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Savarese E, Aicale R, Torsiello E, Bernardini G, Maffulli N. Long head of biceps tendon augmentation for massive rotator cuff tears improves clinical results regardless of the number of tendons involved. Knee Surg Sports Traumatol Arthrosc 2024; 32:1843-1853. [PMID: 38651602 DOI: 10.1002/ksa.12184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Management of massive rotator cuff tears (MRCTs) remains debated, and various arthroscopic and open techniques have been described for their management. Nevertheless, the optimal strategy remains unclear. The present study evaluated the clinical results in patients managed arthroscopically for MRCTs augmented with the long head biceps tendon (LHBT) at a minimum 1-year follow-up, considering different type of tears, demographic data and number of torn tendons. METHODS Patients treated in a secondary referral centre from January 2021 to April 2022 were enroled prospectively. Inclusion criteria were pain, inability to fully elevate the affected shoulder, irreparable tears and active and motivated patients. All patients were managed within 2 months from diagnosis in a single centre by the same surgeons. Preoperative shoulder radiographs and magnetic resonance imaging (MRI) were collected, and clinical assessment was also performed using the Numerical analogue scale (NAS), Constant score (CS) American Shoulder and Elbow Surgeons Shoulder Score (ASES). Tissue retraction and tendon fatty infiltration were evaluated using Patte and Fuchs scale, respectively. Clinical assessment was performed using the same scales at 3-6 months and 1-year follow-up. RESULTS A total of 55 patients (31 female and 24 male) with a mean age of 60 ± 7.1 years were enroled for a mean follow-up of 18.2 ± 4.3 months. The mean preoperative NAS was 7.8 ± 0.6, CS was 20.5 ± 7.6 and ASES was 22.6 ± 9.2, increasing, respectively, to 0.3 ± 0.6, 91.5 ± 6.9 and 94.2 ± 6.7. No adverse side effects (infection, rejection, allergy) were reported during the study period. All patients were evaluated after surgery at 3 and 6 months and 1 year with statistically significant improvement for each score at the first and last follow-up (p < 0.05). CONCLUSIONS The use of LHBT augmentation in patients with MRCTs in appropriately selected patients is safe and effective and can lead to pain relief and acceptable clinical outcomes. Furthermore, its use carries low donor site morbidity and is cost effective. Comparative studies, including randomised controlled trials, with other proposed techniques are needed to confirm these findings. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Eugenio Savarese
- Department of Orthopaedic and Trauma Surgery, Casa di Cura di Bernardini, Taranto, Italy
| | - Rocco Aicale
- Department of Orthopaedic and Trauma Surgery, Casa di Cura di Bernardini, Taranto, Italy
| | - Ernesto Torsiello
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Giulio Bernardini
- Department of Orthopaedic and Trauma Surgery, Casa di Cura di Bernardini, Taranto, Italy
| | - Nicola Maffulli
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, London, UK
- School of Medicine, Institute of Science and Technology in Medicine, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Keele University, Stoke-on-Trent, UK
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University La Sapienza, Roma, Italy
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Baek G, Kim JG, Baek GR, Hui AT, McGarry MH, Baek CH, Lee TQ. Middle trapezius tendon transfer using Achilles allograft for irreparable isolated supraspinatus tendon tears effectively restores the superior stability of the humeral head without restricting range of motion: a biomechanical study. J Shoulder Elbow Surg 2024; 33:1366-1376. [PMID: 38104718 DOI: 10.1016/j.jse.2023.10.033] [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: 07/17/2023] [Revised: 10/17/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Middle trapezius tendon (MTT) transfer has been suggested for promising treatment of irreparable isolated supraspinatus tendon tears (IISTTs). However, there have been no attempts to assess the biomechanical efficacy of MTT transfer. This study aims to evaluate the biomechanical efficacy of MTT transfer in the setting of IISTTs. METHODS Eight fresh frozen cadaveric shoulders were tested in 3 conditions: (1) intact rotator cuff, (2) IISTT, and (3) MTT transfer using Achilles allograft for IISTTs. Total humeral rotational range of motion (ROM), superior translation of the humeral head, and subacromial contact characteristics were measured at 0°, 20°, and 40° glenohumeral abduction (representing 0°, 30°, and 60° shoulder abduction). Superior translation and subacromial contact pressures were measured at 0°, 30°, 60°, and 90° external rotation (ER). Two different MTT muscle loading conditions were investigated. A linear mixed effects model and Tukey post hoc test were used for statistical analysis. RESULTS Total ROM was significantly increased after IISTT at 20° abduction (P = .037). There were no changes in total ROM following MTT transfer compared to the IISTT condition (P > .625 for all comparisons). The IISTT condition significantly increased superior translation compared to the intact rotator cuff condition in 0° and 20° abduction with all ER angles (P < .001), 40° abduction-30° ER (P = .016), and 40° abduction-60° ER (P = .002). MTT transfer significantly decreased superior translation of the humeral head at all abduction angles compared to the IISTT condition (P < .026). MTT transfer significantly decreased peak contact pressure by 638.7 kPa (normal loading) and 726.8 kPa (double loading) at 0° abduction-30° ER compared to the IISTT condition (P < .001). Mean contact pressure was decreased by 102.8 kPa (normal loading) and 118.0 kPa (double loading) at 0° abduction-30° ER (P < .001) and 101.0 kPa (normal loading) and 99.2 kPa (double loading) at 0° abduction-60° ER (P < .001). MTT transfer at 20° abduction-30° ER with 24 N loading significantly decreased contact pressure by 91.2 kPa (P = .035). CONCLUSIONS The MTT transfer biomechanically restored the superior humeral head translation and reduced the subacromial contact pressure in a cadaveric model of IISTT, while not restricting total ROM. These findings suggest that MTT transfer may have potential as a surgical treatment for IISTTs.
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Affiliation(s)
- Gyuna Baek
- Orthopedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Jung Gon Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu-si, Jeollanam-do, Republic of Korea
| | - Gyu Rim Baek
- Orthopedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Aaron T Hui
- Orthopedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Michelle H McGarry
- Orthopedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Chang Hee Baek
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu-si, Jeollanam-do, Republic of Korea
| | - Thay Q Lee
- Orthopedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA.
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Bilgin E, Kilinc BE, Arican CD, Yilmaz B. Investigation of the pressure value while performing biceps tenodesis for superior capsuler reconstruction. J Orthop Surg Res 2024; 19:222. [PMID: 38576016 PMCID: PMC10993498 DOI: 10.1186/s13018-024-04692-1] [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: 02/02/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND To compare the histopathological results of biceps tenodesis (BT) performed with normal, low, and high pressures for superior capsule reconstruction (SCR) in rabbits with massive rotator cuff tears. MATERIALS AND METHODS Thirty rabbits were divided into three groups. Rabbits 1-10 underwent SCR with BT at the same pressure (Group 1), value measured in the groove; 50% lower (Group 2); 50% higher (Group 3). After the 4-week follow-up, shoulder were en-bloc excised and histopathological evaluation was performed with modified Bonar's scale. Results were compared between the groups, statistically. RESULTS Extracellular matrix were significantly lower in group 2 compared to the other groups (p < 0.05). Cellularity levels were significantly lower in group 2 compared to the other groups (p < 0.05). Group 2 had no difference between the sides (p > 0.05). Group 2 had lower vascularity levels compared to the other groups (p = 0.01). DICSUSSION When the biceps tendon was in the bicipital groove and in a more mobile state with lower pressure exposure. BT performed with a tension that creates less pressure than the biceps in the groove is more successful in SCR.
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Affiliation(s)
- Emre Bilgin
- Department of Orthopedics and Traumatology, Health Sciences University Fatih Sultan Mehmet Training and Research Hospital, D100 Uzeri Hastane Sok. No:1/8 34752 Icerenkoy Atasehir, Istanbul, Turkey
| | - Bekir Eray Kilinc
- Department of Orthopedics and Traumatology, Health Sciences University Fatih Sultan Mehmet Training and Research Hospital, D100 Uzeri Hastane Sok. No:1/8 34752 Icerenkoy Atasehir, Istanbul, Turkey.
| | - Cigdem Dicle Arican
- Department of Pathology, Health Sciences University, Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Baris Yilmaz
- Department of Orthopedics and Traumatology, Health Sciences University Fatih Sultan Mehmet Training and Research Hospital, D100 Uzeri Hastane Sok. No:1/8 34752 Icerenkoy Atasehir, Istanbul, Turkey
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Shin KH, Jang IT, Han SB. Outcomes of Superior Capsular Reconstruction Using the Long Head of the Biceps Tendon in Large to Massive Rotator Cuff Tears: A Meta-Analysis and Systematic Review. J Clin Med 2024; 13:1052. [PMID: 38398365 PMCID: PMC10889218 DOI: 10.3390/jcm13041052] [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: 01/04/2024] [Revised: 01/26/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: Addressing large to massive rotator cuff tears (LMRCTs) poses complex challenges. This systematic review investigated outcomes of superior capsular reconstruction (SCR) with the long head of the biceps tendon (LHBT) compared to conventional rotator cuff repair (RCR) for LMRCTs. (2) Methods: A systematic search across the MEDLINE/PubMed, EMBASE, Cochrane Library, and Scopus databases until 1 October 2023 identified studies that directly compared SCR with LHBT with conventional RCR in patients with LMRCTs and included a minimum of a 12-month follow-up period. The assessed outcome measures encompassed retear rates, functional outcomes, range of motion (ROM), and acromiohumeral interval (AHI). Risk of bias assessment was conducted via the Robins-I tool. (3) Results: In six studies with 456 cases (210 SCR using LHBT and 246 using RCR), SCR with LHBT significantly reduced retear rates (OR = 0.21; 95% CI, 0.12-0.36; p < 0.01; I2 = 0%). Furthermore, SCR with LHBT showed significant improvement in range of forward flexion (SMD 0.32, 95% CI: 0.09-0.55, p < 0.01, I2 = 39%) and AHI (SMD 0.61, 95% CI: 0.31-0.92, p < 0.01, I2 = 0%) postoperatively. (4) Conclusion: SCR with LHBT is a safe and effective treatment for LMRCTs, reducing retear rates, maintaining greater postoperative AHI, and improving ROM compared to conventional RCR. Additional high-quality interventional studies are needed to confirm these results.
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Affiliation(s)
- Kyun-Ho Shin
- Department of Orthopedic Surgery, Yeson Hospital, Bucheon-si 14555, Republic of Korea
| | - Il-Tae Jang
- Nanoori Medical Research Institute, Seoul 06048, Republic of Korea;
| | - Seung-Beom Han
- Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea;
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Kim JG, Lim C, Kim BT, Baek CH. Superior Capsular Reconstruction Versus Middle Trapezius Tendon Transfer for Isolated Irreparable Supraspinatus Tendon Tears: Static Versus Dynamic Reconstruction. Am J Sports Med 2024; 52:431-440. [PMID: 38179610 DOI: 10.1177/03635465231213340] [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: 01/06/2024]
Abstract
BACKGROUND Both superior capsular reconstruction (SCR) and middle trapezius tendon (MTT) transfer can be performed in nonarthritic young and active patients with isolated irreparable supraspinatus tendon tears (IISTTs). However, to our knowledge, no comparative clinical studies have been conducted on these procedures. PURPOSE To evaluate and compare the clinical and radiological outcomes of SCR and arthroscopic-assisted MTT transfer in patients with IISTTs. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 60 patients with IISTTs were categorized into 2 groups according to the surgical procedure-Group S underwent SCR (n = 34); Group M underwent MTT transfer (n = 26). The clinical outcomes included the visual analog scale score for pain, active shoulder range of motion, American Shoulder and Elbow Surgeons score, and University of California, Los Angeles, shoulder score. Radiological outcomes included the assessment of the acromiohumeral distance, progression of cuff tear arthropathy (Hamada grade), subacromial bone erosion, and graft failure. RESULTS The mean follow-up time was 39.3 ± 5.2 months (range, 26-59 months) and 37.6 ± 9.8 months (range, 27-54 months) in Group S and Group M, respectively. Significant improvements in clinical outcomes were observed in both groups, while the active forward flexion (148.2°± 24.1° vs 165.9°± 8.7°; P = .003) and abduction (131°± 37.3° vs 152.5°± 17.9°; P = .035) were significantly higher in Group M at the final follow-up. No significant differences were found in the postoperative Constant, American Shoulder and Elbow Surgeons, and University of California, Los Angeles, shoulder scores between the 2 groups. Radiologically, although no difference was found in the Hamada grade at the final follow-up between the 2 groups (P = .143), the rates of acromial wear (58.8% vs 15.4%; P < .001) and graft retear (47.1% vs 7.7%; P < .001) were significantly higher in Group S than in Group M. CONCLUSION Both SCR and MTT transfer improved the overall clinical outcomes of IISTTs postoperatively, whereas MTT transfer was superior to SCR in terms of active forward flexion and abduction range of motion. Although higher rates of graft failure and subacromial bone erosion were observed in Group S, no difference was found in the clinical scores between the 2 groups at the short-term follow-up. However, further well-structured, prolonged comparative trials should be conducted in the future.
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Affiliation(s)
- Jung Gon Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
| | - Chaemoon Lim
- 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
| | - Chang Hee Baek
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
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Park HS, Ham KH, Kim YS. The Arthroscopic Biceps Rerouting Technique Shows Better Early Clinical Outcomes within 1 Year Than Partial Repair in Large to Massive Rotator Cuff Tears. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:240. [PMID: 38399528 PMCID: PMC10890027 DOI: 10.3390/medicina60020240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: The arthroscopic biceps rerouting (BR) technique was introduced as a novel technique for large-to-massive rotator cuff tears (LMRCTs). This method can restore shoulder stability, and its biomechanical effect was verified in a cadaver experiment. Recent reports have shown favorable clinical outcomes. This study aimed to compare the clinical outcomes of partial repair with those of the BR technique in LMRCTs. Materials and Methods: We included 72 patients who had undergone LMRCTs. Arthroscopic partial repair was performed in 31 patients (group I), while repair with the BR technique was performed in 41 patients (group II). Functional and imaging outcomes were evaluated and compared using a visual analog scale for pain, range of motion (ROM), American Shoulder and Elbow Surgeons (ASES) score, Constant score, and Korean Shoulder Score (KSS) before the surgery and at 3, 6, and 12 months after the surgery and at the last follow-up. Tendon integrity was investigated using magnetic resonance in all the patients at 12 months postoperative. Results: The mean follow-up period was 22.11 ± 10.47 months (range, 12-53 months). Forward flexion (p = 0.02) and external rotation at the side (p = 0.04) were significantly higher in group II than in group I on postoperative day (POD) 12 months. For internal rotation, group II showed significant improvement compared to group I on POD 3 months (p = 0.002) and at 6 months postoperative (p = 0.01). On POD 12 months, the ASES (p = 0.047) and KSS (p = 0.048) were better in group II. Significant improvements in pain and clinical scores were observed in both groups at the last follow-up. However, the two groups had no significant differences in pain, clinical scores, or ROM at the last follow-up. Retear of the repaired tendon was observed in nine patients in group I (29.03%) and eight in group II (19.51%, p = 0.35). Conclusions: Partial repair and repair using the BR technique effectively improved clinical and radiologic outcomes. The BR technique revealed early recovery of ROM and better clinical results than partial repair at one year postoperative. This could be a useful method in treating LMRCTs.
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Affiliation(s)
- Hyung-Seok Park
- Department of Orthopedic Surgery, Chosun University Hospital, Gwangju 61453, Republic of Korea; (H.-S.P.); (K.-H.H.)
- Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju 61452, Republic of Korea
| | - Kwon-Hyoung Ham
- Department of Orthopedic Surgery, Chosun University Hospital, Gwangju 61453, Republic of Korea; (H.-S.P.); (K.-H.H.)
- Department of Orthopaedic Surgery, College of Medicine, Chosun University, Gwangju 61452, Republic of Korea
| | - Yang-Soo Kim
- Department of Orthopedic Surgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 14662, Republic of Korea
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Uehara H, Itoigawa Y, Wada T, Morikawa D, Koga A, Maruyama Y, Ishijima M. Shear wave elastography correlates to degeneration and stiffness of the long head of the biceps tendon in patients undergoing tenodesis with arthroscopic shoulder surgery. J Shoulder Elbow Surg 2024; 33:e31-e41. [PMID: 37327988 DOI: 10.1016/j.jse.2023.05.014] [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: 11/22/2022] [Revised: 04/11/2023] [Accepted: 05/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Tendinopathy of the long head of the biceps (LHB) tendon causes degeneration and changes its stiffness. However, a reliable means of diagnosis has not been established. Shear wave elastography (SWE) provides quantitative tissue elasticity measurements. In this study, the relationship of preoperative SWE values with biomechanically measured stiffness and degeneration of the LHB tendon tissue was investigated. METHODS LHB tendons were obtained from 18 patients who underwent arthroscopic tenodesis. SWE values were measured preoperatively at 2 sites, proximal to and within the bicipital groove of the LHB tendon. The LHB tendons were detached immediately proximal to the fixed sites and at their superior labrum insertion. Tissue degeneration was histologically quantified using the modified Bonar score. Tendon stiffness was determined using a tensile testing machine. RESULTS The SWE values of the LHB tendon were 502.1 ± 113.6 kPa proximal to the groove and 439.4 ± 123.3 kPa within the groove. The stiffness was 39.3 ± 19.2 N/mm. The SWE values displayed a moderate positive correlation with the stiffness proximal to the groove (r = 0.80) and within it (r = 0.72). The SWE value of the LHB tendon within the groove showed a moderate negative correlation with the modified Bonar score (r = -0.74). CONCLUSIONS These findings suggest that preoperative SWE values of the LHB tendon correlate moderately positively with stiffness and moderately negatively with tissue degeneration. Therefore, SWE may predict LHB tendon tissue degeneration and changes in stiffness caused by tendinopathy.
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Affiliation(s)
- Hirohisa Uehara
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan; Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshiaki Itoigawa
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan; Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Tomoki Wada
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Daichi Morikawa
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Akihisa Koga
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Yuichiro Maruyama
- Department of Orthopaedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Wan RW, Luo ZW, Yang YM, Zhang HL, Chen JN, Chen SY, Shang XL. Long head of biceps tendon transposition for massive and irreparable rotator cuff tears: A systematic review and meta-analysis. World J Orthop 2023; 14:813-826. [DOI: 10.5312/wjo.v14.i11.813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/21/2023] [Accepted: 10/16/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Superior capsular reconstruction (SCR) with long head of biceps tendon (LHBT) transposition was developed to massive and irreparable rotator cuff tears (MIRCTs); however, the outcomes of this technique remain unclear.
AIM To perform a systematic review of biomechanical outcomes and a meta-analysis of clinical outcomes after LHBT transposition for MIRCTs.
METHODS We performed a systematic electronic database search on PubMed, EMBASE, and Cochrane Library. Studies of SCR with LHBT transposition were included according to the inclusion and exclusion criteria. Biomechanical studies were assessed for main results and conclusions. Included clinical studies were evaluated for quality of methodology. Data including study characteristics, cohort demographics, and outcomes were extracted. A meta-analysis was conducted of the clinical outcomes.
RESULTS According to our inclusion and exclusion criteria, a total of six biomechanical studies were identified and reported an overall improvement in subacromial contact pressures and prevention of superior humeral migration without limiting range of motion (ROM) after LHBT transposition for MIRCTs. A total of five clinical studies were included in the meta-analysis of LHBT transposition outcomes, consisting of 253 patients. The results indicated that compared to other surgical methods for MIRCTs, LHBT transposition had advantages of more significant improvement in ROM (forward flexion mean difference [MD] = 6.54, 95% confidence interval [CI]: 3.07-10.01; external rotation [MD = 5.15, 95%CI: 1.59-8.17]; the acromiohumeral distance [AHD] [MD = 0.90, 95%CI: 0.21-1.59]) and reducing retear rate (odds ratio = 0.27, 95%CI: 0.15-0.48). No significant difference in American Shoulder and Elbow Surgeons score, visual analogue scale score, and University of California at Los Angles score was demonstrated between these two groups for MIRCTs.
CONCLUSION In general, SCR with LHBT transposition was a reliable and economical technique for treating MIRCTs, both in terms of biomechanical and clinical outcomes, with comparable clinical outcomes, improved ROM, AHD, and reduced the retear rates compared to conventional SCR and other established techniques. More high-quality randomized controlled studies on the long-term outcomes of SCR with LHBT transposition are required to further assess.
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Affiliation(s)
- Ren-Wen Wan
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Zhi-Wen Luo
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Yi-Meng Yang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Han-Li Zhang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jia-Ni Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Shi-Yi Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xi-Liang Shang
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
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Cañete San Pastor P, Prosper Ramos I, Garcia Roig A. Arthroscopic Superior Capsular Reconstruction With the Long Head of the Biceps Tendon to Reinforce the Repair of a Supraspinatus Tear and Increase Healing. Arthrosc Tech 2023; 12:e1457-e1465. [PMID: 37654873 PMCID: PMC10466433 DOI: 10.1016/j.eats.2023.04.017] [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: 02/11/2023] [Accepted: 04/14/2023] [Indexed: 09/02/2023] Open
Abstract
Rotator cuff tears continue to be a challenge for the shoulder surgeon since there is still a high rate of retears. To increase the rate of repair and decrease the number of retears, we present a technique, in which we reinforce a tension-free double-row repair of the supraspinatus with reconstruction of the superior capsule with the long head of the biceps (LHB). With this reinforcement of the cuff suture using the LHB, we increase both the biomechanics and biology of the repair and decrease the rate of reruptures.
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Affiliation(s)
- Pablo Cañete San Pastor
- Doctoral School, Catholic University of Valencia San Vicente Martir, Hospital de Manises, Valencia, Spain
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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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Aicale R, Poeta N, Savarese E, Bernardini G, Oliva F, Maffulli N. The use of long head biceps tendon autograft for massive rotator cuff tears: a PRISMA compliant systematic review. Br Med Bull 2022; 144:76-89. [PMID: 36244058 DOI: 10.1093/bmb/ldac021] [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] [Accepted: 08/30/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Rotator cuff tears (RCT) are a common cause of shoulder pain and disability, with massive RCT accounting for 10-40% of all rotator cuff tears. SOURCES OF DATA A systematic search of PubMed and Scopus electronic databases was performed up to August 2022, and a total of 17 scientific articles were included in the present PRISMA compliant systematic review. AREAS OF AGREEMENT Understanding the geometric patterns in RCT is essential to achieve appropriate repositioning of the injured tendons in their anatomic location. The long head of the biceps tendon (LHBT) is usually exposed when defects of the anterolateral corner are present and can be easily used to augment rotator cuff repairs. AREAS OF CONTROVERSY There are no definite guideline regarding the management of massive rotator cuff tears. GROWING POINTS The use of LHBT graft is safe and effective, but technically demanding. All studies were level IV articles of medium to high quality. AREAS TIMELY FOR DEVELOPING RESEARCH Prospective long term follow-up studies and randomized controlled trials are needed, adding imaging evaluation and appropriate clinical outcome measures at follow-up.
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Affiliation(s)
- Rocco Aicale
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi 84084, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'AragonaSalerno 84131, Italy
| | - Nicola Poeta
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi 84084, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona Salerno 84131, Italy
| | - Eugenio Savarese
- Department of Orthopaedic and Trauma Surgery, Casa di Cura di Bernardini, Taranto 74121, Italy
| | - Giulio Bernardini
- Department of Orthopaedic and Trauma Surgery, Casa di Cura di Bernardini, Taranto 74121, Italy
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi 84084, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona Salerno 84131, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Baronissi 84084, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi D'Aragona Salerno 84131, Italy
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London E1 4DG, England
- Keele University, School of Medicine, Institute of Science and Technology in Medicine, Guy Hilton Research Centre, Thornburrow Drive, Hartshill, Stoke-on-Trent, ST4 7QB, England
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Lee A, Farooqi AS, Novikov D, Li X, Kelly JD, Parisien RL. Clinical and Functional Outcomes by Graft Type in Superior Capsular Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med 2022; 50:3998-4007. [PMID: 34633206 DOI: 10.1177/03635465211040440] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND In recent years, superior capsular reconstruction (SCR) has emerged as a promising treatment for massive rotator cuff tears and has been performed with an array of graft options, most commonly dermal allograft and tensor fascia lata (TFL) autograft. PURPOSE To compare the clinical outcomes, functional outcomes, and complication rates after SCR performed with dermal allograft, TFL autograft, long head of the biceps tendon (LHBT) autograft, and porcine xenograft. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS PubMed, Cochrane Library, and Embase were systematically reviewed for studies that enrolled ≥10 patients who underwent SCR and presented clinical outcome data at a minimum follow-up of 12 months. When available, pre- and postoperative patient-reported outcome scores and clinical examination data were extracted. Outcome data were then compared by graft type. A meta-analysis was also conducted of graft tear and reoperation rates after SCR with dermal allograft and TFL autograft. RESULTS Human dermal allograft and TFL autograft were each utilized in 7 studies, LHBT autograft in 2 studies, and porcine xenograft in 1 study. Dermal allograft, TFL autograft, and LHBT autograft demonstrated comparable median (range) postoperative American Shoulder and Elbow Surgeons scores of 85.3 (77.5-89), 88.6 (73.7-94.3), and 82.7 (80-85.4), respectively. The median postoperative pain scores per visual analog scale for dermal allograft, TFL autograft, and LHBT autograft were 0.8, 2.5, and 1.4. Median postoperative forward elevation was 159.0°, 147.0°, 163.8°, and 151.4° for dermal allograft, TFL autograft, LHBT autograft, and porcine xenograft. Meta-analysis demonstrated a comparable pooled graft tear rate between TFL autograft (9%; 95% CI, 4%-16%) and dermal allograft (7%; 95% CI, 2%-13%). Similarly, the pooled reoperation rate was similar for TFL autograft (3%; 95% CI, 0%-7%) and dermal allograft (6%; 95% CI, 2%-12%). Among the 3 studies with pre- and postoperative information on pseudoparalysis, 73 of 76 (96%) patients with an intact/repairable subscapularis had a reversal of their pseudoparalysis after SCR. CONCLUSION Dermal allograft, TFL autograft, and LHBT autograft are all suitable options for SCR and demonstrate significant improvements in American Shoulder and Elbow Surgeons score, pain score per visual analog scale, and forward elevation. Moreover, dermal allograft and TFL autograft have comparable rates of graft tear and reoperation.
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Affiliation(s)
- Alexander Lee
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ali S Farooqi
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Novikov
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Xinning Li
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - John D Kelly
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Llinás PJ, Bailie DS, Sanchez DA, Chica J, Londono JF, Herrera GA. Partial Superior Capsular Reconstruction to Augment Arthroscopic Repair of Massive Rotator Cuff Tears Using Autogenous Biceps Tendon: Effect on Retear Rate. Am J Sports Med 2022; 50:3064-3072. [PMID: 35983981 DOI: 10.1177/03635465221112659] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Massive rotator cuff tears have a high incidence of postoperative retear that can reach 90%. It is still unclear which intervention may reduce the incidence of retear and improve the functional and clinical outcomes. PURPOSE/HYPOTHESIS The purpose of this study was to investigate the clinical and structural outcomes at 2 years after repair of reparable massive rotator cuff tears with and without the use of partial superior capsular reconstruction (pSCR), using the autologous long head of the biceps tendon (LHBT) as a graft. It was hypothesized that augmentation with a pSCR would decrease retear rates. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The authors compared arthroscopic repair of massive posterosuperior rotator cuff tears with and without augmentation using the LHBT for pSCR between 2015 and 2017. After applying the selection criteria, 106 patients were included in the study and distributed into 2 groups of 50 and 56 patients. Patients in the first group (50 patients) underwent arthroscopic repair without use of the LHBT (AR group), and patients in the second group (56 patients) underwent arthroscopic repair with use of the LHBT for pSCR (AR-LHBT group). The structural outcome was evaluated by ultrasound at 2 years of follow-up. Function and pain were evaluated preoperatively and at the 2-year follow-up using the American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS). Pre- and postoperative active range of motion, including forward elevation, external rotation, and abduction, were also documented. RESULTS No significant differences were found between groups regarding the baseline characteristics. After 24 months, both groups showed significant improvement from preoperative ASES scores, VAS score, and active range of motion (P < .01 for all). Patients in the AR-LHBT group showed significant improvements in postoperative functional and pain scores compared with the AR group in all measurements at the 2-year follow-up (ASES score: 77.23 ± 7.45 vs 71.04 ± 9.28, P < .01; VAS score: 1.64 ± 1.03 vs 2.12 ± 1.06, P < .01). Final range of motion was significantly increased for the AR-LHBT group for forward elevation (155 [interquartile range {IQR}, 150-160] vs 150 [IQR, 140-170]; P < .01) and abduction (150 [IQR, 140-157.5] vs 120 [IQR, 100-140]; P < .01), but external rotation was significantly greater for the AR group (54.43 ± 10.55 vs 59.5 ± 10.55; P < .01). Postoperative ultrasonography at the 2-year follow-up revealed a higher retear rate in the AR group than in the AR-LHBT group (46% vs 14%; P < .01). CONCLUSION Use of the LHBT for pSCR to augment massive rotator cuff tears resulted in markedly lower retear rates and modestly improved pain and function outcomes compared with repair alone.
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Affiliation(s)
- Paulo J Llinás
- Fundación Valle del Lili, Cali, Colombia.,Universidad ICESI Facultad de Medicina, Cali, Colombia
| | - David S Bailie
- Arizona Institute for Sports, Knees, and Shoulders, LLC, Scottsdale, Arizona, USA
| | | | - Julian Chica
- Fundación Valle del Lili, Clinical Research Center, Cali, Colombia
| | - Juan Francisco Londono
- Fundación Valle del Lili, Cali, Colombia.,Fundación Valle del Lili, Clinical Research Center, Cali, Colombia
| | - Gilberto A Herrera
- Fundación Valle del Lili, Cali, Colombia.,Universidad ICESI Facultad de Medicina, Cali, Colombia
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Cheng YH, Wu CT, Chiu CH, Hsu KY, Chan YS, Chao-Yu Chen A. Arthroscopic Superior Capsule Reconstruction With Fascia Lata Autograft And In-Situ Biceps Tendon Augmentation: Feasible Outcomes After Minimum Two-Year Follow-Up. Arthrosc Sports Med Rehabil 2022; 4:e1675-e1682. [DOI: 10.1016/j.asmr.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 06/10/2022] [Accepted: 06/23/2022] [Indexed: 10/15/2022] Open
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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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Cheppalli NS, Purudappa PP, Metikala S, Reddy KI, Singla A, Patel HA, Kamineni S. Superior Capsular Reconstruction Using the Biceps Tendon in the Treatment of Irreparable Massive Rotator Cuff Tears Improves Patient-Reported Outcome Scores: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e1235-e1243. [PMID: 35747666 PMCID: PMC9210484 DOI: 10.1016/j.asmr.2022.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/08/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To systematically evaluate the clinical outcomes of superior capsular reconstruction (SCR) using the long head of the biceps tendon for irreparable massive rotator cuff tears. Methods Multiple electronic databases were searched for studies treating massive and/or irreparable rotator cuff tears with SCR using the biceps tendon while retaining its proximal attachment to the superior glenoid. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) flowchart was created. All the included studies were assessed for quality with the Modified Coleman Methodology Score. Multiple variables including patient demographic characteristics, functional scores, visual analog scale (VAS) scores, and complications were extracted and analyzed. Results Seven studies were included in this review, with a total of 133 patients. The age range of patients was 39 to 82 years, and the duration of follow-up ranged from 6 to 40.7 months. Various validated scoring systems were used for functional outcome evaluation in all studies; all of them showed postoperative improvement greater than the minimal clinically important difference. The VAS score improvement ranged from 3.8 to 7.1. Five studies reported improvement in shoulder forward elevation, with a range of 22° to 95°. Three studies reported retear rates of 21%, 37%, and 66% on postoperative magnetic resonance imaging scans. Two studies reported complications, with the first study reporting revision surgery in 4 of 35 patients and the second study reporting 1 infection and 1 case of deltoid detachment (open procedure) among 17 patients. Conclusions SCR using the long head of the biceps tendon is a safe and effective procedure. VAS and patient-reported outcome scores showed significant improvement with minimal short-term complications. Level of Evidence Level IV, systematic review of Level III and IV studies.
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Ma M, Pan Z, Lu L. Clinical effect of arthroscopic long head of biceps transfer and tenodesis on irreparable rotator cuff tear. J Orthop Surg Res 2022; 17:220. [PMID: 35399092 PMCID: PMC8996574 DOI: 10.1186/s13018-022-03121-5] [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: 05/19/2021] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objective
To explore the clinical effect of arthroscopic long head of biceps transfer and tenodesis for on irreparable rotator cuff tear.
Methods
A total of 18 patients with irreparable rotator cuff tear who were treated in the Dongfang Hospital Affiliated to Tongji University School of Medicine from April 2018 to March 2020 were included in this study. They all underwent arthroscopic long head of biceps transfer and tenodesis. Shoulder joint motions (forward flexion, abduction, and external rotation angle) and magnetic resonance imaging (MRI) were performed. Moreover, visual analogue scale (VAS) and university of California Los Angeles (UCLA) score were conducted during follow-up.
Results
Preoperative symptoms lasted from 3 to 16 months, with an average duration of 10 months. All patients healed in the first stage without obvious complications were included. All patients were followed up for 4 to 14 months after the surgery, with an average duration of 11.1 months. The range of shoulder joint motions, including forward flexion (80.52° ± 31.19° vs. 149.47° ± 28.36°), abduction (65.13° ± 37.59° vs. 152.46° ± 28.64°) and lateral rotation (30.17° ± 15.15° vs. 71.49° ± 11.42°) was significantly improved after operation (P < 0.05). The VAS score was notably decreased after operation (8.46 ± 0.80 vs. 1.55 ± 0.70), but the UCLA score was markedly increased (15.27 ± 2.89 vs. 31.17 ± 2.36). MRI imaging showed that 15 patients had good tissue healing, with a healing rate of 83.3% (15/18).
Conclusion
Arthroscopy of the biceps long head tendon transposition can significantly relieve pain in patients with large rotator cuff tears, improve joint mobility, and restore joint function.
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Kawashima K, Terabayashi N, Asano H, Akiyama H. Arthroscopic Long Head of the Biceps Transposition for Superior Capsular Augmentation Results in Comparable Clinical Outcomes to Arthroscopic Partial Repair for Irreparable Rotator Cuff Tears. Arthrosc Sports Med Rehabil 2022; 4:e425-e434. [PMID: 35494304 PMCID: PMC9042770 DOI: 10.1016/j.asmr.2021.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/24/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose To describe a modified arthroscopic technique of long head of biceps transposition (LHBT) for superior capsular augmentation; to investigate the outcomes and effectiveness of LHBT in patients with irreparable rotator cuff tears; and to compare the results with those of arthroscopic partial repair (APR) after a 2-year minimum follow-up. Methods We retrospectively reviewed patients who underwent arthroscopic repair of large to massive superior rotator cuff tears. The inclusion criteria were an irreparable rotator cuff with inability of the tendon to reach the original footprint and postoperative follow-up for a minimum of 2 years. We investigated 22 patients followed up for 30.7 months (mean); 10 patients underwent isolated partial repair and 12 patients underwent LHBT combined with partial repair. The acromiohumeral interval (AHI) was measured using anteroposterior radiographs. Cuff integrity was defined using Sugaya’s classification 2 years postoperatively. Clinical outcomes were assessed preoperatively and during postoperative follow-up (minimum 2 years) using the American Shoulder and Elbow Surgeons and University of California, Los Angeles shoulder rating scales. Results Postoperative functional scores significantly improved in both groups. In the LHBT group, both American Shoulder and Elbow Surgeons and University of California, Los Angeles scores significantly improved postoperatively from 52.0 ± 14.6 to 89.3 ± 10.4 points (P = .002) and 15.2 ± 2.2 to 32.5 ± 2.6 points (P = .002), respectively. In addition, the AHI at the final follow-up was significantly greater in the LHBT group (7.5 ± 2.0 mm) than in the APR group (5.8 ± 1.9 mm) (P = .032). The retear rate, forward flexion, and postoperative functional scores at the final follow-up were better in the LHBT group; however, the intergroup differences were not statistically significant. Conclusions Arthroscopic LHBT for irreparable rotator cuff tears showed comparable clinical outcomes and improvement in postoperative AHI compared with APR after a minimum 2-year follow-up. Level of Evidence Level III, retrospective comparative trial.
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Ângelo ACLPG, de Campos Azevedo CI. Donor-Site Morbidity After Autologous Fascia Lata Harvest for Arthroscopic Superior Capsular Reconstruction: A Midterm Follow-up Evaluation. Orthop J Sports Med 2022; 10:23259671211073133. [PMID: 35141340 PMCID: PMC8819761 DOI: 10.1177/23259671211073133] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Autologous fascia lata (AFL) graft use in arthroscopic superior capsular reconstruction (ASCR) is effective for the treatment of irreparable rotator cuff tears (RCTs). Although donor-site morbidity (DSM) is a recurrent argument against AFL graft use, scientific evidence for this argument is lacking. Purpose: To report the midterm clinical follow-up evaluation of DSM in ASCR using minimally invasively harvested AFL grafts and compare thigh function and patient satisfaction with those of an unharvested control group. Study Design: Cohort study; Level of evidence, 3. Methods: Of 66 consecutive patients who underwent ASCR using a minimally invasively harvested AFL graft, 39 patients with a minimum follow-up of 24 months were retrospectively evaluated (ASCR group) and compared with 39 randomly selected patients who underwent arthroscopic RCT repair by the same surgeons (control group). The functional outcomes of both thighs were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Patient satisfaction was evaluated using the Patient Scar Assessment Questionnaire (PSAQ) and a subjective questionnaire. Pain was quantified using a visual analog scale (VAS). Results: The ASCR group had a mean age of 65 years (range, 51-77 years) and a mean follow-up of 47 months (range, 24-66 months). The WOMAC score in the harvested thigh differed by 0.8% from that in the contralateral thigh ( P = .002). The mean PSAQ score differed by 6 points from the minimum PSAQ score ( P < .001). Overall, 95% of the patients indicated that they would undergo the same surgery again and that the shoulder outcome compensated for the thigh symptoms. There was no significant association between the presence of residual thigh symptoms and the willingness to undergo the same surgery again ( P = .354). The mean VAS score in the harvested thigh was 0.6 (range, 0-5). There was no significant difference in the average WOMAC score or VAS score between groups ( P = .684 and P = .148, respectively). Conclusion: Despite the proportion of residual symptoms, the associated functional effects were small and not clinically significant, and the vast majority of patients were accepting of the harvest symptoms given the improvement in shoulder function.
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Affiliation(s)
| | - Clara Isabel de Campos Azevedo
- Hospital dos SAMS de Lisboa, Lisbon, Portugal
- Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Hospital CUF Tejo, Lisbon, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal
- ICVS/3B’s–Instituto de Investigação em Ciências da Vida e Saúde/Biomaterials, Biodegradables and Biomimetics PT Government Associate Laboratory, Braga/Guimarães, Portugal
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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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Luciani P, Farinelli L, De Berardinis L, Gigante A. The Arthroscopic Intra-Articular Stabilization of the Shoulder for Irreparable Rotator Cuff Tear: A New Technique Proposal. Front Surg 2021; 8:624100. [PMID: 34938765 PMCID: PMC8685248 DOI: 10.3389/fsurg.2021.624100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Superior capsular reconstruction (SCR) has shown good results in the management of irreparable rotator cuff tears due to the depressive effect on the humeral head, but it is a technically demanding and expensive procedure. Purpose: We hypothesized that an intra-articular neoligament that prevents the superior translation of the humeral head could give similar results in terms of the superior translation of humerus (STH) and range of motion (ROM). Study Design: To compare our proposed technique and the SCR, we conducted a biomechanical study on 10 porcine shoulders in a custom shoulder testing system. Methods: STH and total rotational ROM were quantified in the following four scenarios: (1) when the rotator cuff was intact, (2) after cutting the supraspinatus tendon, (3) after the reconstruction of the superior capsule by long head of the biceps tendon (LHB), and (4) after an arthroscopic intra-articular stabilization by an intra-articular graft. Our proposed technique provides the creation of a humeral and glenoid tunnel, the passage of a graft through these tunnels under arthroscopic guidance, and the graft fixation in the two tunnels. We analyzed the STH and total ROM in each scenario. Results: With respect to the STH, we reported that the present proposed technique is characterized by a significant reduction of superior translation at 0 and 45° compared to scenario 2. In addition, the comparison between our proposed technique and SCR showed a significant difference of the STH at 0° of abduction. Total rotational ROMs of the two tenchinques were similar to scenario 2. Therefore, the use of an intra-articular ligament that prevents the STH can restore shoulder stability in irreparable rotator cuff injuries at both 0 and 45° of glenohumeral abduction without apparently limiting the total rotational ROM. Conclusion: Our proposed technique could be an important treatment option in irreparable rotator cuff tears, especially in patients under 65 years in whom reverse shoulder arthroplasty (RSA) has shown poor results and many complications.
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Affiliation(s)
- Pierfrancesco Luciani
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, UniversitàPolitecnicadelle Marche, Ancona, Italy
| | - Luca Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, UniversitàPolitecnicadelle Marche, Ancona, Italy
| | - Luca De Berardinis
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, UniversitàPolitecnicadelle Marche, Ancona, Italy
| | - Antonio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, UniversitàPolitecnicadelle Marche, Ancona, Italy
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Clavert P, Bruyere A, Ollivier I, Nourrissat G, Lädermann A. An anatomical study of the fetal superior capsule of the glenohumeral joint. Orthop Traumatol Surg Res 2021; 107:103073. [PMID: 34562650 DOI: 10.1016/j.otsr.2021.103073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The superior part of the glenohumeral joint capsule has an intimate relationship with the tendons of the rotator cuff and the tendon of the long head of the biceps. One of the strategies currently proposed in the event of a massive cuff rupture is to reconstruct this superior capsule. The main objective of this anatomical study was to describe the superior joint capsule of the embryonic glenohumeral joint and its relationship to the tendons of the rotator cuff. HYPOTHESIS The hypothesis was that this structure was an anatomical entity, morphologically identifiable from the embryogenesis of the joint (more pronounced tissue boundaries in the fetus). MATERIAL AND METHODS In total, 101 continuous fetal anatomical sections (4 fetuses of 336mm), in the frontal plane, made it possible to identify and measure: diameters of the humeral head and glenoid, dimensions of the joint capsule insertion zone at the level of the greater tubercle, as well as the different thicknesses of this insertion zone. The ratios above the head of the biceps and against the superior labrum were also measured. RESULTS At the level of its distal insertion on the greater tuberosity, the thickness of the superior joint capsule varies on average between 0.8mm laterally and 1.2mm next to the tendons of the supraspinatus and infraspinatus; the thickness is 0.9mm next to the middle part of the supraspinatus tendon (the "rotator cable" zone). For its insertion at the level of the glenoid labrum, the superior capsule measures 0.6mm thick on average. The capsule around the tendon of the long head of the biceps is 1.5mm thick on average. DISCUSSION Here, we confirm the existence of this superior joint capsule, which can potentially be reconstructed. It is inserted on the greater tubercle covering 30 to 60% of its surface with variations in thickness. The joint capsule is fused to the supraspinatus tendon at the rotator cuff insertion area, preventing independent reinsertion of the tendon. LEVEL OF EVIDENCE IV; anatomical study.
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Affiliation(s)
- Philippe Clavert
- Faculté de médecine, institut d'anatomie, 4, rue Kirschleger, 67085 Strasbourg cedex, France.
| | - Alexandra Bruyere
- Faculté de médecine, institut d'anatomie, 4, rue Kirschleger, 67085 Strasbourg cedex, France
| | - Irène Ollivier
- Faculté de médecine, institut d'anatomie, 4, rue Kirschleger, 67085 Strasbourg cedex, France
| | | | - Alexandre Lädermann
- Service d'orthopédie et traumatologie, hôpital de la Tour, avenue J.-D.-Maillard 3, 1217 Meyrin, Switzerland; Faculté de médecine medicine, université de Genève, rue Michel-Servet 1, 1206 Geneva, Switzerland; Service d'orthopédie et traumatologie, Department de Chirurgie, rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
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- 15, rue Ampère, 92500 Rueil Malmaison, France
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23
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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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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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25
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Kim JH, Lee HJ, Park TY, Lee JU, Kim YS. Preliminary outcomes of arthroscopic biceps rerouting for the treatment of large to massive rotator cuff tears. J Shoulder Elbow Surg 2021; 30:1384-1392. [PMID: 32919044 DOI: 10.1016/j.jse.2020.08.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND We aimed to evaluate the short-term outcomes of arthroscopic biceps rerouting (ABR) for the treatment of large to massive rotator cuff tears (LMRCTs). METHODS A prospective evaluation of patients treated with ABR for the repair of LMRCTs was performed, with a minimum follow-up period of 18 months. Range of motion and functional outcomes (visual analog scale pain score, American Shoulder and Elbow Surgeons score, and Korean Shoulder Scale score) were assessed preoperatively and at final follow-up. Radiographs were used to evaluate the acromiohumeral interval (AHI). Magnetic resonance imaging was performed at 2 and 12 months postoperatively to examine the integrity of the repaired rotator cuff tendons. RESULTS Eighty patients who met the study criteria underwent ABR from March 2017 to January 2019 in our hospital. Of these patients, 61 could be evaluated ≥18 months after surgery. The average age of the enrolled patients was 64.5 years. The visual analog scale pain score decreased from 3.7 preoperatively to 1.6 at final follow-up (P = .019), the American Shoulder and Elbow Surgeons score improved from 60.0 to 85.2 (P < .001), and the Korean Shoulder Scale score improved from 64.3 to 85.3 (P = .001). Assessment of range of motion showed significant improvement in forward flexion (from 138° to 146°, P < .001), external rotation at 90° of abduction (from 80° to 85°, P = .037), and internal rotation (from spinal level 9 to spinal level 10, P = .015) from preoperatively to last follow-up. The AHI was 7.1 mm at baseline and improved significantly to 9.7 mm at 3 months postoperatively (P < .001). The mean AHI at last follow-up was only 9 mm, but this was still significantly better than the mean preoperative AHI (P < .001). Of the patients, 16 (26%) exhibited a retear of the repaired rotator cuff on magnetic resonance imaging at 12 months postoperatively. Male sex was the only significant risk factor for retear (P = .037). CONCLUSION ABR improved the functional and radiologic outcomes of patients with LMRCTs. The ABR technique can be a useful treatment option for LMRCTs.
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Affiliation(s)
- Jong-Ho Kim
- Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyo-Jin Lee
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Yong Park
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-U Lee
- Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - 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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Superior Capsular Reconstruction of the Shoulder Using the Long Head of the Biceps Tendon: A Systematic Review of Surgical Techniques and Clinical Outcomes. ACTA ACUST UNITED AC 2021; 57:medicina57030229. [PMID: 33801508 PMCID: PMC8000769 DOI: 10.3390/medicina57030229] [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] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/20/2021] [Accepted: 02/25/2021] [Indexed: 12/23/2022]
Abstract
Background and Objectives: Superior capsular reconstruction (SCR) with the use of a fascia lata autograft or a dermal allograft is an established treatment in treating irreparable rotator cuff (RC) tears. The long head of the biceps tendon (LHBT) has been recently proposed as an alternative graft for SCR. The purpose of this study was to present the surgical techniques and clinical studies utilizing the LHBT for SCR. Material and Methods: Medline, Scopus, and the Cochrane library were searched for relevant studies up to December 2020. The primary outcomes were pain intensity improvement and the incidence of RC and LHBT graft retears. Secondary outcomes were functional scores and acromiohumeral distance (AHD) improvements. Results: Nine studies described surgical techniques of SCR using the LHBT, and four clinical studies reported the outcomes of the technique. The mean pain intensity improved from 4.9 ± 2.3 to 1.6 ± 1.5 in terms of the visual analog scale, exceeding the minimum clinically important difference for adequate pain relief. Significant improvements were also noted in functional scores and AHD. When compared with other repair techniques for massive RC tears, i.e., the double-row repair, the transosseous-equivalent technique with absorbable patch reinforcement, and the traditional SCR with a fascia lata autograft, there were no significant differences in pain and function improvements. Conclusion: SCR using the LHBT is a useful treatment option for massive RC tears; it is equally effective with the traditional SCR and other established techniques. It presents numerous advantages being a safe, easy, time-saving, and cost-effective method. The only precondition for the technique is the presence of an intact LHBT. Additional clinical trials are necessary to determine which treatment is superior for treating massive RC tears, as well as to evaluate the long-term results of the technique.
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27
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Terra BB, Sassine TJ, Ejnisman B, de Castro Pochini A, Belangero PS. Arthroscopic partial Superior Capsular Reconstruction using the Long Head of the Biceps Tendon-Technique Description. Arthrosc Tech 2021; 10:e669-e673. [PMID: 33738200 PMCID: PMC7953170 DOI: 10.1016/j.eats.2020.10.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/24/2020] [Indexed: 02/03/2023] Open
Abstract
Superior capsule reconstruction is a valuable intervention for some patients who present symptomatic irreparable posterosuperior rotator cuff tears. Superior capsule reconstruction techniques most commonly use either fascia lata autograft or dermal allograft. Both options have literature support but also present a few drawbacks such as donor site issues, potential allergic reactions, and high cost of the operation. The long head of biceps is a potential graft for rotator cuff tears and may be particularly useful in bridging the gap in irreparable massive rotator cuff tears, specifically as an alternative to more traditional superior capsular reconstruction. Long head of biceps transposition may offer unique and significant advantages over other techniques and can be an effective and valuable alternative in selected cases. The tendon's insertion into the glenoid is left intact, whereas laterally it is transferred to a more central humeral head position and sutured with anchors onto the footprint of the supraspinatus tendon acting as a superior static stabilizer of the shoulder joint. The purpose of this article is to propose a technical modification of superior capsular reconstruction using long head of the biceps tendon autograft.
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Affiliation(s)
| | | | - Benno Ejnisman
- Center of Sports Medicine of São Paulo Federal University
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28
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Arthroscopic repair of massive rotator cuff tear. The role of the LHB distal tenotomy. Musculoskelet Surg 2021; 106:269-277. [PMID: 33641071 DOI: 10.1007/s12306-021-00705-y] [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: 09/23/2020] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of the study was to evaluate the results of an all arthroscopic technique for the treatment of massive rotator cuff tears using the long head of biceps as a graft to reconstruct the superior capsule and to reinforce the cuff. METHODS A retrospective review of a consecutive series of arthroscopic repair of massive rotator cuff tears using the long head of biceps tendon was conducted. Twenty-five patients underwent surgery, and none were lost at follow-up. Minimum follow-up period was more than 12 months. Constant, UCLA and VAS scores as clinical outcome were analyzed. Time for surgical procedures was also registered. Two alternative procedures (transosseous or anchors) were employed to fix laterally the long head of biceps to the greater tuberosity and to reinforce the cuff. This choice was essentially determined by the bone quality of the greater tuberosity. RESULTS All patients of both groups (Transosseous: 15 and Anchors: 10) showed a significant improvement of clinical and functional scores. Difference of the operative times between two procedures was statistically significant in favor of the anchor approach. No intraoperative complications were recorded. Postoperative shoulder stiffness was found in two male patients. In no case biceps tenodesis was performed: Popeye sign was easily detected in 16 patients but they did not complain any superior arm pain and weakness. CONCLUSION This technique represents a valid solution for treatment of massive rotator cuff tears resulting safe, easier and cost saving in comparison with other published techniques.
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29
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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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30
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Denard PJ, Chae S, Chalmers C, Choi JH, McGarry MH, Adamson G, Park M, Lee TQ. Biceps Box Configuration for Superior Capsule Reconstruction of the Glenohumeral Joint Decreases Superior Translation but Not to Native Levels in a Biomechanical Study. Arthrosc Sports Med Rehabil 2021; 3:e343-e350. [PMID: 34027441 PMCID: PMC8129057 DOI: 10.1016/j.asmr.2020.09.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/22/2020] [Indexed: 11/26/2022] Open
Abstract
Purpose To quantitatively biomechanically assess superior stability, subacromial contact pressures, and glenohumeral kinematics of an in situ biceps tenodesis and a box-shaped long head of the biceps tendon (LHBT) superior capsule reconstruction (SCR) in a superior massive rotator cuff tear (MCT) model. Methods Eight cadaveric shoulders (mean age, 62 years; range, 46-70 years) were tested with a custom testing system used to evaluate range of motion, superior translation, and subacromial contact pressure at 0°, 20°, and 40° of abduction. Conditions tested included native state, MCT (complete supraspinatus and one-half of the infraspinatus), a box-shaped LHBT SCR, and an in situ biceps tenodesis. The box-shaped SCR was performed by maintaining the biceps origin, securing 2 corners to the greater tuberosity, and one corner to the posterior glenoid. The in situ tenodesis was performed anatomically at the top of the articular margin in the same shoulder after take-down of the box SCR. Results Range of motion was not impaired with either repair construct (P > .05). The box SCR decreased superior translation by approximately 2 mm compared with the MCT at 0°, but translation remained greater compared with the intact state in nearly every testing position. The in situ tenodesis had no effect on superior translation. Peak subacromial contact pressure was increased in the MCT at 0° and 20° abduction compared with the native state but not different between the native and box SCR at the same positions. Conclusions A box-shaped SCR using the native biceps tendon partially restores increased superior translation and peak subacromial contact pressure due to MCT. The technique may have a role in augmentation of an irreparable MCT. Clinical Relevance The box-shaped LHBT SCR technique may have a role in augmentation of an irreparable MCT.
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Affiliation(s)
| | - Seungbum Chae
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A.,Department of Orthopaedic Surgery, Daegu Catholic University Hospital School of Medicine, Daegu, Korea
| | - Christen Chalmers
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | - Jae Hyuk Choi
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | - Gregory Adamson
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | - Max Park
- Southern California Permanente Group, Woodland Hills, California, U.S.A
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
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31
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Zheng X, Tang K. [Research progress of treatment for massive rotator cuff tears]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:8-13. [PMID: 33448192 DOI: 10.7507/1002-1892.202004056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the research progress of treatment for massive rotator cuff tears. Methods The domestic and foreign literature about the treatment of massive rotator cuff tears was reviewed. The methods and effectiveness were extensively summarized. Results The treatment of massive rotator cuff tears still needs long-term research to promote its continuous improvement. The main goal of treatment is to relieve the symptoms and improve the shoulder joint function. With the development of arthroscopic technique, arthroscopic repair of rotator cuff tears has become a mature surgical protocol. Among these techniques, superior capsule reconstruction and patch augmentation for massive rotator cuff tears acquire more attention in recent years. As for rotator cuff arthropathy, reverse shoulder arthroplasty is considered to be a final choice. Conclusion Surgical treatment is the main choice for massive rotator cuff tears. Patients' age and muscle condition should be taken into consideration to decide the surgical technique.
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Affiliation(s)
- Xiaolong Zheng
- Department of Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
| | - Kanglai Tang
- Department of Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
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Smith TJ, Gowd AK, Kunkel J, Kaplin L, Waterman BR. Superior Capsular Reconstruction Provides Sufficient Biomechanical Outcomes for Massive, Irreparable Rotator Cuff Tears: A Systematic Review. Arthroscopy 2021; 37:402-410. [PMID: 32950647 DOI: 10.1016/j.arthro.2020.09.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/02/2020] [Accepted: 09/06/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To critically review the literature reporting biomechanical outcomes of superior capsular reconstruction (SCR) for the treatment of massive and/or irreparable rotator cuff tears. METHODS A systematic review was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines using the PubMed, MEDLINE, and Cochrane Library databases in August 2020. Cadaveric studies were assessed for glenohumeral translation, subacromial contact pressure, and superior humeral translation comparing SCR with an intact cuff with reference to a torn control state. RESULTS A total of 15 studies (142 shoulders) were included in our data analysis. SCR showed improvements in superior humeral translation, subacromial contact force, and glenohumeral contact force when biomechanically compared with the massive and/or irreparably torn rotator cuff. No statistically significant differences were found between SCR and the intact rotator cuff regarding superior humeral translation (standard mean difference [SMD], 2.09 mm vs 2.50 mm; P = .54) or subacromial contact force (SMD, 2.85 mPa vs 2.83 mPa; P = .99). Significant differences were observed between SCR and the intact cuff for glenohumeral contact force only, in favor of the intact cuff (SMD, 1.73 N vs 5.45 N; P = .03). CONCLUSIONS SCR may largely restore static restraints to superior humeral translation in irreparable rotator cuff tears, although active glenohumeral compression is diminished relative to the intact rotator cuff. CLINICAL RELEVANCE Investigating the biomechanical outcomes of SCR will help surgeons better understand the effectiveness of this treatment option.
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Affiliation(s)
- Tyler J Smith
- Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Anirudh K Gowd
- Division of Sports Medicine, Department of Orthopedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - John Kunkel
- Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Lisa Kaplin
- Division of Sports Medicine, Department of Orthopedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Brian R Waterman
- Division of Sports Medicine, Department of Orthopedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A..
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Brunnader L, Greiner S, Voss A. Superiore Kapselrekonstruktion mittels langer Bizepssehne bei retrahierter Komplettruptur der Supraspinatussehne und der kranialen Infraspinatussehne. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00424-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
ZusammenfassungIn diesem Beitrag berichten die Autoren über einen Patienten mit einer Ruptur der Rotatorenmanschette, welche sich als retrahierte Komplettruptur der Supraspinatussehne und der kranialen Infraspinatussehne präsentierte. Nach 7‑monatiger Schmerzpersistenz und anhaltendem Funktionsverlust wurde im Rahmen eines arthroskopischen Eingriffs eine Rekonstruktion der superioren Kapsel durchgeführt. Die lange Bizepssehne wurde hierzu als Autograft verwendet und mit der kranialen Infraspinatussehne verknüpft. Auf diese Weise konnte ein kompletter Verschluss des posterosuperioren Gelenkraums erreicht werden.
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Rybalko D, Bobko A, Amirouche F, Peresada D, Hussain A, Patetta M, Sood A, Koh J, Goldberg B. Biomechanics in an Incomplete Versus Complete Supraspinatus Tear: A Cadaveric Study. Orthop J Sports Med 2020; 8:2325967120964476. [PMID: 33330732 PMCID: PMC7720321 DOI: 10.1177/2325967120964476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/08/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Degenerative and traumatic changes to the rotator cuff can result in massive and irreparable rotator cuff tears (RCTs). Purpose/Hypothesis: The study objective was to conduct a biomechanical comparison between a small, incomplete RCT and a large, complete RCT. We hypothesized that the incomplete supraspinatus (SS) tear would lead to an incremental loss of abduction force and preserve vertical position of the humeral head, while a complete SS tear would cause superior humeral migration, decrease functional deltoid abduction force, and increase passive range of motion (ROM). Study Design: Controlled laboratory study. Methods: Six cadaveric shoulders were evaluated using a custom testing apparatus. Each shoulder was subjected to 3 conditions: (1) intact/control, (2) 50%, full-thickness, incomplete SS tear, and (3) 100%, complete SS tear. Deltoid abduction force, superior humeral head migration, and passive ROM were measured in static conditions at 0°, 30°, and 60° of glenohumeral abduction, respectively. Results: The intact SS resulted in a mean deltoid abduction force of 2.5, 3.3, and 3.8 N at 0°, 30°, and 60° of abduction, respectively. Compared with the intact shoulder, there was no significant difference in mean abduction force seen in the incomplete tear, while the force was significantly decreased by 52% at 30° of abduction in the complete tear (P = .009). Compared with the incomplete tear, there were significant decreases in abduction force seen in the complete tear, by 33% and 48% (0.9 N and 1.1 N) at 0° and 30° of abduction, respectively (P = .04 and .004). The intact configuration experienced a mean superior humeral head migration of 1.5, 1.4, and 1.1 mm at 0°, 30°, and 60° of abduction, respectively. The complete tear resulted in a superior migration of 3.0 and 4.4 mm greater than the intact configuration at 0° and 30° of abduction, respectively (P = .001). There was a 5° and 10° increase in abduction ROM with 50% and 100% tears, respectively (P = .003 and .03). Conclusion: An incomplete SS tear does not significantly alter the biomechanics of the shoulder, while a large, complete SS tear leads to a significant superior humeral migration, a decreased deltoid abduction force, and a mild increase in passive ROM. Clinical Relevance: Our findings demonstrate the effects of large SS tears on key biomechanical parameters, as they progress from partial tears.
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Affiliation(s)
- Danil Rybalko
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Aimee Bobko
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Farid Amirouche
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Dmitriy Peresada
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
- Dmitriy Peresada, MD, Department of Orthopaedic Surgery, University of Illinois at Chicago, 835 S. Wolcott Avenue, Room 270, Chicago, IL 60612, USA ()
| | - Awais Hussain
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Michael Patetta
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Anshum Sood
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jason Koh
- Department of Orthopaedic Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Benjamin Goldberg
- Department of Orthopaedic Surgery, University of Illinois at Chicago, Chicago, Illinois, USA
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Fandridis E, Zampeli F. Superior Capsular Reconstruction With Double Bundle of Long Head Biceps Tendon Autograft: The "Box" Technique. Arthrosc Tech 2020; 9:e1747-e1757. [PMID: 33294336 PMCID: PMC7695594 DOI: 10.1016/j.eats.2020.07.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/20/2020] [Indexed: 02/03/2023] Open
Abstract
The superior capsular reconstruction (SCR) is an arthroscopic surgical technique recently introduced as an effective solution to restore the defect of superior articular capsule in massive rotator cuff tears that cannot be repaired anatomically. The SCR retains static stability and inhibits the proximal humeral migration, thereby optimizing the force couples about the shoulder. In this surgical technique paper, we present our technique of SCR using a double bundle construct of long head of biceps tendon, called the "box" technique. It is always combined with partial rotator cuff repair.
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Affiliation(s)
| | - Frantzeska Zampeli
- Address correspondence to Frantzeska Zampeli, M.D., Ph.D., General Hospital, Nikis 2, Kifisia, 145 61, Greece.
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Milano G, Marchi G, Bertoni G, Vaisitti N, Galli S, Scaini A, Saccomanno MF. Augmented Repair of Large to Massive Delaminated Rotator Cuff Tears With Autologous Long Head of the Biceps Tendon Graft: The Arthroscopic "Cuff-Plus" Technique. Arthrosc Tech 2020; 9:e1683-e1688. [PMID: 33294326 PMCID: PMC7695575 DOI: 10.1016/j.eats.2020.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/11/2020] [Indexed: 02/03/2023] Open
Abstract
An anatomic and tension-free repair is the goal of arthroscopic rotator cuff repair. However, this purpose is not always achievable in large and massive tears, and sometimes, even when intraoperative results seem acceptable, clinical and radiologic outcomes can be disappointing shortly afterward. Superior capsule reconstruction has been claimed as a valid and viable joint-preserving option for treating irreparable rotator cuff tears. However, the role of the superior capsule in repairable cuff tears has also been questioned. The aim of this article is to present the so-called arthroscopic cuff-plus technique. This technique consists of superior capsule reconstruction using the proximal part of the long head of the biceps tendon associated with a tension-free repair of the rotator cuff tendons in large to massive delaminated tears.
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Affiliation(s)
- Giuseppe Milano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.,Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Giacomo Marchi
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Giuseppe Bertoni
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Niccolò Vaisitti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Galli
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Alessandra Scaini
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Maristella F Saccomanno
- Department of Orthopaedics and Traumatology, Catholic University, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
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Milano G, Saccomanno MF, Colosio A, Adriani M, Galli S, Scaini A, Marchi G. Arthroscopic Superior Capsule Reconstruction With Doubled Autologous Semitendinosus Tendon Graft. Arthrosc Tech 2020; 9:e1665-e1672. [PMID: 33294324 PMCID: PMC7695576 DOI: 10.1016/j.eats.2020.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/09/2020] [Indexed: 02/03/2023] Open
Abstract
Massive and irreparable rotator cuff tears remain a difficult condition to treat. Fatty infiltration of the muscles and excessive retraction of the tendons predispose to high failure rates of arthroscopic repair techniques. In recent years, studies on the superior capsule have shown that it plays a key role in reducing superior humeral head translation and restoring balance to the force couples required for dynamic shoulder function. Superior capsule reconstruction has become common in clinical practice. Several techniques with different types of grafts have been described, such as fascia lata autograft, dermal allograft patch, and long head of the biceps tendon autograft. More recently, an open technique with semitendinosus tendon autograft has been proposed. Our aim is to describe an all-arthroscopic technique for superior capsule reconstruction using a doubled semitendinosus tendon autograft in a box-shaped configuration. We believe that the technique can combine the advantages of other techniques, such as graft availability, low harvest-site morbidity, limited cost, and mechanical strength.
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Affiliation(s)
- Giuseppe Milano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy,Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Maristella F. Saccomanno
- Department of Orthopaedics and Traumatology, Catholic University, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Colosio
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Adriani
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Galli
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Alessandra Scaini
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy,Address correspondence to Alessandra Scaini, M.D., Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia (BS), Italy.
| | - Giacomo Marchi
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
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Zhang H, Jiang C. The Elongation of Biceps Muscle Tendon Unit After Rerouting of the Long Head of Biceps Tendon as Superior Capsular Augmentation: A Quantitative Measurement. Arthrosc Sports Med Rehabil 2020; 2:e531-e537. [PMID: 33134991 PMCID: PMC7588644 DOI: 10.1016/j.asmr.2020.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 06/16/2020] [Indexed: 02/05/2023] Open
Abstract
Purpose The purpose of this study was to investigate the elongation of the biceps muscle tendon unit after rerouting of the long head of the biceps tendon without transection, with and without release of the transverse humeral ligament in a 3-dimensional model. Methods A total of 60 sets of computed tomography images of shoulders were acquired, and a point-cloud model was generated after 3-dimensional reconstruction. Simulation of rerouting of the long head of the biceps tendon was performed by assuming that the long head of the biceps tendon travels to the center of the greater tuberosity from the supraglenoid tubercle and then back to the bicipital groove distally, with or without the release of the transverse humeral ligament. The elongation of the biceps muscle tendon unit by both manners was measured and correlated with age, height, weight, body mass index, gender, and hand dominance. Results The mean length of the long head of the biceps tendon is 74.22 ± 3.06 mm, and the length is significantly longer, at 112.23 ± 4.92 mm (P = 0.0002) and 96.47 ± 2.58 mm (P = 0.0004). The absolute elongation of the biceps muscle tendon unit after rerouting of the long head of the biceps tendon, without or with transverse humeral ligament release, showed significant differences, which were 38.73 ± 3.03 mm and 22.28 ± 3.25 mm, respectively (P = 0.0008). No significant correlations were observed between the amount of the elongation and the subject's age, height, weight, or body mass index. No significant difference was observed in the amount of the elongation between differing gender and hand dominance. Conclusions Rerouting of the long head of the biceps tendon resulted in significant elongation of the biceps muscle tendon unit. Release of the transverse humeral ligament partially decreased this elongation. Clinical Relevance Rerouting of the long head of the biceps tendon may lead to overtension of the biceps. If it is adopted in clinical use, transverse humeral ligament release is recommended.
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Affiliation(s)
- Hailong Zhang
- Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Chunyan Jiang
- Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing, China
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Effect of biceps rerouting technique to restore glenohumeral joint stability for large irreparable rotator cuff tears: a cadaveric biomechanical study. J Shoulder Elbow Surg 2020; 29:1425-1434. [PMID: 32081635 DOI: 10.1016/j.jse.2019.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/31/2019] [Accepted: 11/16/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND The concept of stabilizing the humerus has taken on an important role in the treatment of irreparable cuff tears, and the biceps rerouting (BR) method is considered one of the most effective treatments in this field. The study aimed to evaluate the biomechanical effects of BR for large irreparable rotator cuff tears (LICTs). METHODS A total of 8 cadaveric shoulders were used for testing under 5 conditions: intact shoulder, LICT, partial repair (PR), BR, and biceps rerouting with side-to-side repair (BRSS). Total rotational range of motion was measured at 40°, then 20°, and finally 0° of glenohumeral (GH) abduction. Superior humeral translation and subacromial contact pressure were measured at 0°, 30°, 60°, and 90° of external rotation at each abduction angle. Repeated-measures analyses of variance with Tukey post hoc tests were used for statistical comparisons. RESULTS Superior humeral translation was significantly decreased in the BR and BRSS conditions compared with the LICT and PR conditions at 0° and 20° of GH abduction (P < .001). BR and BRSS significantly reduced subacromial contact pressure compared with LICT and PR at 0° of GH abduction (P < .001). There was no significant decrease in total rotational range of motion after BR at any abduction angle. CONCLUSION BR biomechanically restored shoulder stability without overconstraining range of motion in an LICT model.
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Memon KA, Dimock RA, Cobb T, Consigliere P, Imam MA, Narvani AA. Hamburger Technique: Augmented Rotator Cuff Repair With Biological Superior Capsular Reconstruction. Arthrosc Tech 2020; 9:e987-e993. [PMID: 32714809 PMCID: PMC7372565 DOI: 10.1016/j.eats.2020.03.022] [Citation(s) in RCA: 6] [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: 01/24/2020] [Accepted: 03/28/2020] [Indexed: 02/03/2023] Open
Abstract
Despite profound advancements in arthroscopic rotator cuff repair (RCR) techniques, radiologic failure rates may be in excess of 60% with repairs of large and massive tears in the elderly population. One of the strategies to improve these healing rates has been "patch" augmentation of the cuff repair. At the same time, superior capsular reconstruction (SCR) has gained significant popularity as an option for irreparable rotator cuff (RC) tears. Some have also advocated performing SCR in addition to arthroscopic RCR to reinforce the repair and improve healing rates. Techniques involving the use of fascia lata, ECM patches, and long head of the biceps (LHB) for SCR to reinforce the cuff repair have all been elegantly described. In this article, we propose a technique that enables a combination of the aforementioned procedures and involves performing RCR with patch augmentation, as well as SCR using LHB. In doing so, the repaired RC is bordered by the patch over its bursal surface and the LHB on the articular surface (functioning as the superior capsule), thus giving us the name "Hamburger technique" (a 3-layered construct).
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Affiliation(s)
- Kashif A. Memon
- Rowley Bristow Unit, Ashford and St Peter’s NHS Trust, Chertsey, United Kingdom
| | - Richard A.C. Dimock
- Rowley Bristow Unit, Ashford and St Peter’s NHS Trust, Chertsey, United Kingdom
| | | | - Paolo Consigliere
- The Reading Shoulder Unit, Royal Berkshire NHS Foundation Trust, Reading, Berkshire, United Kingdom
| | - Mohamed A. Imam
- Rowley Bristow Unit, Ashford and St Peter’s NHS Trust, Chertsey, United Kingdom
| | - A. Ali Narvani
- Rowley Bristow Unit, Ashford and St Peter’s NHS Trust, Chertsey, United Kingdom,Fortius Clinic, London, United Kingdom,Address correspondence to A. Ali Narvani, B.Sc., M.B.B.S. (Hons.), M.Sc. (Sports Med.) (Hons.), F.R.C.S. (Tr. & Orth.), M.F.S.E.M. (U.K.), Fortius Clinic, 17 Fitzhardinge St, London W1H 6EQ, United Kindom.
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Adrian SC, Field LD. Biceps Transposition for Biological Superior Capsular Reconstruction. Arthrosc Tech 2020; 9:e841-e846. [PMID: 32577361 PMCID: PMC7301374 DOI: 10.1016/j.eats.2020.02.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/23/2020] [Indexed: 02/03/2023] Open
Abstract
Reconstruction of the superior capsule is a valuable intervention for some patients in whom massive, irreparable posterosuperior rotator cuff tears are identified. Superior capsular reconstruction techniques most commonly use either tensor fascia lata autograft or dermal allograft. As an alternative to more traditional superior capsular reconstruction, we commonly transpose and incorporate the biceps tendon into the rotator cuff repair construct in such patients instead. This biological superior capsular reconstruction biceps transposition technique ("bio-SCR"), described herein, provides increased structural integrity and supplemental tendon graft using viable cells while potentially serving the role of the superior capsule. As such, transposition of the biceps tendon may offer unique and significant advantages over other techniques and can be an effective and valuable alternative in appropriate cases.
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Affiliation(s)
- Scott C. Adrian
- Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, U.S.A
| | - Larry D. Field
- Upper Extremity Service, Sports Medicine Fellowship Program, Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, U.S.A.,Address correspondence to Larry D. Field, M.D., Mississippi Sports Medicine and Orthopaedic Center, 1325 E Fortification St, Jackson, MS 39202, U.S.A.
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Kocaoglu B, Firatli G, Ulku TK. Partial Rotator Cuff Repair With Superior Capsular Reconstruction Using the Biceps Tendon Is as Effective as Superior Capsular Reconstruction Using a Tensor Fasciae Latae Autograft in the Treatment of Irreparable Massive Rotator Cuff Tears. Orthop J Sports Med 2020; 8:2325967120922526. [PMID: 32548183 PMCID: PMC7273572 DOI: 10.1177/2325967120922526] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/12/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Several treatment options are available for stable massive rotator cuff tears, including partial repair with or without tissue augmentation, tendon transfer, superior capsular reconstruction (SCR), and reverse shoulder arthroplasty. PURPOSE/HYPOTHESIS The purpose of this study was to compare the outcomes and effectiveness of partial rotator cuff repair with SCR using the long head of the biceps tendon (PRCR-SCRB) and SCR with a tensor fasciae latae autograft (SCRTF) for the treatment of rotator cuff tears with severe fatty degeneration. The hypothesis of this study was that SCRTF would be superior to PRCR-SCRB in functional and anatomic outcomes. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 26 consecutive patients with massive and fatty degenerative rotator cuff tears were treated surgically. Patients were divided into either the PRCR-SCRB group (n = 14) or SCRTF group (n = 12). Functional outcomes were assessed at final follow-up, and the acromiohumeral distance (AHD) was measured. RESULTS All functional scores significantly improved in both groups at final follow-up. The PRCR-SCRB group showed better overall outcomes in terms of the visual analog scale for pain; American Shoulder and Elbow Surgeons score; and Quick Disabilities of the Arm, Shoulder and Hand, but these differences were not statistically significant. Better outcomes were found for only the AHD for the PRCR-SCRB group without statistical significance (P = .4). No statistical difference was found in terms of retear rate. CONCLUSION PRCR-SCRB had comparable outcomes and improvement in AHD compared with SCRTF without the need for additional graft harvesting.
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Affiliation(s)
- Baris Kocaoglu
- Department of Orthopedic Surgery, School of Medicine, Acibadem
University, Istanbul, Turkey
| | - Goktug Firatli
- Department of Orthopedic Surgery, School of Medicine, Acibadem
University, Istanbul, Turkey
| | - Tekin Kerem Ulku
- Department of Orthopedic Surgery, School of Medicine, Acibadem
University, Istanbul, Turkey
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