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Cho SH, Park CJ, Kim SJ, Lee KG, Baek GR, Chung MS, Hui AT, McGarry MH, Lee TQ, Kim YS. Bursal Acromial Resurfacing Improves Shoulder Biomechanics in a Cadaveric Model of Massive Rotator Cuff Tear. Arthroscopy 2024:S0749-8063(24)00454-7. [PMID: 38925233 DOI: 10.1016/j.arthro.2024.06.019] [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: 05/26/2024] [Revised: 05/26/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE To investigate the effectiveness of bursal acromial resurfacing (acromiograft) on acromiohumeral distance, subacromial contact area, and pressure in a cadaveric model of massive rotator cuff tear. METHODS Eight fresh-frozen cadaveric shoulders were tested using a customized shoulder testing system. Humeral head translation, subacromial contact pressure, and the subacromial contact area were evaluated across 4 conditions: (1) intact shoulder; (2) simulated massive rotator cuff tear, (3) 3-mm acromiograft condition, and (4) 6-mm acromiograft condition. The acromiografts were simulated using Teflon and a reported technique. The values were measured at 0°, 20°, and 40° abduction and 0°, 30°, 60°, and 90° external rotation for each abduction status. RESULTS Compared with a massive cuff tear, the 6-mm acromiograft significantly reduced the superior translation of the humeral head at all abduction/external rotation angles (P < .05). The 3-mm acromiograft also decreased superior translation of the humeral head compared with massive cuff tear, but not all differences were significant. The 3- and 6-mm acromiografts significantly decreased the subacromial contact pressure and increased the subacromial contact area in almost all positions (P < .05). The 3-mm acromiograft maintained biomechanical properties similar to the intact condition, whereas the 6-mm acromiograft increased the contact area. CONCLUSIONS This biomechanical study demonstrated that both 3- and 6-mm acromiografts using Teflon in a cadaveric model of a massive cuff tear resulted in recentering of the superiorly migrated humeral head, increased the subacromial contact area, and decreased the subacromial contact pressure. The 3-mm graft was sufficient for achieving the intended therapeutic effects. CLINICAL RELEVANCE The acromiograft can normalize altered biomechanics and may aid in the treatment of massive cuff tears. Because grafting the acromion's undersurface is new with limited clinical outcomes, further observation is crucial. Using a Teflon instead of an acellular dermal matrix allograft for bursal acromial resurfacing could yield different results, requiring careful interpretation.
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Affiliation(s)
- Sung-Hyun Cho
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan-Joo Park
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang-Jae Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyoung-Geun Lee
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Gyu Rim Baek
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, U.S.A
| | - Min-Shik Chung
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, U.S.A
| | - Aaron T Hui
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, U.S.A
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, U.S.A
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, U.S.A
| | - Yang-Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
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Gan K, Bi M, Zhou K, Xia C, Ding W, Ding S, Li J. Bridging repair reinforced with artificial ligament as an internal brace for irreparable massive rotator cuff tears. J Shoulder Elbow Surg 2024; 33:e322-e335. [PMID: 38072033 DOI: 10.1016/j.jse.2023.10.020] [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: 03/23/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND The irreparable massive rotator cuff tear (IMRCT) is challenging to manage. Although various surgical options have been proposed to treat IMRCTs, the optimal surgical technique remains controversial. Arthroscopic bridging patch repair is clinically used for treating IMRCTs, but the healing rate of the patch graft is negatively affected by superior shift of the humeral head. This study aimed to evaluate the clinical efficacy of artificial ligament as an internal brace (IB) reinforcing fascia lata autograft bridging repair (ABR) in the treatment of IMRCTs. METHODS The data of 50 patients with IMRCTs who underwent ABR reinforced with artificial ligament as an IB (ABR + IB) (internal brace group) or ABR alone (control group) were retrospectively evaluated preoperatively and at 2-year follow-up. Clinical outcomes were assessed based on the shoulder activity, of which the strength was measured using a 0-10 points manual muscle test scale, American Shoulder and Elbow Surgeons score, and visual analog scale for pain. Imaging outcomes were evaluated based on acromiohumeral distance (AHD), Hamada grade, Goutallier grade, and the status of fascia lata grafts as per radiographs or magnetic resonance imaging findings. RESULTS Both groups showed significantly better results in shoulder activity, American Shoulder and Elbow Surgeons score, visual analog scale score, and AHD at 2-year follow-up compared with preoperative levels (P < .001). Compared with the control group (n = 24), the internal brace group (n = 26) had better mean AHD (7.0 ± 1.4 mm vs. 5.9 ± 1.0 mm, P = .002), mean improvement in AHD (3.3 ± 1.5 mm vs. 2.0 ± 0.6 mm, P < .001), healing rate of autografts (92.3% vs. 54.2%, P = .002), and improvement rate of Hamada grade (73.1% vs. 41.7%, P = .025) at 2-year follow-up. No significant differences were found in active elevation, active external rotation, active internal rotation, abduction strength, external rotation strength, internal rotation strength, American Shoulder and Elbow Surgeons score, or visual analog scale between the 2 groups at 2-year follow-up. CONCLUSION Both the ABR + IB and ABR improved the postoperative short-term clinical and imaging outcomes in managing IMRCTs, the ABR + IB is statistically superior to ABR alone in terms of healing rate of the bridging graft, AHD, and Hamada grade at 2-year follow-up, while further clinical investigations with larger sample size and longer follow-ups are required to validate the clinical significance of this novel technique for IMRCTs.
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Affiliation(s)
- Kaifeng Gan
- Department of Orthopaedics, the Affiliated LiHuiLi Hospital of Ningbo University, Ningbo, Republic of China
| | - Mingguang Bi
- Department of Orthopaedics, the Affiliated LiHuiLi Hospital of Ningbo University, Ningbo, Republic of China
| | - Ke Zhou
- Department of Orthopaedics, the Affiliated LiHuiLi Hospital of Ningbo University, Ningbo, Republic of China
| | - Chenjie Xia
- Department of Orthopaedics, the Affiliated LiHuiLi Hospital of Ningbo University, Ningbo, Republic of China
| | - Wei Ding
- Department of Orthopaedics, the Affiliated LiHuiLi Hospital of Ningbo University, Ningbo, Republic of China
| | - Shaohua Ding
- Department of Orthopaedics, the Affiliated LiHuiLi Hospital of Ningbo University, Ningbo, Republic of China
| | - Jin Li
- Department of Orthopaedics, the Affiliated LiHuiLi Hospital of Ningbo University, Ningbo, Republic of China.
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Mahatme RJ, Modrak M, Wilhelm C, Lee MS, Owens JS, Gillinov SM, Fong S, Pettinelli N, Islam W, Jimenez AE. Glenohumeral Superior Translation and Subacromial Contract Pressure Are Both Improved With Superior Capsular Reconstruction: A Systematic Review and Meta-analysis of Biomechanical Investigations. Arthroscopy 2024; 40:1279-1287. [PMID: 37634706 DOI: 10.1016/j.arthro.2023.08.025] [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: 02/16/2023] [Revised: 07/26/2023] [Accepted: 08/18/2023] [Indexed: 08/29/2023]
Abstract
PURPOSE To review cadaveric studies evaluating the biomechanical outcomes of superior capsular reconstruction (SCR) with different graft types for the treatment of irreparable rotator cuff (RTC) tears. METHODS PubMed, Cochrane, and Embase were queried in January 2022 to conduct this meta-analysis using the following key words: "superior capsule reconstruction," "superior capsular reconstruction," and "biomechanics." Articles were included if they reported glenohumeral superior translation or subacromial contact pressure following SCR in cadaveric RTC tears. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. Number of shoulders, graft types, and biomechanical outcomes were recorded and analyzed with forest plots. RESULTS Twelve studies (95 shoulders) were included in the statistical analysis. There was a significant reduction in glenohumeral superior translation following SCR compared with RTC tear across 10 studies (79 shoulders) with standardized mean difference (SMD) -2.48 mm; confidence interval (CI) -3.28 mm, -1.69 mm. The SMD between fascia lata graft and RTC tear was -3.84 mm (CI -4.82 mm, -2.86 mm) and between dermal allograft and RTC tear was -2.05 mm (CI -3.10 mm, -1.00 mm). There was a significant reduction in subacromial contact pressure following SCR compared with RTC tear across 5 studies (55 shoulders) with SMD -3.49 MPa (CI -4.54 MPa, -2.44 MPa). The SMD between fascia lata graft and RTC tear was -3.21 MPa (CI -5.08 MPa, -1.34 MPa) and between dermal allograft and RTC tear was -3.89 MPa (CI -5.91 MPa, -1.87 MPa). CONCLUSIONS Independent of graft type, biomechanical studies suggest that SCR improves glenohumeral superior translation and subacromial contact pressure in comparison with RTC tear at time zero. There was no definitive evidence identified in this study to suggest a biomechanically superior SCR graft option. CLINICAL RELEVANCE Investigating the biomechanical outcomes of several graft types for superior capsular reconstruction will help surgeons better understand the efficacies of different graft types for use in superior capsule reconstruction surgery.
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Affiliation(s)
- Ronak J Mahatme
- University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A
| | - Maxwell Modrak
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Christopher Wilhelm
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Michael S Lee
- Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A
| | - Jade S Owens
- Keck School of Medicine of USC, Los Angeles, California, U.S.A
| | - Stephen M Gillinov
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Scott Fong
- Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A
| | | | - Wasif Islam
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A
| | - Andrew E Jimenez
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A..
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Chung SW, Kim DH, Lee HJ, Hong WK, Chung SH, Yoon JP. Superior capsular reconstruction for irreparable rotator cuff tear: a review of current methods. Clin Shoulder Elb 2023; 26:438-444. [PMID: 37994007 DOI: 10.5397/cise.2023.00514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/30/2023] [Indexed: 11/24/2023] Open
Abstract
Irreparable massive rotator cuff tears can significantly impact daily life; and these types of tears can be difficult to repair completely, especially in younger patients who are more active and have higher functional requirements. Since its introduction by Mihata and the colleagues, superior capsular reconstruction (SCR) has gained popularity in the treatment of irreparable massive rotator cuff tears and has shown promising short-term results. A variety of studies have focused on the clinical and biomechanical outcomes of this procedure. This article reviews the biomechanics, indications for the surgical procedure, graft options, surgical technique, and rehabilitation from SCR.
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Affiliation(s)
- Seok Won Chung
- Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Dong-Hyun Kim
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Hyun Joo Lee
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Won Ki Hong
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Seung Ho Chung
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Jong Pil Yoon
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
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Crook BS, Lorenzana DJ, Danilkowicz R, Herbst K, Wittstein JR, Toth AP, Lassiter T, Lau BC. Early clinical and patient-reported outcomes for arthroscopic and mini-open superior capsular reconstruction are similar for irreparable rotator cuff tears. J ISAKOS 2023; 8:338-344. [PMID: 37414217 DOI: 10.1016/j.jisako.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/12/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVES The purpose of this study was to report and compare postoperative range of motion (ROM), patient-reported outcomes, and failure rates following superior capsular reconstruction (SCR) and to compare outcomes between arthroscopic and mini-open techniques. METHODS All SCR procedures utilising dermal allograft with a minimum of 6 months of follow-up at multiple institutions between November 2015 and October 2019 were retrospectively reviewed. Preoperative patient demographics, imaging measurements, surgical technique (arthroscopic versus mini-open), and outcomes including pain scores, conversion to reverse shoulder arthroplasty, subsequent surgery, and postoperative ROM were recorded. Outcomes for arthroscopic versus mini-open approaches were compared via t-test, Fisher's exact test, or chi square test, as appropriate, with differences of p < 0.05 considered significant. RESULTS 180 total patients were included, including 98 who underwent arthroscopic SCR and 82 who underwent mini-open SCR. Final follow-up was at a mean of 32 months (standard deviation = 11 months). SCR improved pain (visual analog scale = 4.4 pre-operatively vs. 1.4 post-operatively, p < 0.0001) and ROMin active forward flexion (136° pre-operatively vs. 150° post-operatively, p = 0.0012). No difference in post-operative pain visual analog scores was found between mini-open and arthroscopic cohorts (1.3 vs. 1.6, p = 0.3432) at a mean of 14 months post-operatively. At a mean of 32 months post-operatively, there were no differences in ASES, QuickDASH, SST, WORC, or SANE scores between open and arthroscopic cohorts. There was no difference in rates of failure between mini-open and arthroscopic cohorts (15.9% vs. 17.3%, p = 0.789). CONCLUSIONS This study confirmed that SCR improves pain and ROM in the short term. Mini-open SCR appears to provide similar improvements in pain and ROM compared with arthroscopic SCR, as well as patient-reported outcomes at 3 years. No difference in failure rates was detected between the 2 procedures. LEVEL OF EVIDENCE Level 3 evidence.
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Rauck RC, Brusalis CM, Jahandar A, Lamplot JD, Dines DM, Warren RF, Gulotta LV, Kontaxis A, Taylor SA. Complete Restoration of Native Glenoid Width Improves Glenohumeral Biomechanics After Simulated Latarjet. Am J Sports Med 2023; 51:2023-2029. [PMID: 37249128 DOI: 10.1177/03635465231174910] [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: 05/31/2023]
Abstract
BACKGROUND The amount of glenoid width that must be restored with a Latarjet procedure in order to reestablish glenohumeral stability has not been determined. PURPOSE/HYPOTHESIS The purpose of this article was to determine the percentage of glenoid width restoration necessary for glenohumeral stability after Latarjet by measuring anterior humeral head translation and force distribution on the coracoid graft. The hypothesis was that at least 100% of glenoid width restoration with Latarjet would be required to maintain glenohumeral stability. STUDY DESIGN Controlled laboratory study. METHODS Nine cadaveric shoulders were prepared and mounted on an established shoulder simulator. A lesser tuberosity osteotomy (LTO) was performed to allow accurate removal of glenoid bone. Coracoid osteotomy was performed, and the coracoid graft was sized to a depth of 10 mm. Glenoid bone was sequentially removed, and Latarjet was performed using 2 screws to reestablish 110%, 100%, 90%, and 80% of native glenoid width. The graft was passed through a subscapularis muscle split, and the LTO was repaired. A motion tracking system recorded glenohumeral translations, and force distribution was recorded using a TekScan pressure sensor secured to the glenoid face and coracoid graft. Testing conditions included native; LTO; Bankart tear; and 110%, 100%, 90%, and 80% of glenoid width restoration with Latarjet. Glenohumeral translations were recorded while applying an anteroinferior load of 44 N at 90° of humerothoracic abduction and 0° or 45° of glenohumeral external rotation. Force distribution was recorded without an anteroinferior load. RESULTS Anterior humeral head translation progressively increased as the proportion of glenoid width restored decreased. A marked increase in anterior humeral head translation was found with 90% versus 100% glenoid width restoration (10.8 ± 3.0 vs 4.1 ± 2.6 mm, respectively; P < .001). Greater glenoid bone loss also led to increased force on the coracoid graft relative to the native glenoid bone after Latarjet. A pronounced increase in force on the coracoid graft was seen with 90% versus 100% glenoid width restoration (P < .001). CONCLUSION Anterior humeral head translation and force distribution on the coracoid graft dramatically increased when <100% of the native glenoid width was restored with a Latarjet procedure. CLINICAL RELEVANCE If a Latarjet is unable to fully restore the native glenoid width, surgeons should consider alternative graft sources to minimize the risk of recurrent instability or coracoid overload.
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Affiliation(s)
- Ryan C Rauck
- Division of Sports Medicine, Department of Orthopaedic Surgery, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Christopher M Brusalis
- Sports Medicine Institute, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Amirhossein Jahandar
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Joseph D Lamplot
- Division of Sports Medicine, Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - David M Dines
- Sports Medicine Institute, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Russell F Warren
- Sports Medicine Institute, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Lawrence V Gulotta
- Sports Medicine Institute, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Andreas Kontaxis
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Samuel A Taylor
- Sports Medicine Institute, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Ting RS, Rosenthal R, Law TK, Al-Housni HSA, Hackett L, Lam PH, Murrell GAC. Reliability of a Novel Preoperative Protocol for Determining Graft Sizes for Superior Capsular Reconstruction Using Plain Film Radiography. J Clin Med 2023; 12:jcm12072707. [PMID: 37048790 PMCID: PMC10095341 DOI: 10.3390/jcm12072707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Superior capsular reconstruction (SCR) for massive, irreparable rotator cuff tears involves anchoring a graft between the superior glenoid and the greater tuberosity of the humerus. Optimizing the graft size is important. We aimed (1) to evaluate the reliability of plain film radiography in determining graft size for SCR and (2) to create a database to help predict future graft sizes. METHODS An inter- and intra-rater reliability trial was conducted on 10 and 6 subjects with healthy shoulders, respectively, using plain film radiography to measure the distance between the superior glenoid and the supraspinatus footprint. The subjects were positioned upright with an abduction pillow modified to hold the shoulder at 30° abduction and 45° external rotation, afterwhich a true antero-posterior shoulder radiograph was captured. Thirty subjects were recruited for the database and grouped using the aforementioned protocol. RESULTS The inter-rater and intra-rater trial agreement was excellent, with intraclass correlation coefficients of 0.94 (95% CI) and 0.76 (95% CI), respectively. Three medio-lateral patch sizes, of 33 mm, 38 mm, and 47 mm, were proposed based on the protocol in 30 subjects. CONCLUSIONS Plain film radiography demonstrated excellent reliability in measuring the distance between the superior glenoid and the supraspinatus footprint. Three ordinal patch sizes are proposed.
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Affiliation(s)
- Ryan S Ting
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW 2217, Australia
| | - Ron Rosenthal
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW 2217, Australia
| | - Tsz Kit Law
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW 2217, Australia
| | - Hilal S A Al-Housni
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW 2217, Australia
| | - Lisa Hackett
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW 2217, Australia
| | - Patrick H Lam
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW 2217, Australia
| | - George A C Murrell
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW 2217, Australia
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Le Breton S, Forlizzi J, Bono O, MacAskill M, Mousad A, Kush S, O’Brien M, Christensen A, Mithoefer K, Ramappa A, Ross G, Shah SS. Local Intraoperative Marrow-Derived Augmentation for Primary Rotator Cuff Repair: An Updated Systematic Review and Meta-analysis of Studies From 2010 to 2022. Orthop J Sports Med 2023; 11:23259671221147896. [PMID: 37009491 PMCID: PMC10061649 DOI: 10.1177/23259671221147896] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/21/2022] [Indexed: 04/04/2023] Open
Abstract
Background Recurrent tears of the rotator cuff pose a substantial problem despite advances in repair technique. Biologic augmentation via marrow stimulation or vented anchors may strengthen the suture-tendon junction and improve healing rates of native tissue, thereby enhancing outcomes of primary surgical repair. Purpose To provide a focused systematic review and meta-analysis of local, intraoperative marrow-derived augmentation techniques in clinical primary rotator cuff repair. Study Design Systematic review; Level of evidence, 4. Methods A systematic review of PubMed, Embase, and Cochrane was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 2131 studies from 2010 to 2022, focused on either marrow stimulation or vented anchors, were isolated and classified as either preclinical or clinical. Meta-analysis was performed for comparative marrow stimulation and vented anchor studies. Heterogeneity was tested through calculation of I 2. Results A total of 13 clinical studies were included in the review. All 9 comparative studies included in the meta-analysis demonstrated high methodologic quality or a low risk of bias. The pooled retear rate across all 9 clinical studies for patients undergoing marrow stimulation was 11%. For the 5 studies in the meta-analysis, the pooled retear rates were 15% for marrow stimulation and 30% for controls. Meta-analysis demonstrated a significant difference in the overall retear rate that favored marrow stimulation (odds ratio [OR], 0.41; 95% CI, 0.25-0.66; P = .0003; I 2 = 0%). Similarly, meta-analysis of the Constant score at final follow-up demonstrated a statistically significant difference between the 2 groups that favored a higher Constant score in the marrow stimulation group (mean difference, 2.84; 95% CI, 1.02-4.66; P = .002; I 2 = 29%). Vented anchors demonstrated improved ossification and bone density at the anchor site, but no difference in outcomes or retear. Pooled retear rates were 22.5% for vented anchors and 27.8% for controls. Conclusion Current evidence demonstrates that marrow-stimulation techniques may have a positive impact on healing and retear rate, while vented anchors have a muted impact relative to nonvented anchors. Although available evidence is limited and more research is needed, findings to date suggest that marrow stimulation techniques may be an inexpensive, straightforward technique to consider in qualifying patients to prevent rotator cuff retears.
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Affiliation(s)
- Stephen Le Breton
- New England Baptist Hospital, Boston, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
- Stephen Le Breton, BS, Pro Sports Orthopedics, 20 Guest Street, Brighton, MA 02135, USA ()
| | | | - Olivia Bono
- New England Baptist Hospital, Boston, Massachusetts, USA
- Albany Medical College, Albany, New York, USA
| | | | - Albert Mousad
- New England Baptist Hospital, Boston, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Sophie Kush
- New England Baptist Hospital, Boston, Massachusetts, USA
| | - Makenzie O’Brien
- New England Baptist Hospital, Boston, Massachusetts, USA
- Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania, USA
| | - Alaia Christensen
- New England Baptist Hospital, Boston, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Kai Mithoefer
- New England Baptist Hospital, Boston, Massachusetts, USA
| | - Arun Ramappa
- New England Baptist Hospital, Boston, Massachusetts, USA
| | - Glen Ross
- New England Baptist Hospital, Boston, Massachusetts, USA
| | - Sarav S. Shah
- New England Baptist Hospital, Boston, Massachusetts, USA
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Ting RS, Guo AA, Rosenthal R, Al-Housni HSA, Lam PH, Murrell GAC. Biomechanical Comparison of Synthetic Polytetrafluoroethylene (PTFE) vs Human Dermal Allograft (HDA), 2 vs 3 Glenoid Anchors, and Suture vs Minitape in Superior Capsule Reconstruction. HSS J 2023; 19:44-52. [PMID: 36776506 PMCID: PMC9837406 DOI: 10.1177/15563316221114135] [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: 04/12/2022] [Accepted: 06/24/2022] [Indexed: 02/14/2023]
Abstract
Background: Superior capsule reconstruction (SCR) is an option for the treatment of massive, irreparable rotator cuff tears. However, which materials yield the strongest constructs remains undetermined. Purposes: We sought to investigate whether SCR with polytetrafluoroethylene (PTFE) or human dermal allograft (HDA), 2 or 3 glenoid anchors, and suture or minitape resulted in better failure load properties at the patch-glenoid interface. Methods: We conducted a biomechanical study in 30 glenoid-sided SCR repairs in Sawbones models divided into 5 groups. Each was pulled to failure to assess mode of failure, peak load (N), stiffness (N/mm), yield load (N), peak energy (N m), and ultimate energy (N m). The 5 groups were as follows: group 1-PTFE, 2 anchors, and suture; group 2-PTFE, 2 anchors, and minitape; group 3-HDA, 2 anchors, and suture; group 4-HDA, 2 anchors, and minitape; group 5-PTFE, 3 anchors, and minitape. Results: Repairs failed by button-holing of suture/minitape. Group 5 had greater peak load, stiffness, yield load, and peak energy (384 ± 62 N; 24 ± 3 N/mm; 343 ± 42 N; 4 ± 2 N m) than group 3 (226 ± 67 N; 16 ± 4 N/mm; 194 ± 74 N; 2 ± 1 N m) or group 4 (274 ± 62 N; 17 ± 4 N/mm; 244 ± 50 N; 2 ± 1 N m) and greater ultimate energy (8 ± 3 N m) than all other groups. Conclusions: This biomechanical study of SCR repairs in Sawbones models found that yield load was greater in PTFE than HDA, 3 anchors were better than 2, and minitape was no better than suture.
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Affiliation(s)
- Ryan S. Ting
- University of New South Wales, Sydney, NSW, Australia
- Orthopaedic Research Institute, Saint George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Allen A. Guo
- University of New South Wales, Sydney, NSW, Australia
- Orthopaedic Research Institute, Saint George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Ron Rosenthal
- Orthopaedic Research Institute, Saint George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Hilal S. A. Al-Housni
- Orthopaedic Research Institute, Saint George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Patrick H. Lam
- University of New South Wales, Sydney, NSW, Australia
- Orthopaedic Research Institute, Saint George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - George A. C. Murrell
- University of New South Wales, Sydney, NSW, Australia
- Orthopaedic Research Institute, Saint George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
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10
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Zhao X, Jia J, Wen L, Zhang B. Biomechanical outcomes of superior capsular reconstruction for irreparable rotator cuff tears by different graft materials-a systematic review and meta-analysis. Front Surg 2023; 9:939096. [PMID: 36700024 PMCID: PMC9869421 DOI: 10.3389/fsurg.2022.939096] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023] Open
Abstract
Background Irreparable rotator cuff tears (IRCT) are defined as defects that cannot be repaired due to tendon retraction, fat infiltration, or muscle atrophy. One surgical remedy for IRCT is superior capsular reconstruction (SCR), which fixes graft materials between the larger tuberosity and the superior glenoid. Patients and methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) criteria were followed for conducting the systematic review and meta-analysis. From their inception until February 25, 2022, Pubmed, Embase, and Cochrane Library's electronic databases were searched. Studies using cadavers on SCR for IRCT were also included. The humeral head's superior translation and subacromial peak contact pressure were the primary outcomes. The humeral head's anteroposterior translation, the kind of graft material used, its size, and the deltoid load were the secondary outcomes. Results After eliminating duplicates from the search results, 1,443 unique articles remained, and 20 papers were finally included in the quantitative research. In 14 investigations, the enhanced superior translation of the humeral head was documented in IRCTs. In 13 studies, a considerable improvement following SCR was found, especially when using fascia lata (FL), which could achieve more translation restraints than human dermal allograft (HDA) and long head of bicep tendon (LHBT). Six investigations reported a subacromial peak contact pressure increase in IRCTs, which could be rectified by SCR, and these studies found a substantial increase in this pressure. The results of the reduction in subacromial peak contact pressure remained consistent regardless of the graft material utilized for SCR. While there was a statistically significant difference in the change of graft material length between FL and HDA, the change in graft material thickness between FL and HDA was not significant. The humeral head's anterior-posterior translation was rising in IRCTs and could be returned to its original state with SCR. In five investigations, IRCTs caused a significant increase in deltoid force. Furthermore, only one study showed that SCR significantly decreased deltoid force. Conclusion With IRCT, SCR might significantly decrease the glenohumeral joint's superior and anterior-posterior stability. Despite the risks for donor-site morbidity and the longer recovery time, FL is still the best current option for SCR.
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11
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Nicholson AD, Carey EG, Mathew JI, Pinnamaneni S, Jahandar A, Kontaxis A, Dines DM, Dines JS, Blaine TA, Fu MC, Rodeo SA, Warren RF, Gulotta LV, Taylor SA. Biomechanical analysis of anterior stability after 15% glenoid bone loss: comparison of Bankart repair, dynamic anterior stabilization, dynamic anterior stabilization with Bankart repair, and Latarjet. J Shoulder Elbow Surg 2022; 31:2358-2365. [PMID: 35597534 DOI: 10.1016/j.jse.2022.04.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/11/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Dynamic anterior shoulder stabilization (DAS) with Bankart repair is a recently described stabilization technique thought to be more robust than an isolated Bankart repair while avoiding many coracoid transfer-related complications and technical demands. DAS involves transfer of the long head biceps through a subscapularis split to the anterior glenoid to create a sling effect. We hypothesize that DAS with Bankart repair will restore anterior stability in a human-cadaveric model with subcritical (15%) glenoid bone loss. METHODS Eight cadaveric shoulders were tested using an established shoulder simulator to record glenohumeral translations with an accuracy of ±0.2 mm. Shoulders were tested in 5 states-intact soft tissues, Bankart defect with 15% bone loss, isolated Bankart repair, DAS with Bankart repair, isolated DAS, and Latarjet. A 45 N anterior force was applied through the pectoralis major tendon, and translation of the humeral head was recorded and compared with repeated measures analysis of variance. RESULTS The anterior translation in the intact (native) glenoid was 4.7 mm at neutral position and 4.6 mm at 45° external rotation. Anterior translation significantly increased after introducing a Bankart defect with 15% glenoid bone loss to 9.1 mm (neutral, P = .002) and 9.5 mm (45° external rotation, P < .001). All repair conditions showed a significant decrease in anterior translation relative to Bankart defect. DAS with Bankart repair decreased anterior translation compared with the Bankart defect: 2.7 mm (neutral, P < .001) and 2.1 mm (45° external rotation, P < .001). DAS with Bankart repair significantly decreased anterior translation compared with the isolated Bankart repair (2.7 mm vs. 4.7 mm, P = .023) and the isolated DAS (2.7 mm vs. 4.3 mm, P = .041) in neutral position. The Latarjet procedure resulted in the greatest reduction in anterior translation compared with the Bankart defect: 1.2 mm (neutral, P < .001) and 1.9 mm (45° external rotation, P < .001). CONCLUSIONS DAS with Bankart repair is a viable alternative to restore anterior glenohumeral stability with a 15% glenoid defect at a greater degree than either DAS or Bankart repair alone. The Latarjet procedure was the most effective in reducing anterior translation but restrained the anterior translation significantly more than the native glenoid.
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Affiliation(s)
- Allen D Nicholson
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA.
| | - Edward G Carey
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Joshua I Mathew
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Sridhar Pinnamaneni
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Amirhossein Jahandar
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Andreas Kontaxis
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - David M Dines
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Joshua S Dines
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Theodore A Blaine
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Michael C Fu
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Scott A Rodeo
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Russell F Warren
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Lawrence V Gulotta
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
| | - Samuel A Taylor
- Shoulder and Elbow Division, Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
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12
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Rauck RC, Jahandar A, Kontaxis A, Dines DM, Warren RF, Taylor SA, Gulotta LV. The role of the long head of the biceps tendon in posterior shoulder stabilization during forward flexion. J Shoulder Elbow Surg 2022; 31:1254-1260. [PMID: 35066121 DOI: 10.1016/j.jse.2021.12.026] [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: 10/02/2021] [Revised: 12/08/2021] [Accepted: 12/12/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The role of the long head of the biceps tendon (LHBT) in glenohumeral stability is not fully understood. Most objects are lifted in the sagittal plane with forward flexion, which stresses the posterior aspect of the unconstrained glenohumeral joint. Determining the mechanism by which the shoulder maintains stability with functional motions is important to understanding the pathoanatomy of degenerative shoulders. Our hypothesis was that the LHBT resists posterior translation of the humeral head (HH) during forward flexion by tensioning the posterior capsuloligamentous complex. METHODS Ten fresh-frozen cadaveric shoulders were tested using an established shoulder simulator that loads the LHBT, rotator cuff, and deltoid tendons through a system of pulleys. A motion tracking system recorded glenohumeral translations with an accuracy of ±0.2 mm. In each subject, the scapula was fixed and the humerus was tested in 6 positions: 30° and 60° of glenohumeral forward flexion at (1) maximum internal rotation (IR), (2) neutral rotation, and (3) maximum external rotation (ER). The deltoid was loaded with 100 N, and the infraspinatus and subscapularis were loaded with 22 N each. The difference in glenohumeral translation was calculated at each position comparing the LHBT loaded with 45 N or unloaded. RESULTS At 30° of glenohumeral forward flexion, unloading the LHBT increased HH posterior translation by 2.5 mm (±0.9 mm; P < .001), 1.7 mm (±1.0 mm; P < .001), and 1.0 mm (±0.9 mm; P = .01) at maximum ER, neutral rotation, and maximum IR, respectively. At 60° of glenohumeral forward flexion, unloading the LHBT increased HH posterior translation by 2.8 mm (±1.2 mm; P < .001), 2.4 mm (±1.6 mm; P < .001), and 1.7 mm (±1.4 mm; P < .001) at maximum ER, neutral rotation, and maximum IR, respectively. CONCLUSION LHBT loading resists posterior translation of the HH during forward flexion. These data support the role of the LHBT as a posterior stabilizer of the shoulder, specifically when a person is carrying objects in front of them. Further work is needed to determine if unloading the LHBT, as is done with biceps tenotomy or tenodesis, may eventually lead to posterior labral pathology, or to the posterior glenoid wear commonly seen with osteoarthritis.
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Affiliation(s)
- Ryan C Rauck
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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13
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Tibone JE, Mansfield C, Kantor A, Giordano J, Lin CC, Itami Y, McGarry MH, Adamson GJ, Lee TQ. Human Dermal Allograft Superior Capsule Reconstruction With Graft Length Determined at Glenohumeral Abduction Angles of 20° and 40° Decreases Joint Translation and Subacromial Pressure Without Compromising Range of Motion: A Cadaveric Biomechanical Study. Arthroscopy 2022; 38:1398-1407. [PMID: 34785299 DOI: 10.1016/j.arthro.2021.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the biomechanical effects of superior capsule reconstruction (SCR) graft fixation length determined at 20° and 40° of glenohumeral (GH) abduction. METHODS Humeral translation, rotational range of motion (ROM), and subacromial contact pressure were quantified at 0°, 30°, and 60° of GH abduction in the scapular plane in 6 cadaveric shoulders for the following states: intact, massive rotator cuff tear, SCR with dermal allograft fixed at 20° of GH abduction (SCR 20), and SCR with dermal allograft fixed at 40° of GH abduction (SCR 40). Statistical analysis was conducted using a repeated-measures analysis of variance and a paired t test (P < .05). RESULTS A massive cuff tear significantly increased total ROM compared with the intact state at 0° and 60° of abduction. SCR 20 or SCR 40 did not affect ROM. Compared with the intact state, the massive cuff tear model significantly increased superior translation by an average of 4.6 ± 0.5 mm in 9 of 12 positions (P ≤ .002). Both SCR 20 and SCR 40 reduced superior translation compared with the massive cuff tear model (P < .05); however, SCR 40 significantly decreased superior translation compared with SCR 20 at 0° of abduction (P ≤ .046). Peak subacromial pressure for the massive cuff tear model increased by an average of 486.8 ± 233.9 kPa relative to the intact state in 5 of 12 positions (P ≤ .037). SCR 20 reduced peak subacromial pressure in 2 of 12 positions (P ≤ .012), whereas SCR 40 achieved this in 6 of 12 positions (P ≤ .024). CONCLUSIONS SCR with dermal allograft fixed at 20° or 40° of GH abduction decreases GH translation and subacromial pressure without decreasing ROM. CLINICAL RELEVANCE With an increasing abduction angle for graft fixation, the medial-to-lateral graft length is decreased and the graft tension is effectively increased. Surgeons may increase shoulder stability without restricting ROM by fixing the graft at higher abduction angles. However, surgeons should remain cognizant of potential graft failure due to increased tension.
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Affiliation(s)
- James E Tibone
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Colin Mansfield
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Adam Kantor
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | - James Giordano
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Charles C Lin
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | - Yasuo Itami
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A.; Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | - Gregory J Adamson
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A..
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14
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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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15
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Forlizzi JM, Sylvia SM, Pettit RJ, Saini SS, MacAskill M, Ross G, Shah SS. Surgical Technique for Superior Capsule Reconstruction With 6-mm Acellular Dermal Allograft and Knotless Glenoid Anchors. Arthrosc Tech 2021; 10:e1821-e1827. [PMID: 34336581 PMCID: PMC8322625 DOI: 10.1016/j.eats.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/02/2021] [Indexed: 02/03/2023] Open
Abstract
Superior capsule reconstruction (SCR) creates a humeral head depressor in the setting of a massive, irreparable rotator cuff tear. Recently, a 6-mm-thick acellular dermal allograft (ACD) has been shown to be noninferior to the standard fascia lata autograft in recreating native shoulder biomechanics. This paper outlines a reproducible means by which to perform an arthroscopic SCR using a 6-mm ACD. A standard diagnostic arthroscopy first assesses the integrity of the subscapularis and infraspinatus tendons. The glenoid anchors are then placed. Accessory anterior and posterolateral portals are made as well as a lateral portal by which to shuttle the graft. Suture management is paramount. Ideally allograft preparation occurs on the back table simultaneously to maintain efficiency. Suture passage through premade holes in the graft, and when the sutures have passed through and been tensioned, the graft is shuttled into place and tied down with medial and lateral row anchors in SpeedBridge fashion. The thickness of ACD has been shown to influence the ability of the reconstructed superior capsule to perform its role as a humeral head depressor. This technique describes the use of a 6-mm-thick ACD to perform an arthroscopic SCR that minimizes both donor-site morbidity and operative time.
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Affiliation(s)
- Julianne M. Forlizzi
- Department of Orthopaedic Surgery, Sports Medicine, New England Baptist Hospital, Boston, Massachusetts, U.S.A.,Address correspondence to Julianne M. Forlizzi, M.D., Rutgers The State University of New Jersey, 1 RWJ Place, MEB 422, New Brunswick, NJ 08901.
| | | | - Robert J. Pettit
- Department of Orthopaedic Surgery, Sports Medicine, New England Baptist Hospital, Boston, Massachusetts, U.S.A
| | - Sundeep S. Saini
- Department of Orthopaedic Surgery, Sports Medicine, New England Baptist Hospital, Boston, Massachusetts, U.S.A
| | - Meghan MacAskill
- Department of Orthopaedic Surgery, Sports Medicine, New England Baptist Hospital, Boston, Massachusetts, U.S.A
| | - Glen Ross
- Department of Orthopaedic Surgery, Sports Medicine, New England Baptist Hospital, Boston, Massachusetts, U.S.A
| | - Sarav S. Shah
- Department of Orthopaedic Surgery, Sports Medicine, New England Baptist Hospital, Boston, Massachusetts, U.S.A
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16
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Kim DH, Jung YS, Kim KR, Yoon JP. The best options in superior capsular reconstruction. Clin Shoulder Elb 2021; 24:114-121. [PMID: 34078021 PMCID: PMC8181844 DOI: 10.5397/cise.2021.00136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 11/25/2022] Open
Abstract
Irreparable massive rotator cuff tears cause pain, loss of function, and a decrease in range of motion, which cause serious disturbances in daily life. Young patients, in particular, are active and have relatively high functional requirements, and their surgical options are limited. Superior capsular reconstruction (SCR) was first proposed for irreparable massive rotator cuff tears, good clinical results have been reported in short-term follow up. Since then, SCR has been used increasingly worldwide for irreparable massive rotator cuff tears, and various studies have been published on clinical outcomes, biomechanical outcomes, surgical techniques, and graft types. This article reviews the optimal graft and surgical options for improving clinical outcomes in SCR.
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Affiliation(s)
- Dong Hyun Kim
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Young Soo Jung
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kyung-Rock Kim
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jong Pil Yoon
- Department of Orthopedic Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
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