia, U.S.A
| | - Kevin F. Bonner
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A.,Jordan-Young Institute, Virginia Beach, Virginia, U.S.A.,Address correspondence to Kevin F. Bonner, M.D., 5716 Cleveland St., Suite 200, Virginia Beach, VA 23462.
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Liao YT, Li HS, Li Y, Tang KL, Li J, Zhou BH. Revascularization character of autologous fascia lata graft following shoulder superior capsule reconstruction by enhanced magnetic resonance imaging. J Orthop Surg Res 2022; 17:485. [PMID: 36371208 PMCID: PMC9652907 DOI: 10.1186/s13018-022-03375-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 10/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Fascia lata has been used for arthroscopic superior capsule reconstruction (ASCR) and verified to achieve a good clinical outcome. However, it is still not known about revascularization character of the fascia lata after ASCR. This study was performed to evaluate the revascularization of autologous fascia lata grafts after ASCR by enhanced magnetic resonance imaging (MRI). Methods A prospective study of 19 patients with irreparable rotator cuff tears underwent ASCR with autologous fascia lata grafts from September 2019 to April 2021. Radiography examinations and clinical evaluations were performed preoperatively and postoperatively at 6 weeks and 3, 6, and 12 months. The signal-to-noise quotient (SNQ) value and enhancement index (EI) of autologous fascia lata grafts in the great tubercle insertion (GTI), midpoint of the graft (MG), and glenoid insertion (GI) were compared for radiography examination. Clinical evaluation included the American Shoulder and Elbow Surgeons (ASES) score, University of California Los Angeles (UCLA) shoulder score, and Visual Analog Scale (VAS) score. Results The SNQ values in T1WI enhancement at GI and GTI were significantly higher than those at the plain MRI scan at all postoperative observation timepoints; however, the SNQ values in T1WI enhancement at MG did not show a significant difference until 3 months postoperation. EI values at GTI and GI were significantly higher than those at MG at 6 weeks and 3 months postoperation, while there was no significant difference in the EI value between GTI and GI. At 6 months postoperation, the EI value at GI was significantly higher than those at MG. At 12 months postoperation, the EI value at GI was significantly higher than those at MG and GTI; however, there was no significant difference between GTI and MG. The EI values at GTI and MG peaked at 3 months and 6 months postoperation, respectively, and then plateaued at 12 months postoperation. However, there was no significant difference in the EI value among the different postoperative timepoints at GI. The EI value did not correlate with the VAS and ASES, UCLA scores at any time point or any postoperative observation location. Conclusion Revascularization of the fascia lata was dependent on the location of the fascia lata and plateaus at 12 months postoperation. The EI value did not correlate with the VAS and ASES, UCLA scores during12 months postoperation.
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Baek CH, Lee DH, Kim JG. Latissimus dorsi transfer vs. lower trapezius transfer for posterosuperior irreparable rotator cuff tears. J Shoulder Elbow Surg 2022; 31:1810-1822. [PMID: 35339706 DOI: 10.1016/j.jse.2022.02.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Latissimus dorsi transfer (LDT) and lower trapezius transfer (LTT) are effective treatment options for posterosuperior irreparable rotator cuff tears (IRCTs) in relatively young patients and elderly high-demand patients without arthritic changes. However, the optimal treatment option for patients with posterosuperior IRCT remains a subject of ongoing debate. This study aimed to compare clinical and radiologic short-term outcomes between arthroscopic-assisted LDT (aLDT) and arthroscopic-assisted LTT (aLTT) in patients with posterosuperior IRCT. METHODS This retrospective crossover study included patients who underwent aLDT or aLTT for posterosuperior IRCT and who had a minimum clinical follow-up time of 2 years after undergoing surgical procedures between January 2012 and June 2019. A total of 90 patients with posterosuperior IRCT were divided into 2 groups according to the surgical procedure: group D underwent aLDT (n = 48) and group T underwent aLTT (n = 42). Clinical outcomes comprised the visual analog scale score for pain, active shoulder range of motion (ROM), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, and activities of daily living that require active external rotation (ADLER) score. Radiologic outcomes included acromiohumeral distance (AHD). The progression of arthritis was evaluated using Hamada grade. Graft integrity was assessed using postoperative magnetic resonance imaging. RESULTS Significant improvements in clinical outcomes were observed in both groups. Active shoulder external rotation (P < .001), postoperative ASES score (P < .001), and ADLER score (P < .001) were significantly higher in group T than in group D. AHD at 2-year follow-up was significantly higher in group T than in group D (P < .001). The rate of progression of arthritis was significantly higher in group D (31.3%) than in group T (7.1%) (P = .031). CONCLUSIONS Although both LDT and LTT improved the overall clinical outcomes of patients with posterosuperior IRCT, LTT was superior to LDT in terms of shoulder ROM, functional improvement, and progression of arthritis. Our findings indicate that LTT may be the preferred treatment option for posterosuperior IRCT in relatively active and young patients.
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Affiliation(s)
- Chang Hee Baek
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu-si, Republic of Korea.
| | - Dong Hyeon Lee
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu-si, Republic of Korea
| | - Jung Gon Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu-si, Republic of Korea
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Wang Y, Ding W, Xu J, Ruan D, Heng BC, Ding Q, Shen L, Ding S, Shen W. Arthroscopic Superior Capsular Reconstruction for Massive Irreparable Rotator Cuff Tears Results in Significant Improvements in Patient Reported Outcomes and Range of Motion: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e1523-e1537. [PMID: 36033196 PMCID: PMC9402467 DOI: 10.1016/j.asmr.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose The purposes of this study were to evaluate the clinical outcomes (with the minimum mean follow-up period of 2 years) of arthroscopic superior capsular reconstruction (ASCR) using different grafts for massive irreparable rotator cuff tears (MIRCTs) and to explore whether margin convergence in ASCR affects range of motion (ROM) outcomes. Methods This systematic review was registered in PROSPERO and was then conducted following PRISMA guidelines by searching the databases: MEDLINE, EMBASE, Web of Science, and Cochrane Library database before April 2021. These literature searches investigating the clinical outcomes of ASCR were included. The methodological quality of included studies was assessed using the MINORS criteria. The data, including margin convergence, patient-reported outcome scores, range of motion, and complications, were extracted and analyzed. The minimal clinically important differences (MCID) criteria was used to define clinical significance. Results 15 studies met the inclusion criteria. All studies reported statistically significant improvements in visual analog scale scores (range: 2.07 to 7.1) and American Shoulder and Elbow Surgeons scores (range: 18.1 to 58). Significant improvements of Constant scores were noted in 4 of 5 reporting studies (mean improvement ranged from 14.64 to 50.79). Active forward flexion/elevation (11 studies), active abduction (4 studies), and active external rotation (8 studies) displayed improvements in all reporting studies, with mean changes ranging from 12 to 73.68, 19 to 89.21, and 1 to 24.74, respectively. The mean change of postoperative acromiohumeral distance ranged from −0.86 mm to 3.2 mm in 9 studies. The postoperative complication rate of ASCR ranged from 4.5% to 47.6%. The anterior margin convergence in SCR was associated with a relatively poor improvement in active external rotation. Conclusions ASCR contributes to significant improvements in patient-reported clinical outcomes and ROM at follow-up after a mean of more than two years, emerging as a viable option for patients with MIRCTs. The anterior margin convergence should be prudently chosen, especially in ASCR using fascia lata autograft, on account of the probable restriction on postoperative active external rotation. Level of Evidence Level IV, systematic review of Level III and IV studies.
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Affiliation(s)
- Yongjian Wang
- Department of Orthopedics, First People’s Hospital of Wenling, Affiliated Wenling Hospital of Wenzhou Medical University, Wenling, hejiang, PR China
| | - Wei Ding
- Department of Orthopedic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, PR China
| | - Jungang Xu
- Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Dengfeng Ruan
- Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Boon Chin Heng
- Peking University School of Stomatology, Beijing, PR China
| | - Qianhai Ding
- Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lingfang Shen
- Air Force Health Care Center for Special Services, Hangzhou, PR China
| | - Shaohua Ding
- Department of Orthopedic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, PR China
- Shaohua Ding, M.D., Department of Orthopedic Surgery, Ningbo Medical Center Lihuili Hospital, 57 Xingning Road, Ningbo, 315000, PR China.
| | - Weiliang Shen
- Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Orthopaedics Research Institute of Zhejiang University, Zhejiang, PR China; China Orthopaedic Regenerative Medicine (CORMed), Hangzhou, PR China; Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, Zhejiang, PR China; Department of Sports Medicine, School of Medicine, Zhejiang University, Zhejiang, PR China; Department of Orthopedics, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Zhejiang University Huzhou Hospital, Huzhou, Zhejiang, PR China
- Address correspondence to Weiliang Shen, M.D., Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie Fang Road, Hangzhou 310009, China.
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Woodmass JM, Wagner ER, Welp KM, Chang MJ, Morissette MP, Higgins LD, Warner JJ. Partial Rotator Cuff Repair Provides Improved Patient-Reported Outcome Measures Following Superior Capsule Reconstruction (SCR). Arthrosc Sports Med Rehabil 2022; 4:e1261-e1268. [PMID: 36033178 PMCID: PMC9402424 DOI: 10.1016/j.asmr.2022.03.004] [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: 09/15/2020] [Accepted: 03/07/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose To evaluate the role of concomitant partial rotator cuff repair (RCR) (i.e., infraspinatus) on patient-reported clinical outcomes following superior capsule reconstruction (SCR). Methods Postoperative recovery outcomes of SCR alone were compared with SCR with concomitant infraspinatus rotator cuff repair (SCR+RCR) at 3, 6, 12, and 24 months. Patients were included if they had an SCR surgery with or without a concomitant infraspinatus repair. Patients were excluded if they did not have a minimum of 6 months’ follow-up or if a preoperative baseline questionnaire was not performed. Outcome measures included pain visual analog scale, American Shoulder and Elbow Surgeons (ASES) Shoulder Function, ASES Shoulder Index, and Single Assessment Numeric Evaluation (SANE) score. Results Overall, 180 patients were evaluated, including 163 patients who underwent SCR alone and 17 patients who underwent concomitant infraspinatus repair (SCR+RCR). There was no difference in demographic data including age, sex, and body mass index. The postoperative recovery curves demonstrated SCR alone and SCR+RCR both provide significantly improved pain and functional scores at 2 years postoperatively (P < .001). When we compared the 2 groups, SCR+RCR provided significantly improved ASES Index (87.6 vs 78.2, P = .048) and ASES Function (25.5 vs 21.7, P = .02). There was no statistically significant difference in SANE scores (75.5 vs 64.2, P = .07) at 24 months’ follow-up. Conclusions SCR provides modest improvements in pain and function at 2 years postoperatively in patients with irreparable rotator cuff tears. Patients who underwent SCR and concomitant infraspinatus repair demonstrated significantly improved ASES Index and ASES Function scores and statistically nonsignificant improvement in SANE scores at 24 months postoperatively when compared with SCR alone. Level of Evidence III, retrospective cohort study.
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Affiliation(s)
- Jarret M. Woodmass
- Pan Am Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
- Address correspondence to Jarret Woodmass, M.D., F.R.C.S.C., Pan Am Clinic, University of Manitoba, 75 Poseidon Bay, Winnipeg, Manitoba, Canada R3M 3E4.
| | - Eric R. Wagner
- Department of Orthopedic Surgery, Emory University, Atlanta, Georgia, U.S.A
| | - Kathryn M. Welp
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Michelle J. Chang
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri, U.S.A
| | | | | | - Jon J.P. Warner
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
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Outcomes of arthroscopic-assisted middle trapezius tendon transfer for isolated irreparable supraspinatus tendon tears: minimum 2-year follow-up. Arch Orthop Trauma Surg 2022; 143:2547-2556. [PMID: 35840715 DOI: 10.1007/s00402-022-04542-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/01/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Middle trapezius tendon (MTT) transfer has been proposed as a feasible option for managing isolated irreparable supraspinatus tears (IISTTs). However, no clinical study has been attempted. This study aimed to evaluate clinical and radiologic outcomes of arthroscopic-assisted MTT transfer in patients with IISTTs. METHODS This retrospective study included patients who underwent arthroscopic-assisted MTT transfer using fascia lata autograft for IISTTs. Clinical outcomes, including pain visual analog scale (VAS), Constant, American Shoulder and Elbow Society (ASES), University of California Los Angeles (UCLA) shoulder scores and active range of motion (aROM), were assessed. Radiographic analyses included the acromiohumeral distance (AHD), Hamada grade, and transferred tendon integrity at the final follow-up. RESULTS Twenty-two patients (mean age: 63.3 ± 6.8 [51‒74] years; mean follow-up period: 28.9 ± 4.9 [24‒44] months) met the study criteria. The mean VAS, Constant, ASES, and UCLA scores improved postoperatively at the final follow-up (p < 0.001). The mean aROMs for forward flexion and abduction were significantly increased postoperatively. No significant changes of AHD (p = 0.105) and Hamada grade (p = 0.815) were observed postoperatively. One patient had a re-tear of the transferred tendon at the footprint site at the final follow-up. CONCLUSION In this minimum 2-year follow-up study of the novel aMTT transfer using fascia lata autograft, we found significant improvement in pain relief, clinical scores, and active forward flexion and abduction. Additionally, no significant progression of cuff tear arthropathy was observed at the final follow-up. Therefore, aMTT transfer could be a promising treatment option for patients with IISTTs. However, further multicenter and long-term trials are needed to verify its effectiveness. LEVEL OF EVIDENCE Retrospective case series, level IV.
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Cusano A, Kanski G, Uyeki C, Adams K, Cote MP, Muench LN, Connors JP, Garvin P, Messina JC, Berthold DP, Kissenberth MJ, Mazzocca AD. Outcomes of reverse shoulder arthroplasty following failed superior capsular reconstruction. J Shoulder Elbow Surg 2022; 31:1426-1435. [PMID: 35122950 DOI: 10.1016/j.jse.2021.12.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/20/2021] [Accepted: 12/25/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Superior capsular reconstruction (SCR) can be used for massive irreparable rotator cuff tears in the absence of significant degenerative changes; however, those who fail an SCR may require reverse shoulder arthroplasty (RSA). The effect of a previously performed SCR on outcomes following RSA remains unknown. METHODS Subjects who underwent RSA from May 2015 to January 2021 at 2 separate institutions were retrospectively identified through prospectively collected databases. Patients who underwent RSA after failed SCR were matched to those who underwent RSA after failed rotator cuff repair (RCR) based on the number of previous ipsilateral shoulder procedures (n = 1, 2, ≥3) and secondarily by age within 5 years. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS) for pain, and Western Ontario Osteoarthritis of the Shoulder index (WOOS) scores were compared between groups. The minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) thresholds were calculated to determine clinically relevant differences between groups. RESULTS Forty-five patients were included (32 RSA following RCR, 13 following SCR). There were more smokers (P = .001) and worker's compensation cases (P = .034) in the SCR group. The RCR cohort was older (P = .007) and had a greater incidence of mental health (P > .999) and somatic disorders (P = .698), although these did not reach statistical significance. The mean follow-up for the RCR and SCR groups were 24.2 ± 23.3 and 20.4 ± 14.9 months following RSA, respectively (P = .913). The time from index RCR or SCR to RSA were 94.4 ± 22.2 and 89.2 ± 5.3 months, respectively (P = .003). Pre- and postoperative range of motion were similar between groups, as was the overall change in forward flexion (P = .879), abduction (P = .971), and external rotation (P = .968) following RSA. The RCR group had lower postoperative VAS pain (P = .009), higher SANE (P = .015), higher ASES (P = .008), and higher WOOS (P = .018) scores. The percentage achieving the MCID (P = .676) and SCB (P > .999) were similar; however, 56.7% of the RCR group met the SANE PASS threshold compared with 0.0% in the SCR group (P = .005). There were no differences in postoperative complications (P = .698) or revision rates (P = .308) following RSA between cohorts. CONCLUSION When matched for number of previous procedures to the ipsilateral extremity and age, patients who underwent RSA following failed SCR had worse clinical outcome scores than their RSA following failed RCR counterparts. No patient in the SCR group met the SANE PASS threshold, whereas more than half of the RCR group did.
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Affiliation(s)
- Antonio Cusano
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.
| | - Gregory Kanski
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Colin Uyeki
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Kyle Adams
- Steadman Hawkins Clinic of the Carolinas, Greenville, SC, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Lukas N Muench
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA; Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - John Patrick Connors
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Patrick Garvin
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - James C Messina
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Daniel P Berthold
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA; Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | | | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
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Tear pattern after superior capsular reconstruction using an acellular dermal matrix allograft. J Shoulder Elbow Surg 2022; 31:e279-e288. [PMID: 35026395 DOI: 10.1016/j.jse.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/26/2021] [Accepted: 12/04/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The healing rate and tear pattern of grafts in superior capsular reconstruction (SCR) using acellular dermal matrix (ADM) allograft are poorly understood, and clinical results based on the graft status remain controversial. METHODS Fifty-one consecutive patients undergoing arthroscopic SCR with ADM between October 2017 and February 2020 were enrolled. Range of motion, strength, and the visual analog scale pain (PVAS) score, American Shoulder and Elbow Surgeons (ASES) score, and Constant score were evaluated preoperatively and at the last follow-up. Postoperative magnetic resonance imaging was performed in all patients and was obtained at least 6 months (mean, 8.9 ± 3.6 months) after surgery. The graft tear status was analyzed on magnetic resonance imaging, and the numbers of patients who achieved the minimal clinically important difference and patient acceptable symptomatic state were analyzed to determine the differences in outcome according to graft tear status. RESULTS The range of motion and clinical results improved at a minimum of 1 year (mean, 18 ± 5.4 months), whereas strength in forward flexion and external rotation did not (P = .676 and P = .995, respectively). The graft was intact in 36 of 51 patients (70.6%), 9 patients (17.6%) showed an incomplete graft tear with maintained continuity (partial graft rupture at 1 anchor on either the glenoid or humeral side), and 6 patients (11.8%) showed complete graft rupture (5 on the glenoid side and 1 on the humeral side). In cases with a tear (either incomplete or complete), the odds of achieving the minimal clinically important difference for the PVAS score (P = .047) and ASES score (P = .020) was significantly lower than that of the intact graft. However, when the continuity of the graft was maintained, even in cases with a partial tear, patients who reached the patient acceptable symptomatic state showed significantly higher odds for the PVAS score and trends for the ASES score. CONCLUSION After SCR using ADM, the graft status could be classified as intact, an incomplete graft tear (where the continuity between the glenoid and humerus was maintained), or an complete tear. When the graft continuity was maintained, even in incomplete graft tears, patients were generally satisfied with postoperative pain and function at 1 year following SCR.
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Baek CH, Lim C, Kim JG. Superior Capsular Reconstruction Versus Lower Trapezius Transfer for Posterosuperior Irreparable Rotator Cuff Tears With High-Grade Fatty Infiltration in the Infraspinatus. Am J Sports Med 2022; 50:1938-1947. [PMID: 35536232 DOI: 10.1177/03635465221092137] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Superior capsular reconstruction (SCR) and lower trapezius transfer (LTT) have recently been utilized to treat irreparable rotator cuff tears (IRCTs). There is still no clear guideline on which treatment method is a better fit for posterosuperior IRCTs with high-grade 4 fatty infiltration in the infraspinatus. PURPOSE To compare the clinical and radiological outcomes between arthroscopic-assisted SCR (aSCR) and arthroscopic-assisted LTT (aLTT) in patients with posterosuperior IRCTs with high-grade (Goutallier grade 4) fatty infiltration in the infraspinatus muscle. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This retrospective study included patients who underwent aSCR or aLTT for posterosuperior IRCTs with high-grade 4 fatty infiltration in the infraspinatus and had a minimum follow-up of 2 years between 2017 and 2019. A total of 58 patients were divided into 2 groups according to the surgical procedure: aSCR group (n = 22) and aLTT group (n = 36). Clinical outcomes comprised the visual analog scale score for pain, active shoulder range of motion (ROM), the American Shoulder and Elbow Surgeons (ASES) score, and patient satisfaction. Radiological outcomes comprised the acromiohumeral distance (AHD). The progression of arthritis was evaluated via the Hamada grade. Graft integrity was assessed on postoperative magnetic resonance imaging scans. RESULTS Significant improvements in clinical outcomes were observed in both groups. However, active shoulder ROM (forward elevation: 165.7°± 22.3° vs 145.5°± 32.3°, respectively [P = .015]; external rotation: 51.7°± 10.9° vs 41.1°± 7.0°, respectively [P < .001]), the postoperative ASES score (84.8 ± 7.6 vs 76.8 ± 20.3, respectively; P = .045), and patient satisfaction (8.9 ± 1.2 vs 6.4 ± 2.1, respectively; P = .041) were significantly higher with aLTT than with aSCR. There was no significant difference between the groups in AHD at 2 years postoperatively. However, the rate of progression of arthritis was significantly higher with aSCR (22.7%) than with aLTT (2.8%) (P = .027). Moreover, the graft retear rate was significantly higher with aSCR (63.6%) than with aLTT (8.3%) at 2 years postoperatively (P < .001). CONCLUSION Although aSCR and aLTT both provided improvements in overall clinical outcomes for posterosuperior IRCTs with high-grade 4 fatty infiltration in the infraspinatus, aLTT was superior in terms of functional improvement, patient satisfaction, progression of arthritis, and graft integrity. Therefore, we prefer aLTT for posterosuperior IRCTs under the condition of high-grade 4 fatty infiltration in the infraspinatus.
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Affiliation(s)
- Chang Hee Baek
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu, Republic of Korea
| | - Chaemoon Lim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu, Republic of Korea
| | - Jung Gon Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu, Republic of Korea
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Shoulder Superior Capsular Reconstruction Hybrid Graft Thickness Greater Than Preoperative Acromiohumeral Distance Increases Graft Retear Rate and Subacromial Erosion. Arthroscopy 2022; 38:1784-1792. [PMID: 34942316 DOI: 10.1016/j.arthro.2021.11.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 11/15/2021] [Accepted: 11/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the impact of graft thickness on clinical outcomes and graft retear after superior capsular reconstruction (SCR) using a hybrid graft combining both fascia lata autograft and dermal allograft in patients with massive rotator cuff tear (MRCT). METHODS Between January 2017 and February 2019, this study enrolled 58 patients with MRCT who underwent SCR using a hybrid graft combining both fascia lata autograft and dermal allograft. We evaluated clinical outcomes and compared differences between the graft intact and the graft retear group. Moreover, subgroup analysis was performed for patients having a preoperative acromiohumeral distance (AHD) less than or equal to the used graft thickness (group 1) and the results were compared with those for preoperative AHD greater than the used graft thickness (group 2). RESULTS Fifty-five patients who underwent MRCT with a mean age of 65.1 ± 5.7 years old were followed up during a mean period of 30.5 ± 6.5 (range, 24-37) months. There were significant differences in clinical outcome measures preoperatively and postoperatively (P < .05). There were no significant differences in clinical outcomes between the graft intact and graft retear groups (P > .05). The subgroup analysis revealed that the retear (68.6% vs 30.4%, P = .004) and subacromial erosion rates (91.4% vs 60.9%, P = .005) were significantly greater in for patients having a preoperative AHD less than or equal to the used graft thickness (group 1). CONCLUSIONS SCR using a hybrid graft combining both fascia lata autograft and dermal allograft is promising with improved clinical scores (P < .05) irrespective of the graft integrity. The use of a graft with a thickness greater than a patient's preoperative AHD could increase graft retear and subacromial erosion rates after SCR. However, there was no significant difference in clinical outcomes according to the relationship between used graft thickness and preoperative AHD. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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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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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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Hammad AM, Phillips C, Wijdicks CA, Adams CR, Denard PJ. Two-Year Retrospective Patient-Reported Outcomes Following Superior Capsular Reconstruction. Arthroscopy 2022; 38:262-266. [PMID: 34052377 DOI: 10.1016/j.arthro.2021.05.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the short-term patient-reported outcomes of superior capsular reconstruction (SCR) and identify factors contributing to the success or failure of the procedure at 2 years. METHODS A retrospective review was performed on data prospectively collected from the Surgical Outcomes System database. Patient-reported outcomes (PROMs) including American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, visual analog scale for pain, and Veterans RAND 12-Item Health Survey (VR-12) were evaluated at a minimum of 2 years postoperatively and reported using a minimal clinically important difference (MCID) and the percent of maximal possible improvement (MPI). In addition, preoperative and intraoperative variables were evaluated in patients with and without a postoperative improvement in ASES and SANE scores meeting the threshold of MCID. RESULTS Two-year follow-up data were available for 350 patients. Statistically significant improvements were noted in all PROMs at 2-year follow-up. In total, 240 patients (68.8%) achieved an MCID improvement of >17.5 in ASES score, and 185 patients (52.9%) achieved an MCID of >29.8 improvement in the SANE score. Primary SCRs were associated with a higher MPI in the ASES score (60.1% ± 39.8% vs 40.4% ± 47.9%; P = .025) and VR-12 physical score (14.0% ± 13.8% vs 8.0% ± 14.7%; P = .028) compared to revision repairs. Only diabetes was identified as a predictor of SANE score improvement (64.5% vs 62.2%; P = .041). CONCLUSIONS SCR is associated with improvement in patient-reported outcomes at short-term follow-up, with 53% to 69% of patients achieving an improvement considered to meet the MCID. Greater improvement is expected when SCR is performed as a primary procedure rather than as a revision procedure for failed rotator cuff repair. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
| | | | | | - Christopher R Adams
- Arthrex, Inc., Naples, Florida, U.S.A.; Naples Community Hospital, Naples, Florida, U.S.A
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Berthold DP, Ravenscroft M, Bell R, Obopilwe E, Cote MP, Kane Z, Morgan BW, Mühlenfeld N, Mazzocca AD, Muench LN. Bursal Acromial Reconstruction (BAR) Using an Acellular Dermal Allograft for Massive, Irreparable Posterosuperior Rotator Cuff Tears: A Dynamic Biomechanical Investigation. Arthroscopy 2022; 38:297-306.e2. [PMID: 34329702 DOI: 10.1016/j.arthro.2021.07.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the effect of bursal acromial reconstruction (BAR) using an acellular dermal allograft on glenohumeral joint kinematics including maximum abduction angle, glenohumeral superior translation, cumulative deltoid force, and subacromial contact pressure. METHODS In this dynamic biomechanical cadaveric shoulder study, 8 fresh-frozen cadaveric shoulders (age 53.4 ± 14.2 years, mean ± standard deviation) were tested using a dynamic shoulder testing system. Maximum abduction angle (MAA), glenohumeral superior translation (ghST), maximum cumulative deltoid force (cDF), and subacromial peak contact pressure (sCP) were compared across 3 conditions: (1) intact shoulder; (2) massive retracted irreparable posterosuperior rotator cuff tear (psRCT) according to Patte III; and (3) BAR. Additionally, humeral head containment was measured using contact pressure. RESULTS Compared with the simulated psRCT, BAR significantly increased mean MAA and significantly decreased ghST (P < .001, respectively) and cDF (P = .017) Additionally, BAR was found to significantly decrease sCP compared with psRCT (P = .024). CONCLUSION In a dynamic biomechanical cadaveric shoulder simulator, resurfacing the undersurface of the acromion using the BAR technique leads to significantly improved ghST, MAA, cDF, and sCP compared with the irreparable rotator cuff tear. CLINICAL RELEVANCE With the BAR technique, native humeral containment may be restored, which can potentially delay progressive subacromial and glenoidal abrasive wear and improve overall shoulder function. As such, the proposed BAR technique can be considered as a technically feasible and potentially cost- and timesaving procedure, as no bone anchors are needed, glenoidal or humeral side graft ruptures can be avoided, and postoperative rehabilitation can be started immediately. However, future clinical studies are needed.
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Affiliation(s)
- Daniel P Berthold
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A..
| | | | | | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Zenon Kane
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | | | - Nils Mühlenfeld
- Department of Trauma, Hand and Reconstructive Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Augustus D Mazzocca
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A
| | - Lukas N Muench
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany; Orthoteam Centre, Manchester, UK
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Muench LN, Pogorzelski J, Scheiderer B. [Arthroscopic superior capsule reconstruction using a 6 mm thick acellular dermal allograft for irreparable posterosuperior rotator cuff tears]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2022; 34:13-20. [PMID: 35037093 DOI: 10.1007/s00064-021-00758-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/21/2021] [Accepted: 07/28/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Implantation of an acellular dermal allograft between glenoid and humerus to restore a stable glenohumeral center of rotation in cases of irreparable posterosuperior rotator cuff tears. INDICATIONS Irreparable posterosuperior rotator cuff tears with low-grade cuff tear arthropathy (Hamada grade 1 and 2) and isolated pseudoparesis for flexion. CONTRAINDICATIONS Absolute: Infection, nerve lesions (brachial plexus, axillary nerve), concomitant irreparable subscapularis tendon tear, anterosuperior subluxation of the humeral head ("anterosuperior escape"). Relative: Cuff tear arthropathy ≥ Hamada grade 3, fatty infiltration of the infraspinatus muscle ≥ Goutallier grade 2, deficiency of the deltoid muscle, inability to adhere to the rehabilitation program, poor compliance. SURGICAL TECHNIQUE Arthroscopic fixation of a 6 mm thick acellular dermal allograft with three suture anchors at the superior glenoid rim and a double-row construct at the greater tuberosity. Dorsal and ventral interval closure with side-to-side sutures. POSTOPERATIVE MANAGEMENT Abduction brace for 6 weeks with passive mobilization. Active motion exercises are commenced at 6 weeks with progression to strengthening exercises after 12 weeks. RESULTS Between April 2019 and September 2020, 15 patients (5 women and 10 men) underwent arthroscopic superior capsule reconstruction using a 6 mm thick acellular dermal allograft for treatment of irreparable posterosuperior rotator cuff tears. After a mean follow-up of 15.4 ± 5.5 months, there was a significant improvement in active flexion (102° ± 37°preop vs. 143° ± 24°postop; P = 0.001; 95% CI 19.6-63.7), ASES score (45.5 ± 16.1preop vs. 68.2 ± 17.4postop; P < 0.001; 95% CI; 12.9-33.7) and DASH score (57.2 ± 18.6preop vs. 22.0 ± 17.4postop; P < 0.001; 95% CI; -46.0 to 24.7), along with significant pain reduction (4.5 ± 2.0preop vs. 2.5 ± 2.1postop; P = 0.001; 95% CI; -3.2 to 1.1). There were no complications requiring revision surgery.
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Affiliation(s)
- Lukas N Muench
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Jonas Pogorzelski
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Bastian Scheiderer
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland.
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Werthel JD, Vigan M, Schoch B, Lädermann A, Nourissat G, Conso C. Superior capsular reconstruction - A systematic review and meta-analysis. Orthop Traumatol Surg Res 2021; 107:103072. [PMID: 34560311 DOI: 10.1016/j.otsr.2021.103072] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/13/2021] [Accepted: 08/05/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Since Mihata's 2012 proposal to arthroscopically reconstruct the superior capsule of patients with massive irreparable cuff tears, many studies have reported the clinical results of this technique using different types of grafts (fascia lata autograft, dermal allograft, porcine dermal xenograft or long head of biceps autograft). PURPOSE The objective of this meta-analysis was to report the clinical and radiological results of these superior capsule reconstructions. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) recommendations were used to conduct this systematic review. A bibliographic search was performed of the electronic databases MEDLINE, Scopus, Embase and the Cochrane Library. The quality of the studies was assessed according to the MINORS criterion (Methodological Index for Nonrandomized Studies). The inclusion criteria were studies in English evaluating superior capsular reconstruction. RESULTS No level I or II studies met the inclusion criteria. Eighteen studies were selected from the 97 identified, including 637 shoulders (64% male) with a mean age of 62 years [95% CI: 60.3-63.5]. At the mean follow-up of 24.3 months (12-60), the range of motion was significantly increased from 82.6° [60.0-105.2] to 141.9° [109.9-173.8] in abduction, from 113.1° [98.3-127.9] to 153.3° [147.4-159.2] in elevation, from 35.5° [30.9-40.2] 43.4° [35.4-51.3] in external rotation and from 7.2 [5.4-9] to 9.9 [8.9-10.9] in internal rotation. Functional scores were significantly improved from 5.4 [4.8-5.9] to 1.3 [0.9-1.7] points for VAS, from 42.5 [15.7-69.3] to 59.3 [30.1-88.6] points for Constant, from 39.0% [38.1-39.8] to 79.8% [76.4-83.3] for the SSV, and from 48.2 [45.2-51.1] to 81.2 [77.2-85.1] points for the ASES. The healing rate was 76.1% [64.4-84.9]. The complication rate was 5.6% [1.8-16.3] and the reverse shoulder arthroplasty revision rate was 7.1% [3.8-12.8]. CONCLUSION Superior capsule reconstructions allow satisfactory clinical and radiological results to be obtained at 2 years of follow-up. Due to the small number of high quality comparative studies available, its true place in the therapeutic arsenal cannot be fully confirmed. However, it seems that the best indication for this technique is isolated irreparable rupture of the supraspinatus, in cases of medical treatment failure. LEVEL OF EVIDENCE III; meta-analysis of heterogeneous studies.
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Affiliation(s)
- Jean-David Werthel
- Hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
| | - Marie Vigan
- Hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
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- 15, rue Ampère, 92500 Rueil Malmaison, France
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Faculty of Medicine, La Tour Hospital, University of Geneva, Geneva University Hospitals, Geneva, Switzerland
| | | | - Christel Conso
- Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
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Kucirek NK, Hung NJ, Wong SE. Treatment Options for Massive Irreparable Rotator Cuff Tears. Curr Rev Musculoskelet Med 2021; 14:304-315. [PMID: 34581991 PMCID: PMC8497660 DOI: 10.1007/s12178-021-09714-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW Massive irreparable rotator cuff tears present a significant challenge to the orthopedic surgeon. No single treatment, particularly among joint-preserving options, has been shown to be superior. The purpose of this review is to discuss recent advances in the treatment of massive irreparable rotator cuff tears, including partial repair with and without graft augmentation, interposition grafts, superior capsule reconstruction, subacromial balloon spacers, tendon transfer, and reverse total shoulder arthroplasty. We will also offer guidance on surgical indications based on our clinical experience. RECENT FINDINGS Partial repair may offer reasonable clinical improvement for patients with lower preoperative function despite high re-tear rates. Additionally, several types of interposition grafts have shown promising short-term results and may outperform repair alone. Subacromial balloon spacers may lead to clinical improvement, especially in patients without glenohumeral osteoarthritis or pseudoparalysis, and recently received FDA approval for use in the USA. Superior capsule reconstruction is a technically demanding procedure that appears to produce excellent short-term results particularly when performed at high volume, but long-term studies in heterogeneous study groups are needed. Tendon transfers improve function by restoring force coupling in the shoulder, offering a promising option for younger patients. Reverse total shoulder arthroplasty (RTSA) is a reliable option for treatment of irreparable cuff tears in elderly patients with lower functional demands. Irreparable cuff tears remain a difficult condition to treat. Recommended treatment for younger patients without glenohumeral osteoarthritis is particularly controversial. For older patients with low-demand lifestyles and glenohumeral osteoarthritis, RTSA is an effective treatment option. For all discussed procedures, patient selection appears to play a critical role in clinical outcomes.
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Affiliation(s)
- Natalie K. Kucirek
- School of Medicine, University of California, San Francisco, San Francisco, CA USA
| | - Nicole J. Hung
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | - Stephanie E. Wong
- Department of Orthopaedic Surgery, University of California, San Francisco, 1500 Owens Street, San Francisco, CA 94158 USA
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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] [MESH Headings] [Grants] [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 HospitalArmy Military Medical UniversityChongqingChina
| | - Binghua Zhou
- Department of Orthopedic Surgery, Southwest HospitalArmy Military Medical UniversityChongqingChina
| | - Kanglai Tang
- Department of Orthopedic Surgery, Southwest HospitalArmy Military Medical UniversityChongqingChina
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Shah SS, Kontaxis A, Jahandar A, Bachner E, Gulotta LV, Dines DM, Warren RF, Dines JS, Taylor SA. Superior capsule reconstruction using a single 6-mm-thick acellular dermal allograft for massive rotator cuff tears: a biomechanical cadaveric comparison to fascia lata allograft. J Shoulder Elbow Surg 2021; 30:2166-2176. [PMID: 33418091 DOI: 10.1016/j.jse.2020.11.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/08/2020] [Accepted: 11/16/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Success of superior capsule reconstruction (SCR) using both fascia lata (FL) and human acellular dermal (ACD) allografts have been reported. One possible explanation for a discrepancy in outcomes may be attributed to graft thickness. SCR with commercially available 3-mm-thick ACD allograft is not biomechanically equivalent to FL. Our hypothesis was that SCR with a single 6-mm-thick ACD allograft will restore the subacromial space distance (SubDist) and peak subacromial contact pressures (PSCPs) to intact shoulder and will be comparable to SCR with an 8-mm FL allograft. METHODS Eight cadaveric shoulders were tested in 4 conditions: intact, irreparable supraspinatus tear (SST), SCR FL allograft (8-mm-thick), and SCR single ACD allograft (6-mm-thick). SubDist and PSCP were measured at 0°, 30°, and 60° of glenohumeral abduction in the scapular plane. Parameters were compared using a repeated measures analysis of variance with Tukey post hoc test, and graft dimensions were compared using a Student t test. RESULTS SST had decreased SubDist (P < .05) and increased PSCP (P < .05) compared with the intact state. At all angles, the SCR ACD allograft demonstrated increased SubDist compared with the tear condition (P < .001), with no difference between grafts. Furthermore, there was decreased PSCP after both ACD and FL SCR compared with the intact condition, with no difference between grafts at 0° (P = .006, P = .028) and 60° abduction (P = .026, P = .013). Both ACD and FL grafts elongated during testing. CONCLUSIONS Our results suggest SCR with a single 6-mm-thick ACD allograft is noninferior to FL regarding SubDist and PSCP while completely restoring the superior stability of the glenohumeral joint compared with the intact state.
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Affiliation(s)
| | | | | | - Emily Bachner
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Alarcon JF, Uribe-Echevarria B, Clares C, Apablaza D, Vargas JC, Benavente S, Rivera V. Superior Capsular Reconstruction With Autologous Fascia Lata Using a Single Lateral-Row Technique Is an Effective Option in Massive Irreparable Rotator Cuff Tears: Minimum 2-Year Follow-Up. Arthroscopy 2021; 37:2783-2796. [PMID: 33957215 DOI: 10.1016/j.arthro.2021.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate clinical and radiologic outcomes of arthroscopic superior capsular reconstruction (ASCR) with fascia lata autograft in patients with irreparable rotator cuff tears (IRCTs) performed using a single lateral-row fixation technique. METHODS We studied a retrospective case series of patients with large or massive IRCTs for ASCR with fascia lata autograft. Clinical outcomes were evaluated using the Visual Analog Scale (VAS) and the Constant score. Healing of the graft was assessed by magntic resonance imaging or ultrasound. Acromiohumeral distance was evaluated by radiographs. RESULTS Thirty-one patients with an average age of 61 years and an average follow-up of 35 months (24-51 months) underwent ASCR with fascia lata autograft. There was a significant improvement in VAS (7.7-0.7), Constant score (36.0-78.7), forward elevation (115°-171°), external rotation (33°-50°), strength (0.3 kg-2.3 kg), and acromiohumeral distance (6.1 mm-8.6 mm) (P < 0.001). Graft failure was present in 13.8% of patients, as shown by magnetic resonance imaging (26 patients) or ultrasound (3 patients). Patients with failed ASCR showed worse Constant scores (68.5.8 vs 80.2, P = 0.007), worse VAS (2.5 vs 0.4, P = 0.00002), worse external rotation (20° vs 54°, P = 0.004), lower acromiohumeral distance (5mm vs 9mm, P = 0.007), and a high association with the presence of os acromiale (χ2P = 0.003). No revision or subsequent surgical procedures were required. CONCLUSIONS ASCR, with autologous fascia lata and single lateral row configuration, is an effective option in irreparable rotator cuff tears and results in clinical and radiologic improvement. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
| | - Bastian Uribe-Echevarria
- Centro de Especialides Traumatologicas, Puerto Varas, Chile; Centro de Especialides Traumatologicas, Puerto Varas, Chile.
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Sommer MC, Wagner E, Zhu S, McRae S, MacDonald PB, Ogborn D, Woodmass JM. Complications of Superior Capsule Reconstruction for the Treatment of Functionally Irreparable Rotator Cuff Tears: A Systematic Review. Arthroscopy 2021; 37:2960-2972. [PMID: 33887411 DOI: 10.1016/j.arthro.2021.03.076] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this systematic review is to characterize the complications associated with superior capsule reconstruction (SCR) for the treatment of functionally irreparable rotator cuff tears (FIRCTs). METHODS This systematic review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Two independent reviewers completed a search of PubMed, Embase, and Medline databases. Studies were deemed eligible for inclusion if they reported postoperative outcomes of arthroscopic SCR for FIRCTs and considered at least 1 postoperative complication. Statistical heterogeneity was quantified via the I2 statistic. Due to marked heterogeneity, pooled proportions were not reported. All complications and patient-reported outcomes were described qualitatively. RESULTS Fourteen studies met the inclusion/exclusion criteria. The overall complication rate post-SCR ranged from 5.0% to 70.0% (I2 = 84.9%). Image-verified graft retear ranged from 8% to 70%, I2 = 79.4%), with higher rates reported when SCR was performed using allograft (19%-70%, I2 76.6%) compared to autograft (8%-29%, I2 = 66.1%). Reoperation (0%-36%, I2 = 73.4%), revision surgeries (0%-21%, I2 = 81.2%), medical complications (0%-5%, I2 = 0.0%), and infections (0%-5%, I2 = 0.0%) were also calculated. CONCLUSIONS SCR carries a distinct complication profile when used for the treatment of FIRCTs. The overall rate of complications ranged from 5.0% to 70.0%. The most common complication is graft retear with higher ranges in allografts (19%-70%) compared to autografts (8%-29%). The majority of studies reported at least 1 reoperation (range, 0%-36%), most commonly for revision to reverse shoulder arthroplasty. LEVEL OF EVIDENCE Level IV, systematic review of Level IV or better investigations.
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Affiliation(s)
- Micah C Sommer
- Pan Am Clinic, Winnipeg, Manitoba, Canada; Department of Orthopaedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eric Wagner
- Department of Orthopaedic Surgery, Emory University, Atlanta, Georgia, U.S.A
| | - Sophie Zhu
- Pan Am Clinic, Winnipeg, Manitoba, Canada; Department of Orthopaedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sheila McRae
- Pan Am Clinic, Winnipeg, Manitoba, Canada; Department of Orthopaedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peter B MacDonald
- Pan Am Clinic, Winnipeg, Manitoba, Canada; Department of Orthopaedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Dan Ogborn
- Pan Am Clinic, Winnipeg, Manitoba, Canada
| | - Jarret M Woodmass
- Pan Am Clinic, Winnipeg, Manitoba, Canada; Department of Orthopaedic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
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Broida SE, Sweeney AP, Gottschalk MB, Woodmass JM, Wagner ER. Clinical outcomes of latissimus dorsi tendon transfer and superior capsular reconstruction for irreparable rotator cuff tears: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1023-1043. [PMID: 34370112 DOI: 10.1007/s00590-021-03046-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Functionally irreparable rotator cuff tears (FIRCTs) present an ongoing challenge to the orthopedic surgeon. The aim of this systematic review was to critically compare the outcomes of three latissimus dorsi tendon transfer (LDT) techniques and two superior capsular reconstruction (SCR) techniques in treatment of FIRCTs. METHODS A systematic review of studies evaluating the outcome of FIRCT treatment was performed via a search of four databases in April 2020. Each included study was reviewed in duplicate by two reviewers for evaluation of methodological quality. The treatments analyzed were arthroscopic LDT (aLDT), open LDT Gerber technique (oLDTG), open LDT L'Episcopo technique (oLDTL), SCR with allograft (SCR-Allo), and SCR with autograft (SCR-TFL). Demographics, range of motion, patient-reported outcome measures, radiographic acromiohumeral distance (AHD), treatment failures, and revisions were recorded. RESULTS Forty-six studies (1287 shoulders) met criteria for inclusion. Twenty-three studies involved open latissimus transfer, with 445 shoulders undergoing oLDTG with mean follow-up of 63.2 months and 60 patients undergoing oLDTL with mean follow-up of 51.8 months. Ten studies (n = 369, F/U 29.2mo) reported on aLDT. Seven studies (n = 253, F/U 16.9mo) concerned SCR-Allo, and six studies (n = 160, F/U 32.mo) reported on SCR-TFL. Range of motion and subjective outcome scores improved in all techniques with no differences across treatments. Both SCR methods provided greater improvement in AHD than open LDT methods (p < 0.01). The re-tear rates were lower in both oLDT groups compared to the SCR groups (p = 0.03). Clinical failure rates were higher in the SCR-Allo and oLDTG groups, while overall treatment failures were lowest in oLDTL compared to all four other groups. CONCLUSION SCR techniques were associated with improved short-term radiographic acromiohumeral distance, while the open LDT techniques had lower tendon re-tear and treatment failure rates. All techniques resulted in improved clinical outcomes and pain relief compared to preoperative levels with no differences across techniques. LEVEL OF EVIDENCE IV Systematic review of case series and cohort studies.
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Affiliation(s)
- Samuel E Broida
- Department of Orthopaedic Surgery, Emory University, 59 S Executive Park NW, Atlanta, GA, 30329, USA
| | - Aidan P Sweeney
- Department of Orthopaedic Surgery, Emory University, 59 S Executive Park NW, Atlanta, GA, 30329, USA
| | - Michael B Gottschalk
- Department of Orthopaedic Surgery, Emory University, 59 S Executive Park NW, Atlanta, GA, 30329, USA
| | - Jarret M Woodmass
- Department of Orthopaedic Surgery, PanAm Clinic, University of Manitoba, Winnipeg, Canada
| | - Eric R Wagner
- Department of Orthopaedic Surgery, Emory University, 59 S Executive Park NW, Atlanta, GA, 30329, USA.
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Chiang CH, Shaw L, Chih WH, Yeh ML, Ting HH, Lin CH, Chen CP, Su WR. Modified Superior Capsule Reconstruction Using the Long Head of the Biceps Tendon as Reinforcement to Rotator Cuff Repair Lowers Retear Rate in Large to Massive Reparable Rotator Cuff Tears. Arthroscopy 2021; 37:2420-2431. [PMID: 33864834 DOI: 10.1016/j.arthro.2021.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/04/2020] [Accepted: 04/02/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To retrospectively assess the clinical outcomes of the patients with large to massive reparable RCTs treated by arthroscopic rotator cuff repair (ARCR) combined with modified superior capsule reconstruction (mSCR) using the long head of biceps tendon (LHBT) as reinforcement with a minimum of 2 years of follow-up. METHODS We retrospectively evaluated 40 patients with large to massive reparable RCTs who underwent ARCR and mSCR (group I) between February 2017 and June 2018 (18 patients) or underwent ARCR and tenotomy of LHBT performed at the insertion site (group II) between January 2015 and January 2017 (22 patients). The pain visual analog score (VAS) was assessed preoperatively and 1, 3, 6, 12, 24 months postoperatively. American Shoulder and Elbow Surgeons (ASES) scores, the University of California, Los Angeles (UCLA) shoulder rating scale, and active range of motion (AROM) were assessed before surgery and 6, 12, and 24 months after surgery. The integrity of the rotator cuff and mSCR was evaluated using magnetic resonance images at 12 months postoperatively. RESULTS After surgery, both groups had significantly improved in VAS, ASES, UCLA and AROM scores in the final follow-up. There were no significant between-group differences in the characteristics of the patients before surgery. Group I had improved pain relief at 1 month (P < .001) and at 3 months (P < .01) after surgery. For the AROM, group I (flexion, external rotation, internal rotation) demonstrated better improvement than group II 6 months after surgery (all P < .05) and better internal rotation 12 and 24 months after surgery (all P < .05). The mSCR survival rate was 94.4% (17/18). The retear rate of repaired rotator cuffs for groups I and II was 16.7% (3/18) and 40.9% (9/22), respectively, and the differences were significant (P < .046). CONCLUSIONS ARCR combined with mSCR using LHBT as reinforcement may lead to a lower retear rate and earlier functional recovery than conventional ARCR with tenotomy of LHBT for large to massive reparable RCTs. LEVEL OF EVIDENCE Level III, retrospective therapeutic comparative trial.
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Affiliation(s)
- Chen-Hao Chiang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Leo Shaw
- Department of Orthopaedics, Taichung Veterans' General Hospital, Taichung, Taiwan.
| | - Wei-Hsing Chih
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Hsiao-Hsien Ting
- Department of Anesthesiology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Chang-Hao Lin
- Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Chao-Ping Chen
- Department of Orthopaedics, Taichung Veterans' General Hospital, Taichung, Taiwan; Department of Health Services Administration, China Medical University, Taichung, Taiwan; Department of Acupressure Technology, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedics, National Cheng Kung University Hospital, Tainan, Taiwan, R.O.C
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Berthold DP, Bell R, Muench LN, Jimenez AE, Cote MP, Obopilwe E, Edgar CM. A new approach to superior capsular reconstruction with hamstring allograft for irreparable posterosuperior rotator cuff tears: a dynamic biomechanical evaluation. J Shoulder Elbow Surg 2021; 30:S38-S47. [PMID: 33892119 DOI: 10.1016/j.jse.2021.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/31/2021] [Accepted: 04/04/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Superior capsular reconstruction (SCR) treatment of massive, symptomatic, irreparable rotator cuff tears (RCTs) has become a more recently used procedure. However, there is a lack of consensus surrounding optimal graft choice for the SCR technique, and current dermal grafts have increased cost and are technically challenging because of a need for multiple implants. The purpose of this study was to biomechanically investigate a biological lower-cost alternative as a support for the superior capsule reconstruction concept: an isolated semitendinosus tendon (STT) allograft and a combination graft with the long head of the biceps tendon (LHBT) in an established massive posterosuperior RCT cadaver model. METHODS Ten fresh-frozen cadaveric shoulders (53.3 ± 12.4 years: range: 26-65) were tested on an established dynamic shoulder simulator using dynamic muscle loading. Cumulative deltoid forces, maximum abduction angle, and superior humeral head translation were compared across 4 testing conditions: (1) intact state, (2) massively retracted (Patte III), irreparable posterosuperior RCT, (3) SCR repair using an STT allograft, and (4) SCR repair using a combined STT-LHBT repair. RESULTS Intact shoulders required a mean deltoid force of 154.2 ± 20.41 N to achieve maximum glenohumeral abduction (55.3° ± 2.3°). Compared with native shoulders, the maximum abduction angle decreased following a massively retracted posterosuperior RCT by 52% (28.3° ± 8.4°; P < .001), whereas the cumulative deltoid forces increased by 48% (205.3 ± 40.9 N; P = .001). The STT repair and the STT-LHBT repair improved shoulder function compared with the tear state, with a mean maximum abduction angle of 30.6° ± 9.0° and 31.8° ± 7.7° and a mean deltoid force of 205.3 ± 40.9 N and 201.0 ± 34.0 N, respectively, but this was not statistically significant (P > .05). The STT-LHBT repair significantly improved the range of motion with respect to the tear state (P = .04). CONCLUSIONS In a dynamic shoulder simulator model, both the STT and the STT-LHBT repair techniques improved glenohumeral joint kinematics in an amount similar to previously reported "traditional" SCR techniques for treatment of an irreparable posterosuperior RCT.
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Affiliation(s)
- Daniel P Berthold
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA; Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Ryan Bell
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Lukas N Muench
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA; Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Andrew E Jimenez
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Mark P Cote
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
| | - Cory M Edgar
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.
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Takayama K, Yamada S, Kobori Y. Clinical effectiveness of mini-open superior capsular reconstruction using autologous tensor fascia lata graft. J Shoulder Elbow Surg 2021; 30:1344-1355. [PMID: 33010432 DOI: 10.1016/j.jse.2020.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/31/2020] [Accepted: 09/08/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND When one is performing superior capsular reconstruction (SCR), graft thickness is an important factor for achieving sufficient glenohumeral stability. However, when a graft of sufficient length and thickness is prepared and inserted into the subacromial space, it is often challenging to secure the field of view arthroscopically. To solve this problem, we devised a mini-open SCR technique. This study aimed to compare the clinical effectiveness of this technique with that of arthroscopic SCR. METHODS This retrospective cohort study included 46 consecutive patients with Hamada classification grade 2-3b who were treated between June 2014 and February 2018 with SCR performed by a single surgeon for irreparable rotator cuff tears (grade 3 or higher according to the Goutallier classification) using autologous tensor fascia lata. We evaluated the duration of the operation, length of the skin incision of the lateral portal used to insert the graft, graft size (length, width, and thickness), American Shoulder and Elbow Surgeons score, range of motion, and graft retear rate. RESULTS This study included 46 patients who underwent arthroscopic SCR (n = 20) or mini-open SCR (n = 26). The mean follow-up period was 36.5 months (range, 24-66 months). The operative duration was significantly longer in the arthroscopic SCR group than in the mini-open SCR group (175 ± 48 minutes vs. 133 ± 25 minutes, P < .001); however, no significant difference was noted in the length of the skin incision (2.4 ± 0.2 cm vs. 2.5 ± 0.1 cm) and graft size. At the final follow-up, no significant differences were observed in American Shoulder and Elbow Surgeons scores, all ranges of motion (flexion, P = .60; abduction, P = .60; external rotation, P = .20; and internal rotation, P = .54), and graft retear rates (5% [1 case] vs. 3.8% [1 case], P > .999). CONCLUSIONS Good clinical outcomes were obtained in both the arthroscopic and mini-open SCR groups. The surgical stress experienced by the patients who underwent mini-open SCR was similar to that experienced by those who underwent the arthroscopic technique, as no significant difference was noted in the length of the skin incision. This study shows that mini-open SCR, which contributes to reductions in operative duration and difficulty associated with the surgical technique, is an effective and alternative method to arthroscopic SCR.
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Affiliation(s)
- Kazumasa Takayama
- Department of Orthopedics, Kurashiki Central Hospital, Okayama, Japan.
| | - Shunsuke Yamada
- Department of Orthopedics, Kurashiki Central Hospital, Okayama, Japan
| | - Yuu Kobori
- Department of Orthopedics, Kurashiki Central Hospital, Okayama, Japan
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Boydstun SM, Adamson GJ, McGarry MH, Tibone JE, Lee TQ. Load-to-failure characteristics of patellar tendon allograft superior capsule reconstruction compared with the native superior capsule. JSES Int 2021; 5:623-629. [PMID: 34223406 PMCID: PMC8245992 DOI: 10.1016/j.jseint.2021.04.013] [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: 11/17/2022] Open
Abstract
Background The potential use of a patellar tendon allograft for superior capsular reconstruction has been demonstrated biomechanically; however, there are concerns regarding compromised fixation strength owing to the longitudinal orientation of the fibers in the patellar tendon. Therefore, the purpose of this study was to compare the fixation strength of superior capsule reconstruction using a patellar tendon allograft to the intact superior capsule. Methods The structural properties of the intact native superior capsule (NSC) followed by superior capsular reconstruction using a patellar tendon allograft (PT-SCR) were tested in eight cadaveric specimens. The scapula and humerus were potted and mounted onto an Instron testing machine in 20 degrees of glenohumeral abduction. Humeral rotation was set to achieve uniform loading across the reconstruction. Specimens were preloaded to 10 N followed by cyclic loading from 10 N to 50 N for 30 cycles, then load to failure at a rate of 60 mm/min. Video digitizing software was used to quantify the regional deformation characteristics. Results During cyclic loading, there was no difference found in stiffness between PT-SCR and NSC (cycle 1 - PT-SCR: 12.9 ± 3.6 N/mm vs. NSC: 22.5 ± 1.6 N/mm; P = .055 and cycle 30 - PT-SCR: 27.3 ± 1.4 N/mm vs. NSC: 25.4 ± 1.7 N/mm; P = .510). Displacement at the yield load was not significantly different between the two groups (PT-SCR: 7.0 ± 1.0 mm vs. NSC: 6.5 ± 0.3 mm; P = .636); however, at the ultimate load, there was a difference in displacement (PT-SCR: 20.7 ± 1.1 mm vs. NSC: 8.1 ± 0.5 mm; P < .001). There was a significant difference at both the yield load (PT-SCR: 71.4 ± 2.2 N vs. NSC: 331.6 ± 56.6 N; P = .004) and the ultimate load (PT-SCR: 217.1 ± 26.9 N vs. NSC: 397.7 ± 62.4 N; P = .019). At the yield load, there was a difference found in the energy absorbed (PT-SCR: 84.4 ± 8.9 N-mm vs. NSC: 722.6 ± 156.8 N-mm; P = .005), but no difference in energy absorbed was found at the ultimate load. Conclusions PT-SCR resulted in similar stiffness to NSC at lower loads, yield displacement, and energy absorbed to ultimate load. The ultimate load of the PT-SCR was approximately 54% of the NSC, which is comparable with the percent of the ultimate load in rotator cuff repair and the intact supraspinatus at time zero.
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Affiliation(s)
- Seth M. Boydstun
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Gregory J. Adamson
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
- Corresponding author: Gregory J. Adamson, MD, Congress Medical Foundation, 800 South Raymond Ave, Pasadena, CA 91105, USA.
| | - Michelle H. McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - James E. Tibone
- Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Thay Q. Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
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Weber SC. Editorial Commentary: Mechanics Versus Biology: Both Are Relevant Principles in Understanding Superior Capsular Reconstruction. Arthroscopy 2021; 37:1126-1127. [PMID: 33812517 DOI: 10.1016/j.arthro.2020.12.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 12/27/2020] [Indexed: 02/02/2023]
Abstract
The topic of superior capsular reconstruction remains controversial. Whereas identifying the best time-zero graft configuration for this procedure remains important, the success or failure of the procedure will be dependent on the biology, not just the bench performance. Any conforming object placed in the subacromial space at time zero could center the humeral head and decrease superior translation compared with a massive rotator cuff tear but may not restore translation to normal. It does appear that a thicker graft is better in this regard, but how much thicker is better is unclear. Most of all, whether the mechanical benefits of a thicker graft will be offset by a thicker and potentially less biologically compatible construct is also unclear. In most orthopaedic settings, autografts remain consistently superior to allografts. The contrast in results may be better explained by biology, and the excellent superior capsular reconstruction results reported with autograft have not been replicated universally with dermal allograft.
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Greiner S, Kaeaeb M, Voss A, Lawton R, Bhide P, Achenbach L. Comparison of Superior Capsular Reconstruction and Partial Infraspinatus Repair: A Matched-Pair Analysis of Irreparable Rotator Cuff Tears. Orthop J Sports Med 2021; 9:2325967120984264. [PMID: 33738310 PMCID: PMC7934040 DOI: 10.1177/2325967120984264] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 09/04/2020] [Indexed: 01/27/2023] Open
Abstract
Background Superior capsular reconstruction (SCR) represents a new option for the treatment of irreparable rotator cuff tears. Purpose/Hypothesis This study aimed to evaluate the clinical and radiologic outcomes of SCR and compare them with the outcomes of partial repair (PR) of the infraspinatus tendon. The hypothesis was that there would be no significant differences between the clinical and radiologic outcome parameters of SCR and PR after a minimum follow-up of 2 years. Study Design Cohort study; Level of evidence, 3. Methods Of 21 patients who underwent SCR, 20 patients were matched in a 1:1 ratio according to sex, age, and tear configuration with 20 of 60 patients who had undergone PR; all patients were prospectively evaluated for a minimum follow-up of 2 years. The investigated outcome measures included the Constant score; Western Ontario Rotator Cuff (WORC) index; Disabilities of the Arm, Shoulder and Hand (DASH) score; and radiologic analysis of acromiohumeral distance (AHD) and humeral head centralization (HHC). Results There were no differences in the demographic data between the SCR and PR groups. The mean age of both groups was 62.3 years (range, 47-79 years), the mean tear configuration was Bateman 3.0 and Patte 2.8, and the mean follow-up period was 29.4 months (range, 24-53 months). At final follow-up, no significant differences were seen between the SCR and PR groups with regard to Constant score (77.1 vs 82.7), age- and sex-adapted Constant score (85.5% vs 91.4%), DASH score (15.6 vs 7.8), or WORC index (81.1 vs 90.4). No significant differences in the AHD or HHC were seen between the groups. The reoperation rate was 4.8% (1/21) in the SCR cohort and 15% (9/60) in the PR cohort. Conclusion Both SCR and PR resulted in significant improvements in patient-reported outcomes at 2-year follow-up, with no significant differences in clinical outcomes between the 2 techniques. Further follow-up is needed to determine whether there are long-term differences in HHC and development of cuff tear arthropathy. Further investigations should also focus on the cost-effectiveness of the respective procedures.
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Affiliation(s)
- Stefan Greiner
- Sporthopaedicum, Straubing and Regensburg, Germany.,Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Max Kaeaeb
- Sporthopaedicum, Straubing and Regensburg, Germany.,Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Andreas Voss
- Sporthopaedicum, Straubing and Regensburg, Germany.,Department of Trauma Surgery, University Medical Center Regensburg, Regensburg, Germany
| | | | | | - Leonard Achenbach
- Sporthopaedicum, Straubing and Regensburg, Germany.,Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Medical Center Würzburg, Würzburg, Germany
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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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Berthold DP, Muench LN, Dyrna F, Scheiderer B, Obopilwe E, Cote MP, Krifter MR, Milano G, Bell R, Voss A, Imhoff AB, Mazzocca AD, Beitzel K. Comparison of Different Fixation Techniques of the Long Head of the Biceps Tendon in Superior Capsule Reconstruction for Irreparable Posterosuperior Rotator Cuff Tears: A Dynamic Biomechanical Evaluation. Am J Sports Med 2021; 49:305-313. [PMID: 33395317 DOI: 10.1177/0363546520981559] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In the past decade, superior capsular reconstruction has emerged as a potential surgical approach in young patients with irreparable posterosuperior rotator cuff tears (RCT) and absence of severe degenerative changes. Recently, the use of locally available and biological viable autografts, such as the long head of the biceps tendon (LHBT) for SCR has emerged, with promising early results. PURPOSE/HYPOTHESIS The purpose of this study was to investigate the effect of using the LHBT for reconstruction of the superior capsule on shoulder kinematics, along with different fixation constructs in a dynamic biomechanical model. The authors hypothesized that each of the 3 proposed fixation techniques would restore native joint kinematics, including glenohumeral superior translation (ghST), maximum abduction angle (MAA), maximum cumulative deltoid force (cDF), and subacromial peak contact pressure (sCP). STUDY DESIGN Controlled laboratory study. METHODS Eight fresh-frozen cadaveric shoulders (mean age, 53.4 ± 14.2 years) were tested using a dynamic shoulder simulator. Each specimen underwent the following 5 conditions: (1) intact, (2) irreparable posterosuperior rotator cuff tear (psRCT), (3) V-shaped LHBT reconstruction, (4) box-shaped LHBT reconstruction, and (5) single-stranded LHBT reconstruction. MAA, ghST, cDF and sCP were assessed in each tested condition. RESULTS Each of the 3 LHBT techniques for reconstruction of the superior capsule significantly increased MAA while significantly decreasing ghST and cDF compared with the psRCT (P < .001 and P < .001, respectively). Additionally, the V-shaped and box-shaped techniques significantly decreased sCP (P = .009 and P = .016, respectively) compared with the psRCT. The V-shaped technique further showed a significantly increased MAA (P < .001, respectively) and decreased cDF (P = .042 and P = .039, respectively) when compared with the box-shaped and single-stranded techniques, as well as a significantly decreased ghST (P = .027) when compared with the box-shaped technique. CONCLUSION In a dynamic biomechanical cadaveric model, using the LHBT for reconstruction of the superior capsule improved shoulder function by preventing superior humeral migration, decreasing deltoid forces and sCP. As such, the development of rotator cuff tear arthropathy in patients with irreparable psRCTs could potentially be delayed. CLINICAL RELEVANCE Using a biologically viable and locally available LHBT autograft is a cost-effective, potentially time-saving, and technically feasible alternative for reconstruction of the superior capsule, which may result in favorable outcomes in irreparable psRCTs. Moreover, each of the 3 techniques restored native shoulder biomechanics, which may help improve shoulder function by preventing superior humeral head migration and the development of rotator cuff tear arthropathy in young patients with irreparable rotator cuff tears.
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Affiliation(s)
- Daniel P Berthold
- Investigation performed at the University of Connecticut Health Center/ UConn Musculoskeletal Institute, Farmington, Connecticut, USA
| | - Lukas N Muench
- Investigation performed at the University of Connecticut Health Center/ UConn Musculoskeletal Institute, Farmington, Connecticut, USA
| | - Felix Dyrna
- Investigation performed at the University of Connecticut Health Center/ UConn Musculoskeletal Institute, Farmington, Connecticut, USA
| | - Bastian Scheiderer
- Investigation performed at the University of Connecticut Health Center/ UConn Musculoskeletal Institute, Farmington, Connecticut, USA
| | - Elifho Obopilwe
- Investigation performed at the University of Connecticut Health Center/ UConn Musculoskeletal Institute, Farmington, Connecticut, USA
| | - Mark P Cote
- Investigation performed at the University of Connecticut Health Center/ UConn Musculoskeletal Institute, Farmington, Connecticut, USA
| | - Michael R Krifter
- Investigation performed at the University of Connecticut Health Center/ UConn Musculoskeletal Institute, Farmington, Connecticut, USA
| | - Guiseppe Milano
- Investigation performed at the University of Connecticut Health Center/ UConn Musculoskeletal Institute, Farmington, Connecticut, USA
| | - Ryan Bell
- Investigation performed at the University of Connecticut Health Center/ UConn Musculoskeletal Institute, Farmington, Connecticut, USA
| | - Andreas Voss
- Investigation performed at the University of Connecticut Health Center/ UConn Musculoskeletal Institute, Farmington, Connecticut, USA
| | - Andreas B Imhoff
- Investigation performed at the University of Connecticut Health Center/ UConn Musculoskeletal Institute, Farmington, Connecticut, USA
| | - Augustus D Mazzocca
- Investigation performed at the University of Connecticut Health Center/ UConn Musculoskeletal Institute, Farmington, Connecticut, USA
| | - Knut Beitzel
- Investigation performed at the University of Connecticut Health Center/ UConn Musculoskeletal Institute, Farmington, Connecticut, USA
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Kholinne E, Jeon IH. Arthroscopic superior capsular reconstruction of the shoulder: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:268. [PMID: 33708895 PMCID: PMC7940888 DOI: 10.21037/atm-20-5925] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Irreparable rotator cuff tears (IRCTs) in young and considerably active patients are difficult to treat because it is mostly associated with poor outcome which may lead to a painful and dysfunctional shoulder. Most of the IRCTs are encountered in massive size rotator cuff tears which associated with high failure rate following surgical repair. Thus, the IRCTs was considered challenging for its poor healing rate following repair which may induce the arthritic changes. Since the advent of arthroscopic superior capsular reconstruction (ASCR) of the shoulder in 2013, it has gained its popularity. The procedure has become the most popular option for joint-preserving shoulder surgery for patients with IRCTs. It works by providing a static restraint to the superior humeral head migration to optimize the rotator cuff force couples, hence improving joint kinematics. The acceptance of superior capsular reconstruction has made it rapidly evolving in terms of a wider variety of procedures and broader surgical indications. Despite the enthusiasm and widely acceptance towards the procedure, there are still many queries that exist regarding the best indications, surgical technique particularly graft of choice, the long-term outcome, and the complication and risk of the superior capsular reconstruction (SCR). This narrative review provide the current evidence of SCR in an attempt to provide a state-of-the-art knowledge.
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Affiliation(s)
- Erica Kholinne
- Faculty of Medicine, Trisakti University, Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia.,Department of Orthopaedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
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50
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Kovacevic D, Suriani RJ, Grawe BM, Yian EH, Gilotra MN, Hasan SA, Srikumaran U, Hasan SS, Cuomo F, Burks RT, Green AG, Nottage WM, Theja S, Kassam HF, Saad MA, Ramirez MA, Stanley RJ, Williams MD, Nadarajah V, Konja AC, Koh JL, Rokito AS, Jobin CM, Levine WN, Schmidt CC. Management of irreparable massive rotator cuff tears: a systematic review and meta-analysis of patient-reported outcomes, reoperation rates, and treatment response. J Shoulder Elbow Surg 2020; 29:2459-2475. [PMID: 32763381 PMCID: PMC7669555 DOI: 10.1016/j.jse.2020.07.030] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/17/2020] [Accepted: 07/19/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is no consensus on the treatment of irreparable massive rotator cuff tears. The goal of this systematic review and meta-analysis was to (1) compare patient-reported outcome scores, (2) define failure and reoperation rates, and (3) quantify the magnitude of patient response across treatment strategies. METHODS The MEDLINE, Embase, CENTRAL (Cochrane Central Register of Controlled Trials), and Scopus databases were searched for studies including physical therapy and operative treatment of massive rotator cuff tears. The criteria of the Methodological Index for Non-randomized Studies were used to assess study quality. Primary outcome measures were patient-reported outcome scores as well as failure, complication, and reoperation rates. To quantify patient response to treatment, we compared changes in the Constant-Murley score and American Shoulder and Elbow Surgeons (ASES) score with previously reported minimal clinically important difference (MCID) thresholds. RESULTS No level I or II studies that met the inclusion and exclusion criteria were found. Physical therapy was associated with a 30% failure rate among the included patients, and another 30% went on to undergo surgery. Partial repair was associated with a 45% retear rate and 10% reoperation rate. Only graft interposition was associated with a weighted average change that exceeded the MCID for both the Constant-Murley score and ASES score. Latissimus tendon transfer techniques using humeral bone tunnel fixation were associated with a 77% failure rate. Superior capsular reconstruction with fascia lata autograft was associated with a weighted average change that exceeded the MCID for the ASES score. Reverse arthroplasty was associated with a 10% prosthesis failure rate and 8% reoperation rate. CONCLUSION There is a lack of high-quality comparative studies to guide treatment recommendations. Compared with surgery, physical therapy is associated with less improvement in perceived functional outcomes and a higher clinical failure rate.
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Affiliation(s)
- David Kovacevic
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA.
| | - Robert J Suriani
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Brian M Grawe
- Department of Orthopaedic Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Edward H Yian
- Kaiser Permanente Southern California, Anaheim, CA, USA
| | - Mohit N Gilotra
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - S Ashfaq Hasan
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Samer S Hasan
- MercyHealth/Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, OH, USA
| | - Frances Cuomo
- Department of Orthopaedic Surgery, Montefiore Medical Center, New York, NY, USA
| | - Robert T Burks
- Department of Orthopaedic Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Andrew G Green
- Department of Orthopaedic Surgery, Warren Alpert Medical School at Brown University/Rhode Island Hospital, Providence, RI, USA
| | - Wesley M Nottage
- The Sports Clinic Orthopaedic Medical Associates, Laguna Hills, CA, USA
| | - Sai Theja
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Hafiz F Kassam
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Maarouf A Saad
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | | | | | | | - Vidushan Nadarajah
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alexis C Konja
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Jason L Koh
- NorthShore Orthopaedic Institute, NorthShore University Health System, Evanston, IL, USA
| | - Andrew S Rokito
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Charles M Jobin
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - William N Levine
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Christopher C Schmidt
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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