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Ben H, Yeom JW, Kholinne E, Guo J, Park JY, Ryu SM, Koh KH, Jeon IH. Effect of age and gender in rates of achieving minimal clinically important difference and patient-acceptable symptom state 2 years after arthroscopic superior capsular reconstruction. Knee Surg Sports Traumatol Arthrosc 2024; 32:1038-1048. [PMID: 38477103 DOI: 10.1002/ksa.12128] [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: 10/10/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE This study aimed to evaluate patient-reported outcome measures (PROMs) and the effects of gender and age on achieving clinically significant outcomes in patients undergoing arthroscopic superior capsular reconstruction (ASCR) with a minimum 2-year follow-up. METHODS Patients undergoing ASCR for irreparable rotator cuff tear between 2013 and 2020 were reviewed. Preoperative and minimum 2-year postoperative PROMs were collected, including American Shoulder and Elbow Surgeons (ASES), Constant, single assessment numeric evaluation (SANE), and visual analog scale (VAS) scores. Minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS) were calculated for each functional score and analyzed according to age and gender. The percentages of patients achieving MCID and PASS were recorded. RESULTS The study included 83 patients, with a mean follow-up of 3.5 ± 1.4 years. Significant improvements were found in ASES, Constant, SANE, and VAS for all groups based on gender and age. Based on receiver-operating characteristic curves, all scores had acceptable areas under the curve for PASS. Values for PASS and MCID were 81.5 and 10.3 for ASES; 61.5 and 6.2 for Constant; 82.5 and 11.5 for SANE and 1.5 and 1.1 for VAS, respectively. Analysis of achieving MCID and PASS showed no difference between the groups in the majority of outcome measures. However, female patients achieved the SANE thresholds for PASS at significantly higher rates than male patients. Patients ≥65 years old achieved ASES and Constant thresholds for MCID at significantly higher rates than patients ˂65 years old. CONCLUSION Most patients achieved MCID and PASS at a 2-year follow-up. Patients showed comparable rates of MCID and PASS achievement on most outcome tools based on age and gender. Female patients achieved PASS on SANE at significantly higher rates than male patients and older patients achieved MCID on ASES and Constant at higher rates than young patients. Thus, age is a stronger factor for achieving MCID than gender. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Hui Ben
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji Woong Yeom
- Department of Orthopaedic Surgery, Gangbook Yonsei Hospital, Seoul, South Korea
| | - Erica Kholinne
- Department of Orthopedic Surgery, St. Carolus Hospital, Faculty of Medicine, Universitas Trisakti, Jakarta, Indonesia
| | - Jia Guo
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji Yeon Park
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung Min Ryu
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kyoung-Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Hurley ET, Crook BS, Danilkowicz RM, Buldo-Licciardi M, Anakwenze O, Mirzayan R, Klifto CS, Jazrawi LM. Acellular Collagen Matrix Patch Augmentation of Arthroscopic Rotator Cuff Repair Reduces Re-Tear Rates: A Meta-analysis of Randomized Control Trials. Arthroscopy 2024; 40:941-946. [PMID: 37816398 DOI: 10.1016/j.arthro.2023.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 09/09/2023] [Accepted: 09/13/2023] [Indexed: 10/12/2023]
Abstract
PURPOSE To perform a meta-analysis of randomized controlled trials (RCTs) to compare the outcomes of arthroscopic rotator cuff repair (ARCR) with and without acellular collagen matrix patch (ACMP) augmentation. METHODS A literature search of 3 databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RCTs comparing ACMP augmentation and a control for ARCR were included. Clinical outcomes were compared using Revman, and a P value < .05 was considered to be statistically significant. RESULTS Five RCTs with 307 patients were included. Overall, 11% of patients treated with ACMP augmentation and 34% of patients in the control group had a re-tear (P = .0006). The mean Constant score was 90.1 with ACMP augmentation, and 87.3 in controls (P = .02). Additionally, there was a significant higher American Shoulder and Elbow Surgeons score with ACMP augmentation (87.7 vs 82.1, P = .01). CONCLUSIONS The RCTs in the literature support the use of ACMP augment as a modality to reduce re-tear rates and improve outcomes after ARCR. LEVEL OF EVIDENCE Level II, Meta-Analysis of Level II Studies meta-analysis of Level II studies.
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Affiliation(s)
- Eoghan T Hurley
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A..
| | - Bryan S Crook
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A
| | - Richard M Danilkowicz
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A
| | - Michael Buldo-Licciardi
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A
| | - Oke Anakwenze
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A
| | - Raffy Mirzayan
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A
| | - Christopher S Klifto
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A
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Kimball JS, Woodard D, Gulbrandsen MT, Jobe CM, Phipatanakul WP, Syed HM. Patients With Intact Shoulder Superior Capsular Reconstruction Grafts on Ultrasound Show Significant Improvement in Functional Outcomes at Minimum 2-Year Follow-up. Arthrosc Sports Med Rehabil 2024; 6:100857. [PMID: 38288033 PMCID: PMC10823090 DOI: 10.1016/j.asmr.2023.100857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/04/2023] [Indexed: 01/31/2024] Open
Abstract
Purpose To assess the utility of using dynamic ultrasound for postoperative evaluation after superior capsular reconstruction (SCR) by evaluating graft integrity and its correlation with clinical outcomes at a minimum 2-year follow-up. Methods A retrospective chart review was conducted to identify patients who underwent SCR between July 2015 and July 2020 with a minimum 2-year clinical and ultrasound follow-up. Clinical outcome measures included Simple Shoulder (SS) and American Shoulder and Elbow Surgeon (ASES) scores. Integrity of the SCR graft was evaluated by dynamic ultrasound. Results We evaluated 22 shoulders in 21 patients with a mean follow-up of 44.8 months (range, 24-71 months). The graft was found to be intact by ultrasound evaluation in 82% (18/22). Patients with intact grafts had higher mean SS (11.6 vs 7.8, P = .00079) and ASES (91.2 vs 64.1, P = .0296) scores at latest follow-up compared to those with failed grafts. Those with intact grafts also had significant improvement in SS (3.7 vs 11.6, P < .00001) and ASES (23.2 vs 91.2, P < .00001) scores at latest follow-up compared to their preoperative scores. In contrast, patients with graft failure had no significant improvement in SS (6.3 vs 9.0, P = .123) and ASES (40.4 vs 58.3, P = .05469) scores at latest follow-up compared to their preoperative scores. There was no difference between clinical outcomes at 6 to 12 months vs latest follow-up for both SS (P = .11, P = .5) and ASES (P = .27, P = .21) scores. Conclusions SCR grafts were found by ultrasound to be intact in 82% of cases. Patients with intact grafts on ultrasound had significant improvement in functional outcome scores while those with graft failure did not. Functional outcome scores suggest that maximal recovery from this procedure occurs by 6 to 12 months. Level of Evidence Level IV, therapeutic case series.
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Affiliation(s)
- Jeff S. Kimball
- Department of Orthopaedic Surgery, Loma Linda University School of Medicine, Loma Linda, California, U.S.A
| | - David Woodard
- Department of Orthopaedic Surgery, Loma Linda University School of Medicine, Loma Linda, California, U.S.A
| | - Matthew T. Gulbrandsen
- Department of Orthopaedic Surgery, Loma Linda University School of Medicine, Loma Linda, California, U.S.A
| | - Christopher M. Jobe
- Department of Orthopaedic Surgery, Loma Linda University School of Medicine, Loma Linda, California, U.S.A
- Veterans Administration Loma Linda, Loma Linda, California, U.S.A
| | - Wesley P. Phipatanakul
- Department of Orthopaedic Surgery, Loma Linda University School of Medicine, Loma Linda, California, U.S.A
| | - Hasan M. Syed
- Department of Orthopaedic Surgery, Loma Linda University School of Medicine, Loma Linda, California, U.S.A
- Veterans Administration Loma Linda, Loma Linda, California, U.S.A
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Green CK, Scanaliato JP, Sandler AB, Patrick CM, Dunn JC, Parnes N. Concomitant Biceps Tenodesis Does Not Portend Inferior Outcomes After Anterior Glenohumeral Stabilization. Am J Sports Med 2023; 51:3851-3857. [PMID: 37975490 DOI: 10.1177/03635465231209731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Military patients are known to suffer disproportionately high rates of glenohumeral instability as well as superior labrum anterior to posterior (SLAP) tears. Additionally, a concomitant SLAP tear is frequently observed in patients with anterior shoulder instability. Even though biceps tenodesis has been demonstrated to produce superior outcomes to SLAP repair in military patients with isolated SLAP lesions, no existing studies have reported on outcomes after simultaneous tenodesis and anterior labral repair in patients with co-existing abnormalities. PURPOSE To evaluate outcomes after simultaneous arthroscopic-assisted subpectoral biceps tenodesis and anterior labral repair in military patients younger than 40 years. We also sought to compare these outcomes with those after repair of an isolated anterior labral tear. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This study is a retrospective analysis of all military patients younger than 40 years from a single base who underwent arthroscopic anterior glenohumeral stabilization with or without concomitant biceps tenodesis between January 2010 and December 2019. Patients with glenoid bone loss of >13.5% were not eligible for inclusion. Outcome measures including the visual analog scale (VAS) for pain, the Single Assessment Numeric Evaluation (SANE), the American Shoulder and Elbow Surgeons (ASES) shoulder score, the Rowe instability score, and range of motion were administered preoperatively and postoperatively, and scores were compared between groups. RESULTS A total of 82 patients met inclusion criteria for the study. All patients were active-duty service members at the time of surgery. The mean follow-up was 87.75 ± 27.05 months in the repair + tenodesis group and 94.07 ± 28.72 months in the isolated repair group (P = .3085). Patients who underwent repair + tenodesis had significantly worse preoperative VAS pain (6.85 ± 1.86 vs 5.02 ± 2.07, respectively; P < .001), ASES (51.78 ± 11.89 vs 62.43 ± 12.35, respectively; P = .0002), and Rowe (26.75 ± 7.81 vs 37.26 ± 14.91, respectively; P = .0002) scores than patients who underwent isolated repair. Both groups experienced significant improvements in outcome scores postoperatively (P < .0001 for all), and there were no statistically significant differences in postoperative outcome scores or range of motion between groups. There were no differences in the percentage of patients who achieved the minimal clinically important difference, substantial clinical benefit, and patient acceptable symptom state for the VAS pain, SANE, ASES, and Rowe scores between groups. Overall, 37 of the 40 (92.50%) patients in the repair + tenodesis group and 40 of the 42 (95.24%) patients in the isolated repair group returned to unrestricted active-duty military service (P = .6045). In addition, 38 (95.00%) patients in the repair + tenodesis group and 40 (95.24%) patients in the isolated repair group returned to preinjury levels of sporting activity (P = .9600). There were no significant differences in the number of failures, revision surgical procedures, or patients discharged from the military between groups (P = .9421, P = .9400, and P = .6045, respectively). CONCLUSION The findings of this study indicate that simultaneous biceps tenodesis and labral repair was a viable treatment option for the management of concomitant SLAP and anterior labral lesions in young, active military patients younger than 40 years.
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Affiliation(s)
- Clare K Green
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - John P Scanaliato
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Alexis B Sandler
- William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Cole M Patrick
- William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - John C Dunn
- William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Nata Parnes
- Carthage Area Hospital, Carthage, New York, USA
- Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
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Lee JB, Kholinne E, Ben H, So SP, Alsaqri H, Koh KH, Jeon IH. Superior Capsular Reconstruction Combined With Lower Trapezius Tendon Transfer Improves the Biomechanics in Posterosuperior Massive Rotator Cuff Tears. Am J Sports Med 2023; 51:3817-3824. [PMID: 37975524 DOI: 10.1177/03635465231207834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Surgical treatments for chronic posterosuperior massive rotator cuff tear (MRCT) are still controversial. Superior capsular reconstruction (SCR), which provides a static stabilizer to decrease superior humeral head translation, and lower trapezius tendon transfer (LTTT) with centralization of the humeral head, which prevents superior humeral head migration, are potential surgical options. To date, SCR combined with LTTT has not been fully investigated. HYPOTHESIS Restoration of static stabilizer and dynamic stabilizer together would effectively improve shoulder kinematics in posterosuperior MRCT. STUDY DESIGN Controlled laboratory study. METHODS A custom-made shoulder mechanics testing system was used to test 8 fresh-frozen cadaveric shoulders. The testing conditions were as follows: (1) intact; (2) posterosuperior MRCT (supraspinatus and infraspinatus removed); (3) SCR using the fascia lata; (4) LTTT; and (5) SCR combined with LTTT. The total rotational range of motion (ROM), superior translation, anteroposterior translation, and peak subacromial contact pressure were evaluated at 0°, 30°, and 60° of shoulder abduction. Repeated-measures analysis of variance and Tukey post hoc tests were performed. RESULTS The total rotational ROM, superior translation, anteroposterior translation, and peak subacromial contact pressure increased in posterosuperior MRCTs (all, P < .05). The rotational ROM, superior translation, anteroposterior translation, and peak subacromial contact pressure at 0° and 30° of shoulder abduction decreased in SCR (all, P < .05). However, there was no significant improvement in rotational ROM, superior translation, and peak subacromial contact pressure at 60° of shoulder abduction (P > .05). LTTT resulted in a significant decrease in the superior translation, anteroposterior translation, and peak subacromial contact pressure at 0°, 30°, and 60° of shoulder abduction (P < .05). SCR combined with LTTT restored the total rotational ROM, superior translation, anteroposterior translation, and peak subacromial contact pressure at 0°, 30°, and 60° of shoulder abduction (all, P < .05). CONCLUSION In the cadaveric model, SCR combined with LTTT showed improved shoulder kinematics and contact pressures in the posterosuperior MRCT model compared with SCR or LTTT alone. CLINICAL RELEVANCE SCR combined with LTTT may be regarded as an alternative surgical procedure for posterosuperior MRCTs.
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Affiliation(s)
- Jun-Bum Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Erica Kholinne
- Department of Orthopedic Surgery, Saint Carolus Hospital, Faculty of Medicine, Universitas Trisakti, Jakarta, Indonesia
| | - Hui Ben
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Pil So
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hood Alsaqri
- Department of Orthopaedic Surgery, Rustaq Hospital, Rustaq, Sultanate of Oman
| | - Kyoung-Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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von Knoch M, Hoffmann DB, Baums MH. Which Factors Are Associated With Rerupture After Superior Capsular Reconstruction of the Shoulder With Autologous Long Biceps Tendon? - A Systematic Review. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2023. [PMID: 37967830 DOI: 10.1055/a-2195-0790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Based on a systematic review, the present work analyses factors associated with the rerupture rate or non-healing after superior capsular reconstruction with autologous long biceps tendon in the reconstruction of the rotator cuff of the shoulder.A systematic review of the U.S. National Library of Medicine/National Institutes of Health (PubMed) database and the Cochrane Library was conducted in September 2021 using the PRISMA checklist. Articles were identified and analysed that contained data on the rerupture rate after superior capsular reconstruction with autologous long biceps tendon in reconstruction of the rotator cuff of the shoulder. The aim was to identify factors associated with rerupture or non-healing. The risk of bias was determined using the Newcastle-Ottawa scale.Primarily 86 hits could be generated. Seven articles from 2020 and 2021 met the inclusion criteria and were further analysed in terms of content. The evidence level was III to IV. Follow-up was between 12 (minimum) and 24 to 48 months. The risk of bias was not low. Factors that may be associated with rerupture or non-healing are diabetes mellitus and high-grade fatty degeneration of the subscapularis, infraspinatus, or teres minor as preoperative factors. Age, percent footprint coverage, tear size, symptom duration, number of bundles, acromioplasty performed, and tear configuration were not significant factors. Gender, degree of fatty degeneration of the supraspinatus and lesions of the subscapularis tendon were rated differently.According to the literature, but still currently with short-term observation periods, superior capsular reconstruction with an autologous long biceps tendon is another treatment option in the case of massive tears and elderly patients, if there is no high-grade fatty degeneration of the subscapularis, infraspinatus or teres minor. Diabetes mellitus has an unfavorable prognosis. Additional acromioplasty has so far not been associated with better outcomes.
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Affiliation(s)
- Marius von Knoch
- Schulterchirurgie, Kreiskrankenhaus Osterholz, Osterholz-Scharmbeck, Deutschland
- Schulterchirurgie, AMEOS Klinikum Seepark Geestland, Geestland, Deutschland
| | - Daniel B Hoffmann
- Klinik für Unfallchirurgie, Orthopädie und plastische Chirurgie, Universitätsmedizin Göttingen, Gottingen, Deutschland
| | - Mike H Baums
- Fachbereich Orthopädie, Unfallchirurgie und Sporttraumatologie, Katholisches Klinikum Ruhrgebiet Nord GmbH, Dorsten, Deutschland
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Lee JB, Kholinne E, Yeom JW, So SP, Ben H, Alsaqri H, Koh KH, Jeon IH. Evaluation of a New MRI-Based Classification of Graft Status After Superior Capsule Reconstruction. Orthop J Sports Med 2023; 11:23259671231193315. [PMID: 37781637 PMCID: PMC10536853 DOI: 10.1177/23259671231193315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/03/2023] [Indexed: 10/03/2023] Open
Abstract
Background A classification system for the graft state after superior capsule reconstruction (SCR) using magnetic resonance imaging (MRI) has not been described previously. Purpose To introduce a new, MRI-based classification system for graft integrity after SCR and to evaluate the system according to postoperative outcomes. Study Design Cohort study (diagnosis); Level of evidence, 3. Method Included were 62 consecutive patients who underwent SCR using autologous fascia lata graft between January 2013 and April 2021. Postoperative outcomes were assessed (American Shoulder and Elbow Surgeons [ASES] score, Constant score, pain visual analog scale [pVAS], range of motion [ROM], acromiohumeral distance [AHD], Hamada grade). Graft status was classified by 2 orthopaedic surgeons on postoperative MRI in accordance with the signal intensity and the presence or extent of the tear, as follows: type 1 (hypointense signal without tear), type 2 (hyperintense signal without tear), type 3 (partial-thickness tear), type 4 (full-thickness tear with partial continuity), and type 5 (full-thickness tear with complete discontinuity). Intra- and interobserver agreement were assessed using Cohen kappa. The correlation between postoperative outcomes (ASES score, Constant score, pVAS, ROM, AHD, and Hamada grade) and the SCR graft classification system was assessed with the Pearson correlation coefficient, and the outcomes were compared according to classification type. Results Patients were classified according to the new system as follows: type 1 (n = 15), type 2 (n = 20), type 3 (n = 7), type 4 (n = 8), and type 5 (n = 12). There was excellent interobserver agreement (κ = 0.819) and intraobserver agreement (κ = 0.937 and 0.919). The classification system showed a moderate to high correlation with the ASES score (r = -0.451; P = .001), pVAS (r = 0.359; P = .005), AHD (r = -0.642; P < .001), and Hamada grade (r = 0.414; P < .001). Patients classified as having types 1 and 2 showed better outcomes in terms of ASES score, pVAS, ROM, and AHD compared with type 5 patients (P ≤ .021 for all). Conclusion The new classification system was highly reproducible and showed clinical utility for both radiological and clinical evaluation after SCR.
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Affiliation(s)
- Jun-Bum Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Erica Kholinne
- Department of Orthopedic Surgery, St Carolus Hospital, Faculty of Medicine, Universitas Trisakti, Jakarta, Indonesia
| | - Ji Woong Yeom
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Pil So
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hui Ben
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hood Alsaqri
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyoung-Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Kizilay YO, Güneş Z, Turan K, Aktekin CN, Uysal Y, Kezer M, Camurcu Y. Volumetric Analysis of Subacromial Space After Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears. Indian J Orthop 2023; 57:967-974. [PMID: 37214362 PMCID: PMC10192490 DOI: 10.1007/s43465-023-00881-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/24/2023] [Indexed: 05/24/2023]
Abstract
Purpose Subacromial volume measurement on magnetic resonance images is relatively new. It has been shown that decreased subacromial volume increases after surgical repair of full-thickness rotator cuff tears. There is no study examining subacromial volume changes after superior capsular reconstruction (SCR). The purpose of this study was to compare subacromial volume changes on magnetic resonance images (MRI) after superior capsular reconstruction performed for primary irreparable rotator cuff tears. Methods Patients who underwent an SCR procedure between 2017 and 2019 with a minimum 2-year postoperative follow-up were included in this retrospective study. Subacromial volume was measured on MRI using software. The preoperative and postoperative acromiohumeral distance, Constant Scores, graft thickness, and Hamada grades of the patients were evaluated. Results A total of 18 patients with a mean age of 59.7 years (range: 49-74 years) underwent an SCR for massive irreparable cuff tear. The mean preoperative subacromial volume was 3.54 ± 0.39 cm3 (range 2.88-4.36 cm3), which increased to 4.46 ± 0.39 cm3 (range 3.75-5.32 cm3) postoperatively (p = < 0.001). The increase in subacromial volume and acromiohumeral distance did not correlate with Constant scores and graft thickness. We observed a significantly higher subacromial volume increase among Hamada grade 1 patients, compared to those with Hamada grade 2 (p = 0.011). Conclusions We observed that subacromial volume significantly increased after superior capsular reconstruction. However, the increase in subacromial volume did not correlate with clinical scores, acromiohumeral distance changes, or graft thickness.Level of evidence: Level III - Retrospective Cohort Study.
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Affiliation(s)
- Yusuf Onur Kizilay
- Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul Atlas University, Anadolu Caddesi 40, Kagithane, 34408 Istanbul, Turkey
| | - Zafer Güneş
- Ankara, Turkey Department of Orthopedics and Traumatology, Ankara Training and Research Hospital
| | - Kayhan Turan
- Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul Atlas University, Istanbul, Turkey
| | - Cem Nuri Aktekin
- Ankara, Turkey Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara Yıldırım Beyazıt University
| | - Yunus Uysal
- Department of Orthopedics and Traumatology, Bursa Osmangazi Aritmi Hospital, Bursa, Turkey
| | - Murat Kezer
- Department of Orthopedics and Traumatology, Bursa Osmangazi Aritmi Hospital, Bursa, Turkey
| | - Yalkin Camurcu
- Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul Atlas University, Istanbul, Turkey
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Kim DS, Han JY, Park YJ, Kwak JW, Lee BS. Comparative analysis of superior capsule reconstruction between long head of biceps tendon autograft and human dermis allograft. J Shoulder Elbow Surg 2023; 32:820-831. [PMID: 36174817 DOI: 10.1016/j.jse.2022.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/18/2022] [Accepted: 08/11/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although many superior capsule reconstruction (SCR) techniques are currently practiced in clinical settings, guidelines for choosing the appropriate graft material are lacking. Therefore, at most times, the surgeon's personal preference becomes the deciding factor. This study compared 2 fairly recent SCR techniques-SCR with biceps tendon (BT) autograft and SCR with human dermis (HD) allograft-by evaluating clinical and radiologic outcomes to aid the surgeon's decision in choosing the appropriate graft. METHODS Thirty-one patients underwent SCR using BT autograft (SCR BT), and 22 underwent SCR using HD allograft (SCR HD). SCR BT was selected for patients with a partial BT tear <20%, no severe inflammation signs, and favorable anchor conditions. SCR HD was performed in patients with a BT tear >20%, a superior labrum anterior-posterior (SLAP) lesion, severe inflammation, or subluxation. Range of motion (ROM), strength and shoulder function scoring, plain radiography, and magnetic resonance imaging were evaluated before and after surgery at regular intervals. RESULTS In the SCR BT group, forward flexion ROM increased from 122° ± 43° to 149° ± 18° at 2 years postoperatively, whereas in the SCR HD group, forward flexion ROM improved from 129° ± 28° to 149° ± 18°. In the SCR BT group, internal rotation (IR) ROM increased from 5 ± 3 to 6 ± 2 at 2 years postoperatively, whereas in the SCR HD group, IR ROM improved from 5 ± 3 to 6 ± 1. Although ROM, strength, visual analog scale score, American Shoulder and Elbow Surgeons score, and Constant score all improved 2 years after surgery, no statistically significant differences were found. Six months after surgery, graft thickness was 3.58 ± 0.384 mm in the SCR BT group and 2.49 ± 0.326 mm in the SCR HD group (P < .001). At 2 years postoperatively, graft thickness was 3.54 ± 0.399 mm in the SCR BT group and 2.49 ± 0.306 mm in the SCR HD group (P < .001). The SCR HD group showed a negative correlation of -0.475 between graft thickness and IR ROM (P = .026). In the SCR BT group, a negative correlation of -0.466 was found between graft thickness and IR ROM (P = .008). A positive correlation of 0.363 was found between IR ROM and the acromiohumeral distance when the results were compared before and 2 years after surgery (P = .045). CONCLUSION Both SCR using BT autograft and SCR using HD allograft tissue showed favorable results, and no significant difference was noted between the 2 techniques. Given that the 2 techniques show equally favorable results, the surgeon's personal preference in choosing the SCR technique appears to be acceptable. Understanding the costs and patient's characteristics may aid the surgeon in deciding on the graft material.
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Affiliation(s)
- Doo Sup Kim
- Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Jin Young Han
- Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Wonju, Republic of Korea.
| | - Yeon Jae Park
- Department of Medical Statistics, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Ji Woong Kwak
- Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Bum Seok Lee
- Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Wonju, Republic of Korea
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Krishnan P, Maassen N, Lee C, Baker H, Koh J, Amirouche F, Athiviraham A. Long Head of the Biceps Autograft Performs Biomechanically Similar to Human Dermal Allograft for Superior Capsule Reconstruction After Rotator Cuff Tear. Arthroscopy 2023; 39:706-715. [PMID: 36395965 DOI: 10.1016/j.arthro.2022.10.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To provide a biomechanical comparison between human dermal (HD) allograft and long head of biceps tendon (LHBT) autograft with and without posterior side-to-side suturing for superior capsule reconstruction. METHODS Eight fresh-frozen cadaveric shoulder specimens were tested in 5 conditions: (1) intact, (2) complete supraspinatus tear, (3) LHBT, (4) LHBT with side-to-side suturing, and (5) HD allograft with side-to-side suturing. Functional abduction force, superior translation of humeral head, translational range of motion, and rotational range of motion were tested at 0°, 30°, 60°, and 90° of abduction within each condition. Data were analyzed using analysis of variance with post-hoc Tukey testing for pairwise comparison, with a significance value set at .05. RESULTS Functional abduction force in the LHBT, LHBT + suture, and HD + suture conditions was significantly increased compared with the supraspinatus tear condition at abduction angles of 30° (P = .011, .001, and .017, respectively), 60° (P = .004, .001, and .002, respectively), and 90° (P = .013, .001, and .038, respectively). In addition, superior translation of the humeral head in the LHBT, LHBT + suture, and HD + suture conditions was significantly decreased compared with the tear condition at abduction angles of 30° (P = .03, .049, .03, respectively) and 60° (P = .02, .04, .03, respectively). All 3 reconstructive techniques were statistically identical to the intact rotator cuff condition in regard to translational and rotational range of motion. CONCLUSIONS Superior capsule reconstruction with LHBT autograft without side-to-side suturing, LHBT with posterior side-to-side suturing, and HD allograft with posterior side-to-side suturing all equivalently restore functional abduction force and decrease superior translation of the humeral head after a complete supraspinatus tear. CLINICAL RELEVANCE Superior capsule reconstruction with long head of the biceps tendon autograft and human dermal allograft both restore functional abduction force and decrease superior translation of the humeral head, while displaying no losses in the range of motion in a cadaveric model.
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Affiliation(s)
- Pranav Krishnan
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, U.S.A
| | - Nicholas Maassen
- Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois, U.S.A
| | - Cody Lee
- Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois, U.S.A
| | - Hayden Baker
- Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois, U.S.A
| | - Jason Koh
- Department of Orthopaedic Surgery, Northshore University Health System, Chicago, Illinois, U.S.A
| | - Farid Amirouche
- Department of Orthopaedic Surgery, Northshore University Health System, Chicago, Illinois, U.S.A.; Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois, U.S.A
| | - Aravind Athiviraham
- Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois, U.S.A..
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Ben H, Kholinne E, Zeng CH, So SP, Lee JB, Sun Y, Koh KH, Jeon IH. Early Postoperative MRI Evaluation of a Fascia Lata Autograft With and Without Polypropylene Mesh Augmentation After Superior Capsular Reconstruction. Am J Sports Med 2023; 51:912-918. [PMID: 36786289 DOI: 10.1177/03635465231151927] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND Recently, a polypropylene mesh has been introduced and reported to improve clinical outcomes after superior capsular reconstruction (SCR) using a fascia lata autograft (FLA). However, mesh-related events such as a foreign body response may trigger inflammation, which might affect graft healing and remodeling. PURPOSE/HYPOTHESIS The aim was to investigate whether the healing and remodeling of an FLA were affected by the use of a mesh by comparing the signal intensity of an FLA-alone group vs an FLA + Mesh group on postoperative magnetic resonance imaging (MRI). The hypothesis was that the use of a mesh would decrease the MRI signal intensity of FLA during the early postoperative phase. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who had undergone SCR using an FLA with or without a mesh between March 2013 and August 2021 were retrospectively analyzed. Follow-up MRI was performed at 3 months. A total of 78 patients (24 in the FLA group and 54 in the FLA + Mesh group) with intact grafts were included. Graft remodeling was evaluated by analyzing the signal-to-noise quotient (SNQ) at the humeral, mid-substance, and glenoid sites. Theoretically, lower SNQ ratios indicate higher strength and better healing of the graft. RESULTS The mean SNQ was 30.603 (range, 11.790-72.710) in the FLA group and 18.367 (range, 4.464-69.500) in the FLA + Mesh group (P < .001). Furthermore, significant differences were found between the 2 groups at the humeral and mid-substance sites (37.863 [range, 5.092-81.187] vs 15.512 [range, 1.814-80.869], P < .001; and 29.168 [range, 6.103-73.900] vs 16.878 [range, 2.454-92.416], P = .003; respectively). However, there was no difference between the 2 groups at the glenoid site (25.346 [range, 7.565-86.353] vs 20.354 [range, 3.732-88.468], P = .057). CONCLUSION At the 3-month follow-up, the FLA + Mesh group showed a lower MRI signal intensity than the FLA group. The healing and remodeling of an FLA may be enhanced when a mesh is used.
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Affiliation(s)
- Hui Ben
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Erica Kholinne
- Faculty of Medicine, Universitas Trisakti, Department of Orthopedic Surgery, St Carolus Hospital, Jakarta, Indonesia
| | - Chu Hui Zeng
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Pil So
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun-Bum Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yucheng Sun
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Kyoung-Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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12
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Greiner JJ, Carrazana-Suarez LF, Dunn R, Lin A. Arthroscopic Superior Capsular Reconstruction. VIDEO JOURNAL OF SPORTS MEDICINE 2023. [DOI: 10.1177/26350254221131069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: Limited options exist for young patients with massive, irreparable rotator cuff tears. While several treatment options exist, superior capsular reconstruction (SCR) was developed to restore glenohumeral joint stability by preventing superior humeral head migration during glenohumeral motion. Indications: Arthroscopic SCR is indicated in young patients with a massive, irreparable rotator cuff tear. Patients require a functioning deltoid muscle with minimal to no glenohumeral joint arthritis. In addition, patients should have Hamada grade 2 or less and should have an intact or repairable subscapularis tendon. Technique Description: The patient is positioned in the beach chair position. Standard anterior, posterior, and mid-lateral portals are established. An accessory posterior-superior lateral portal is used for visualization. Three 3.0 mm knotless anchors are placed in the glenoid through lateral percutaneous incisions. Two 4.75 mm anchors are placed adjacent to the humeral articular cartilage for medial row fixation. The graft dimensions are measured using the distance between the anchors. The graft is prepared using a gown card as a template with 5 mm added to the medial, posterior, and anterior graft dimensions, and 10 mm added to the lateral dimension. Sutures are passed through the graft in an inverted horizontal mattress for the glenoid anchors to diminish friction and allow appropriate suture passage through the knotless mechanism of the anchor. The graft is then shuttled into the joint through a lateral PassPort button cannula. Two lateral row anchors are used to secure the lateral graft on the humerus. Native rotator cuff tissue is repaired to the graft using sutures from the medial row anchors as well as free SutureTape. Results: Outcomes following SCR have demonstrated improvements in clinical outcomes and shoulder range of motion. Similar outcomes have been identified between the use of allograft and autograft. Patients generally are able to return to light recreational activities and work. Discussion/Conclusion: Arthroscopic SCR yields favorable results in the setting of a massive, irreparable rotator cuff tear. Meticulous surgical technique is needed to avoid intraoperative surgical complications. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
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Affiliation(s)
- Justin J. Greiner
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Robin Dunn
- Colorado Permanente Medical Group, Denver, Colorado, USA
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13
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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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14
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Yeom JW, Kim DM, Lee JB, Ben H, Alahmadi BM, Park JH, Koh KH, Jeon IH. Patient Acceptable Symptom State, Minimal Clinically Important Difference, and Substantial Clinical Benefit After Arthroscopic Superior Capsular Reconstruction. Am J Sports Med 2022; 50:3308-3317. [PMID: 36041050 DOI: 10.1177/03635465221118582] [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 Patient Acceptable Symptom State (PASS), minimal clinically important difference (MCID), and substantial clinical benefit (SCB) have rarely been assessed after arthroscopic superior capsular reconstruction (ASCR) with fascia lata autograft. PURPOSE (1) To investigate PASS, MCID, and SCB values for pain visual analog scale (pVAS), American Shoulder and Elbow Surgeons (ASES) score, Constant score, and Single Assessment Numeric Evaluation (SANE) after ASCR with fascia lata autograft, (2) to investigate factors for achieving PASS, MCID, and SCB. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS We retrospectively collected data from patients who underwent ASCR between June 2013 and October 2020. A total of 88 patients were included, and anchor questions for deriving PASS, MCID, and SCB values were applied at a minimum 1-year follow-up postoperatively. PASS, MCID, and SCB were derived using sensitivity- and specificity-based approaches. Univariable and multivariable logistic regression analyses were performed to determine factors for achieving PASS, MCID, and SCB. RESULTS Based on receiver operating characteristic curves, all 4 scores had acceptable area under the curve values (>0.7) for PASS, MCID, and SCB values. The PASS, MCID, and SCB values were 1.5, 2.5, and 4.5 for pVAS; 81.0, 19.0, and 27.5 for the ASES score; 60.5, -0.5, and 5.5 for the Constant score; and 75.0, 27.5, and 32.5 for SANE, respectively. Poor preoperative scores were related to significantly higher odds ratios (ORs) for achieving MCID and SCB. Wide acromiohumeral distance and dominant side were related to higher ORs for achieving PASS for the ASES score, and subscapularis tear was related to lower ORs for achieving PASS for pVAS and SCB for the Constant score. CONCLUSION Reliable PASS, MCID, and SCB values were achieved for at least 1 year after ASCR surgery. Poor preoperative score, wide acromiohumeral distance, and dominant side all demonstrated higher ORs for at least one value, but a subscapularis tear demonstrated lower ORs for achieving PASS for pVAS and SCB for the Constant score.
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Affiliation(s)
- Ji Woong Yeom
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, Gangbook Yonsei Hospital, Seoul, Republic of Korea
| | - Dong Min Kim
- Department of Orthopaedic Surgery, Sarang Plus Hospital, Seoul, Republic of Korea
| | - Jun-Bum Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hui Ben
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Basim Masoud Alahmadi
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Hee Park
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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15
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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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16
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Tibone JE, Mansfield C, Kantor A, Giordano J, Lin CC, Itami Y, McGarry MH, Adamson GJ, Lee TQ. Human Dermal Allograft Superior Capsule Reconstruction With Graft Length Determined at Glenohumeral Abduction Angles of 20° and 40° Decreases Joint Translation and Subacromial Pressure Without Compromising Range of Motion: A Cadaveric Biomechanical Study. Arthroscopy 2022; 38:1398-1407. [PMID: 34785299 DOI: 10.1016/j.arthro.2021.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the biomechanical effects of superior capsule reconstruction (SCR) graft fixation length determined at 20° and 40° of glenohumeral (GH) abduction. METHODS Humeral translation, rotational range of motion (ROM), and subacromial contact pressure were quantified at 0°, 30°, and 60° of GH abduction in the scapular plane in 6 cadaveric shoulders for the following states: intact, massive rotator cuff tear, SCR with dermal allograft fixed at 20° of GH abduction (SCR 20), and SCR with dermal allograft fixed at 40° of GH abduction (SCR 40). Statistical analysis was conducted using a repeated-measures analysis of variance and a paired t test (P < .05). RESULTS A massive cuff tear significantly increased total ROM compared with the intact state at 0° and 60° of abduction. SCR 20 or SCR 40 did not affect ROM. Compared with the intact state, the massive cuff tear model significantly increased superior translation by an average of 4.6 ± 0.5 mm in 9 of 12 positions (P ≤ .002). Both SCR 20 and SCR 40 reduced superior translation compared with the massive cuff tear model (P < .05); however, SCR 40 significantly decreased superior translation compared with SCR 20 at 0° of abduction (P ≤ .046). Peak subacromial pressure for the massive cuff tear model increased by an average of 486.8 ± 233.9 kPa relative to the intact state in 5 of 12 positions (P ≤ .037). SCR 20 reduced peak subacromial pressure in 2 of 12 positions (P ≤ .012), whereas SCR 40 achieved this in 6 of 12 positions (P ≤ .024). CONCLUSIONS SCR with dermal allograft fixed at 20° or 40° of GH abduction decreases GH translation and subacromial pressure without decreasing ROM. CLINICAL RELEVANCE With an increasing abduction angle for graft fixation, the medial-to-lateral graft length is decreased and the graft tension is effectively increased. Surgeons may increase shoulder stability without restricting ROM by fixing the graft at higher abduction angles. However, surgeons should remain cognizant of potential graft failure due to increased tension.
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Affiliation(s)
- James E Tibone
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Colin Mansfield
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Adam Kantor
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | - James Giordano
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Charles C Lin
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | - Yasuo Itami
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A.; Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | - Gregory J Adamson
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A..
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17
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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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Superior Capsular Reconstruction: A Salvage Option for Massive Irreparable Rotator Cuff Tears with Pseudoparalysis or Subscapularis Insufficiency. Arthroscopy 2022; 38:253-261. [PMID: 34052375 DOI: 10.1016/j.arthro.2021.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We sought to examine superior capsular reconstruction (SCR) outcomes after minimum 2-year follow-up and determine risk factors that were predictive of outcomes. METHODS Forty consecutive patients (mean age 57.3 years, 87.5% male) who underwent SCR for massive irreparable rotator cuff tears (RCT) met the inclusion criteria. Minimum 2-year follow-up was obtained for 32 patients (80% follow-up). Patient demographics and preoperative clinical findings were collected. Postoperative data, including complications, patient satisfaction, strength and range-of-motion (ROM), and patient-reported outcomes were collected. RESULTS The Hamada score was ≤2 in 88% with average acromiohumeral interval distance of 6.8 mm. Preoperatively, 6 patients had external rotation lag (19%) and 6 had pseudoparalysis (19%). Intraoperative assessment of the subscapularis demonstrated true insufficiency in 38%. There was significant improvement in forward elevation (FE) (31° increase; P = .007) and strength in all planes (all P < .05). Patient-reported outcomes significantly improved (American Shoulder and Elbow Surgeon [ASES] 34-point increase; visual analog scale [VAS] 2.9-point decrease; single alpha-numeric evaluation [SANE] 48-point increase; all P < .05). Twenty-six patients (81%) were completely or somewhat satisfied with surgery. At time of final follow-up, 3/32 patients (9%) failed SCR and converted to reverse total shoulder arthroplasty. There were 4 (13%) reported complications (2 patients had postoperative falls; 1 patient had persistent severe pain; 1 had persistent stiffness). One patient was deceased. Patients with pseudoparalysis (n = 6) had significant improvement in post-operative FE (28 vs 154°; P < .0001) and SANE score (P = .016) with 66% patient satisfaction. However, outcome scores overall remained lower than SCR without pseudoparalysis. Regarding subscapularis insufficiency (n = 12), significant improvement was seen in postoperative FE (108 vs 158°; P = .019) and patient-reported outcome scores (P < .005). In patients converted from SCR to reverse total shoulder arthroplasty (n = 3), there were no distinguishing characteristics present. CONCLUSION Superior capsular reconstruction is an effective salvage operation for massive irreparable RCT. Patients with pseudoparalysis or subscapularis insufficiency demonstrate significant postoperative improvement in FE and patient-reported outcomes. LEVEL OF EVIDENCE IV, retrospective cohort.
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Lee KW, Choi HG, Yang DS, Yu YT, Kim WS, Choy WS. Achilles Tendon Allograft for Superior Capsule Reconstruction in Irreparable Massive Rotator Cuff Tears. Clin Orthop Surg 2021; 13:395-405. [PMID: 34484633 PMCID: PMC8380524 DOI: 10.4055/cios20284] [Citation(s) in RCA: 4] [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: 11/19/2020] [Revised: 12/23/2020] [Accepted: 12/23/2020] [Indexed: 11/10/2022] Open
Abstract
Backgroud Treatment remains a challenge in massive and irreparable rotator cuff tears (RCTs), and superior capsular reconstruction (SCR) has become an increasingly popular choice. The objective of this study was to evaluate clinical and radiological outcomes after SCR using an Achilles tendon allograft in irreparable massive RCTs. Methods From December 2015 to March 2018, 11 patients (mean age, 66.3 ± 5.8 years) with irreparable massive RCTs who underwent SCR using an Achilles tendon allograft were enrolled in this study. The range of motion (ROM), visual analog scale (VAS), clinical scores, muscle strength, and acromiohumeral distance (AHD) were measured preoperatively and at 3, 6, and 12 months, and final follow-up postoperatively. Magnetic resonance imaging (MRI) was performed preoperatively and at 6 months postoperatively to assess the global fatty degeneration index and graft failure. Ultrasonography was also conducted preoperatively and at 3, 6, and 12 months, and final follow-up postoperatively to assess graft continuity. Results The mean follow-up period was 27.6 months (range, 24–32 months). The shoulder ROM at final follow-up increased significantly in forward flexion (p = 0.023), external rotation (p = 0.018), internal rotation (p = 0.016), and abduction (p = 0.011). All patients showed improvement in VAS score (p = 0.005) and clinical scores (p < 0.001) compared with the preoperative state. Pseudoparalysis improved in all patients. The AHD was 3.88 mm (± 1.21 mm) preoperatively, 7.75 mm (± 1.52 mm, p = 0.014) at 6 months postoperatively, and 6.37 mm (± 1.72 mm, p = 0.031) at final follow-up. Graft removal and synovectomy were performed in 1 patient who developed postoperative infections. Radiological failure on follow-up MRI occurred in 2 patients at 6 and 12 months postoperatively, respectively. Conclusions SCR using an Achilles tendon allograft in irreparable massive RCTs achieved functional and clinical improvement. The use of Achilles tendon allograft also has the advantages of short operation time without donor site morbidity, sufficient thickness, and robustness; therefore, this allograft can be a useful graft for SCR.
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Affiliation(s)
- Kwang Won Lee
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
| | - Han Gyeol Choi
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Dae Suk Yang
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
| | - Young Tak Yu
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
| | - Woo Suk Kim
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
| | - Won Sik Choy
- Department of Orthopedic Surgery, Eulji University College of Medicine, Daejeon, Korea
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Kim D, Um J, Lee J, Kim J. Improved Clinical and Radiologic Outcomes Seen after Superior Capsule Reconstruction using Long Head Biceps Tendon Autograft. Arthroscopy 2021; 37:2756-2767. [PMID: 33892071 DOI: 10.1016/j.arthro.2021.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The objective of this study was to investigate the clinical and radiologic outcomes after superior capsule reconstruction (SCR) with biceps tendon (BT) for irreparable rotator cuff tears. METHODS The retrospective study period was May 2015 through February 2018. The average follow-up was 32 months (24-48 months) after surgery. Study inclusion criteria included an arthroscopic SCR performed using only our technique and minimum 2-year clinical follow-up by office visit and survey. Exclusion criteria included irreparable subscapularis tear and those patients lost to follow-up. This method enabled SCR by using the extraarticular portion and the intraarticular portion and making it 2 to 3 bundles by moving back and forth in the intraarticular area. Physical examination and functional scoring procedures were performed before surgery and at 3, 6, 12, and 24 months after surgery. Radiography and magnetic resonance imaging (MRI) were performed before surgery, after surgery (only radiography), and at 6 and 24 months after surgery. RESULTS Fifty-three shoulders involving 45 consecutive patients underwent BT technique for irreparable massive rotator cuff tears. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES), and constant score (CS) showed statistically significant improvement (VAS, 4.1-1.0; ASES, 60.9-82.7; and CS, 64.9-80.0; P < .0001). The shoulder active range of motion improved significantly by 23 for forward elevation (125.3-148.4; P < .0001) and by 12 for external rotation (38.0-50.9, P < .0001). The acromiohumeral distance (AHD) was significantly increased by 2.7 mm (4.4 ± 1.4 mm -> 7.1 ± 1.3 mm). No graft tear was detected in 39 patients (86.7%) during follow-up (24-48 months). CONCLUSIONS SCR via our technique improved clinical and radiologic outcomes. Thirty-five (77.7%) patients achieved 17-point improvement (the minimally clinically important difference) in the last follow-up of ASES score. Clinical scores and AHD had significantly increased, and good healed rate (86.7%) was observed in MRI. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Doosup Kim
- Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Wonju, Republic of Korea; Yonsei Institute of Sports Science and Exercise Medicine (YISSEM), Wonju, Republic of Korea
| | - Jaewoong Um
- Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Junhyeok Lee
- Department of biostatistics, College of Medicine, Yonsei University, Republic of Korea
| | - Jaehyeon Kim
- Yonsei Institute of Sports Science and Exercise Medicine (YISSEM), Wonju, Republic of Korea.
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Kholinne E, Kwak JM, Cho CH, AlSomali K, Van Nguyen T, Kim H, Koh KH, Jeon IH. Arthroscopic Superior Capsular Reconstruction for Older Patients With Irreparable Rotator Cuff Tears: A Comparative Study With Younger Patients. Am J Sports Med 2021; 49:2751-2759. [PMID: 34264134 DOI: 10.1177/03635465211024652] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic superior capsular reconstruction (ASCR) is a method for treating irreparable chronic rotator cuff tears. However, the extent to which ASCR can be performed with regard to the patient's age has yet to be determined. PURPOSE To compare the surgical outcomes of ASCR for the treatment of irreparable rotator cuff tears (IRCTs) in patients aged <65 years versus patients aged ≥65 years. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Of 105 patients with IRCTs who underwent ASCR between March 2013 and June 2020, 73 patients were enrolled in this study based on the selection criteria. Polypropylene mesh augmentation to the graft was used in 18 of 36 patients in the younger adults group (age, <65 years) and 20 of 37 patients in the older adults group (age, ≥65 years). The clinical and radiological outcomes were evaluated preoperatively and at the final clinical follow-up. The graft integrity status was evaluated using serial magnetic resonance imaging and set as the primary endpoint. Furthermore, subgroup analysis was performed based on age group and graft type. RESULTS The mean age of the patients was 59.2 ± 3.8 years in the younger adults group and 70.5 ± 4.1 years in the older adults group. Both groups showed improvement based on the clinical and radiological outcomes at the final follow-up. The mean American Shoulder and Elbow Surgeons scores improved from 52.3 ± 15.4 to 77.3 ± 13.5 in the younger adults group (P < .001) and from 45.7 ± 16.1 to 76.6 ± 11.4 in the older adults group (P < .001). The mean visual analog scale for pain scores improved from 5.5 ± 1.2 to 2.1 ± 0.9 in the younger adults group (P < .001) and from 5.5 ± 1.4 to 2.1 ± 1.2 in the older adults group (P < .001). The graft healing rate was significantly higher in the younger adults group (81%) than in the older adults group (65%) (P = .049). Subgroup analysis showed that after mesh augmentation, the healing rate in the younger adults group (84%) was similar to that in the older adults group (85%) (P = .299). CONCLUSION ASCR resulted in a favorable surgical outcome for both younger and older adult patients with IRCT. The younger patients had lower graft failure rates and superior surgical outcomes. In older patients, ASCR using polypropylene mesh augmentation may reduce graft failure and result in surgical outcomes similar to those in younger patients.
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Affiliation(s)
- Erica Kholinne
- Faculty of Medicine, Universitas Trisakti, Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia
| | - Jae-Man Kwak
- Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, College of Medicine, Eulji University, Uijeongbu, Republic of Korea
| | - Chang-Ho Cho
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Khalid AlSomali
- Department of Orthopedic Surgery, King Fahad Military Medical Complex, Dhahran, Saudi Arabia
| | - Thanh Van Nguyen
- Department of Orthopedic Surgery, University Medical Center, Ho Chi Minh City, Vietnam
| | - Hyojune Kim
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Kyoung-Hwan Koh
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
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Kholinne E, Jeon IH. Arthroscopic superior capsular reconstruction of the shoulder: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:268. [PMID: 33708895 PMCID: PMC7940888 DOI: 10.21037/atm-20-5925] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Irreparable rotator cuff tears (IRCTs) in young and considerably active patients are difficult to treat because it is mostly associated with poor outcome which may lead to a painful and dysfunctional shoulder. Most of the IRCTs are encountered in massive size rotator cuff tears which associated with high failure rate following surgical repair. Thus, the IRCTs was considered challenging for its poor healing rate following repair which may induce the arthritic changes. Since the advent of arthroscopic superior capsular reconstruction (ASCR) of the shoulder in 2013, it has gained its popularity. The procedure has become the most popular option for joint-preserving shoulder surgery for patients with IRCTs. It works by providing a static restraint to the superior humeral head migration to optimize the rotator cuff force couples, hence improving joint kinematics. The acceptance of superior capsular reconstruction has made it rapidly evolving in terms of a wider variety of procedures and broader surgical indications. Despite the enthusiasm and widely acceptance towards the procedure, there are still many queries that exist regarding the best indications, surgical technique particularly graft of choice, the long-term outcome, and the complication and risk of the superior capsular reconstruction (SCR). This narrative review provide the current evidence of SCR in an attempt to provide a state-of-the-art knowledge.
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Affiliation(s)
- Erica Kholinne
- Faculty of Medicine, Trisakti University, Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia.,Department of Orthopaedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
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Kholinne E, Kwak JM, Kim H, Koh KH, Jeon IH. Arthroscopic Superior Capsular Reconstruction With Mesh Augmentation for the Treatment of Irreparable Rotator Cuff Tears: A Comparative Study of Surgical Outcomes. Am J Sports Med 2020; 48:3328-3338. [PMID: 32970951 DOI: 10.1177/0363546520958708] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic superior capsular reconstruction (ASCR) is an alternative to open surgery for irreparable chronic rotator cuff tears (RCTs). This approach can provide static restraint while avoiding upward migration of the humeral head. However, graft tears and their effect on clinical outcomes after ASCR remain a debated topic. PURPOSE To evaluate the clinical outcomes of ASCR with mesh augmentation for the treatment of irreparable RCTs. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The data of 72 patients with irreparable RCTs who underwent ASCR between 2013 and 2018 were retrospectively evaluated. Among them, 64 patients who met the inclusion and exclusion criteria were enrolled in this study. Fascia lata grafts augmented with a polypropylene mesh were used for 30 patients (mesh group), and grafts without mesh augmentation were used for 34 patients (control group). Clinical outcomes were evaluated using range of motion, the American Shoulder and Elbow Surgeons (ASES) questionnaire, and visual analog scale for pain. Radiological outcomes were evaluated according to acromiohumeral distance and stage of rotator cuff arthropathy. The status of fatty infiltration and graft integrity was evaluated using magnetic resonance imaging. Outcomes were assessed preoperatively and at the final follow-up. RESULTS Both groups showed improvement in clinical and radiological outcomes at the final follow-up. The mesh group demonstrated a larger improvement in ASES score (mean ± SD, 29.1 ± 15.8) than the control group (18.1 ± 15.9) (P = .006). The mean improvement in active forward flexion was significantly higher in mesh group (40°± 26°) than in control group (28°± 23°) (P = .003). The mean improvement in active external rotation was also significantly higher in the mesh group (11°± 5°) than in the control group (6°± 3°) (P = .004). Graft healing rate was significantly higher in the mesh group (83.3%) than in the control group (58.8%) (P = .039), and acromiohumeral distance was significantly greater in the mesh group (9.1 ± 2.4 mm) than in the control group (6.3 ± 1.8 mm) at the final follow-up (P = .001). Subgroup analysis revealed that patients with graft failure generally showed progression of fatty infiltration without improvement in the stage of rotator cuff arthropathy. Patients with intact grafts demonstrated a more substantial improvement in functional outcomes (ASES score and forward flexion motion). CONCLUSION ASCR with mesh augmentation reduced graft failure rate to restore superior shoulder joint stability.
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Affiliation(s)
- Erica Kholinne
- Department of Orthopedic Surgery, St Carolus Hospital, Faculty of Medicine, Trisakti University, Jakarta, Indonesia.,Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Jae-Man Kwak
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Hyojune Kim
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Kyoung Hwan Koh
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
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Aramberri-Gutiérrez M, Tiso-D’Orazio G, Gómez-Garrido D, Antequera-Cano JM, Murillo-González JA, Mediavilla-Arza I. A Lasso-Loop Traction Technique for Arthroscopic Superior Capsular Reconstruction. Arthrosc Tech 2020; 9:e1423-e1428. [PMID: 33024686 PMCID: PMC7528755 DOI: 10.1016/j.eats.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/05/2020] [Indexed: 02/03/2023] Open
Abstract
Irreparable rotator cuff tears (RCTs) cause shoulder pain and disfunction. Management of RCT patients has classically been difficult due to few treatment options. Since Mihata et al. in 2013 introduced the superior capsular reconstruction (SCR) technique as a treatment option, it has become widespread among surgeons, especially for young active patients in whom reverse shoulder arthroplasty is not recommended. With SCR, a reduced humeral head can be maintained and superior displacement is avoided, improving shoulder pain and restoring active shoulder motion. A variety of grafts may be used, but the surgery can be technically complicated. An arthroscopic lasso-loop traction technique for SCR is described here, which simplifies graft shoulder reduction by traction from the anteromedial and posteromedial portals.
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Affiliation(s)
- Mikel Aramberri-Gutiérrez
- Alai Sports Medicine Clinic, Madrid, Spain,Address correspondence to Mikel Aramberri Gutiérrez, M.D., Ph.D., Alai Sports Medicine Clinic, C/Arturo Soria, 342, Madrid, Spain 28033.
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