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Bi AS, Anil U, Colasanti CA, Kwon YW, Virk MS, Zuckerman JD, Rokito AS. Comparison of Multiple Surgical Treatments for Massive Irreparable Rotator Cuff Tears in Patients Younger Than 70 Years of Age: A Systematic Review and Network Meta-analysis. Am J Sports Med 2024:3635465231204623. [PMID: 38291995 DOI: 10.1177/03635465231204623] [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] [Indexed: 02/01/2024]
Abstract
BACKGROUND Massive irreparable rotator cuff tears (MIRCTs) remain a challenging treatment paradigm, particularly for nonelderly patients without pseudoparalysis or arthritis. PURPOSE To use a network meta-analysis to analyze comparative studies of surgical treatment options for MIRCTs in patients <70 years of age for several patient-reported outcomes, range of motion (ROM), and acromiohumeral distance (AHD). STUDY DESIGN Network meta-analysis of comparative studies; Level of evidence, 3. METHODS A systematic review of the literature, using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, of the MEDLINE, Embase, and Cochrane Library databases was conducted from 2017 to 2022. Inclusion criteria were (1) clinical comparative studies of MIRCTs (with several study-specific criteria); (2) ≥1 outcome of interest reported on, with standard deviations; (3) minimum 1-year follow-up; and (4) mean age of <70 years for both cohorts, without arthritis or pseudoparalysis. There were 8 treatment arms compared. Outcomes of interest were the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, visual analog scale for pain, AHD, and forward flexion and external rotation ROM. A frequentist approach to network meta-analysis with a random-effects model was performed using the netmeta package Version 0.9-6 in R. RESULTS A total of 23 studies met the inclusion criteria, with 1178 patients included in the network meta-analysis. There was a mean weighted age of 62.8 years, 568 (48.2%) men, with a mean follow-up of 28.9 months. There were no significant differences between groups in regard to sex (P = .732) or age (P = .469). For the ASES score, InSpace balloon arthroplasty (mean difference [MD], 12.34; 95% CI, 2.18 to 22.50; P = .017), arthroscopic bridging graft (aBG) (MD, 7.07; 95% CI, 0.28 to 13.85; P = .041), and long head of biceps augmented superior capsular reconstruction (BSCR) (MD, 5.16; 95% CI, 1.10 to 9.22; P = .013) resulted in the highest P-scores. For the Constant-Murley score, debridement (MD, 21.03; 95% CI, 8.98 to 33.08; P < .001) and aBG (MD, 6.97; 95% CI, 1.88 to 12.05; P = .007) resulted in the highest P-scores. For AHD, BSCR resulted in the highest P-score (MD, 1.46; 95% CI, 0.45 to 2.48; P = .005). For forward flexion ROM, debridement (MD, 45.77; 95% CI, 25.41 to 66.13; P < .001) resulted in the highest P-score, while RSA resulted in the lowest P-score (MD, -16.70; 95% CI, -31.20 to -2.20; P = .024). CONCLUSION For patients <70 years with MIRCT without significant arthritis or pseudoparalysis, it appears that graft interposition repair techniques, superior capsular reconstruction using the long head of the biceps tendon, arthroscopic debridement, and balloon arthroplasty provide superiority in various outcome domains, while RSA provides the least benefit in forward flexion.
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Affiliation(s)
- Andrew S Bi
- Department of Orthopedic Surgery, Division of Shoulder and Elbow Surgery, NYU Langone Health, New York, New York, USA
| | - Utkarsh Anil
- Department of Orthopedic Surgery, Division of Shoulder and Elbow Surgery, NYU Langone Health, New York, New York, USA
| | - Christopher A Colasanti
- Department of Orthopedic Surgery, Division of Shoulder and Elbow Surgery, NYU Langone Health, New York, New York, USA
| | - Young W Kwon
- Department of Orthopedic Surgery, Division of Shoulder and Elbow Surgery, NYU Langone Health, New York, New York, USA
| | - Mandeep S Virk
- Department of Orthopedic Surgery, Division of Shoulder and Elbow Surgery, NYU Langone Health, New York, New York, USA
| | - Joseph D Zuckerman
- Department of Orthopedic Surgery, Division of Shoulder and Elbow Surgery, NYU Langone Health, New York, New York, USA
| | - Andrew S Rokito
- Department of Orthopedic Surgery, Division of Shoulder and Elbow Surgery, NYU Langone Health, New York, New York, USA
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Morsy MG, Gawish HM. Double Attack Repair for Massive Rotator Cuff Tears: Superior Capsular Reconstruction Using the Long Head of Biceps Tendon Plus Margin Convergence Repair. Arthrosc Tech 2023; 12:e2187-e2195. [PMID: 38196864 PMCID: PMC10772973 DOI: 10.1016/j.eats.2023.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/28/2023] [Indexed: 01/11/2024] Open
Abstract
Arthroscopic repair of massive retracted rotator cuff tears is very challenging with a high incidence of retears. Many techniques have been described to improve the outcomes of arthroscopic repair. In this technique, a superior capsular reconstruction using the long head of the biceps is combined with margin convergence repair aimed at improving the mechanical strength of the repair. The long head of the biceps is used as a superior capsular reconstruction to stabilize the humeral head and prevent proximal migration. Moreover, margin convergence provides an efficient gap filling between remnants of the supraspinatus and infraspinatus tendons to restore an efficient rotator repair in anatomical, biological, and tension-free fashion.
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Affiliation(s)
- Mohamed Gamal Morsy
- Department of Orthopedic Surgery and Traumatology, Arthroscopy and Sports Injury Unit, Alexandria University, Alexandria, Egypt
| | - Hesham Mohamed Gawish
- Department of Orthopedic Surgery and Traumatology, Kafr el-sheik University, Kafr Elsheikh, Egypt
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Lee JB, Kholinne E, Ben H, So SP, Alsaqri H, Lee HJ, Koh KH, Jeon IH. Clinical and Radiological Outcomes of Arthroscopic Superior Capsular Reconstruction Versus Primary Rotator Cuff Repair in Massive Rotator Cuff Tears: A Propensity Score-Matched Study. Am J Sports Med 2023; 51:1971-1978. [PMID: 37260275 DOI: 10.1177/03635465231171928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Arthroscopic superior capsular reconstruction (aSCR) has emerged as a treatment option for managing massive rotator cuff tears (MRCTs) given the unpredictable results after an arthroscopic rotator cuff repair (aRCR). Yet, few comparative studies of aSCR and aRCR have been conducted. PURPOSE To compare the clinical and radiological outcomes between aRCR and aSCR in patients with MRCT. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 163 cases of MRCT from 2010 to 2020 with follow-up ≥2 years were retrospectively reviewed. Among them, 102 had aRCR and 61 had aSCR using fascia lata autograft. Propensity score matching was used to select controls matched for age, sex, diabetes mellitus, osteoporosis, preoperative American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation score, Constant score, pain visual analog scale (pVAS) score, range of motion (ROM), tear size, global fatty degeneration index, and acromiohumeral distance (AHD). Last, 33 cases in each group were selected after propensity score matching. Radiological assessment was conducted using serial postoperative magnetic resonance imaging. Pre- and postoperative findings-including American Shoulder and Elbow Surgeons, pVAS, Single Assessment Numeric Evaluation, and Constant scores and ROM-were assessed to compare clinical outcomes. For radiological outcomes, global fatty degeneration index, AHD, and healing rate were evaluated. Healing failure was defined as Sugaya classification IV or V in the aRCR group, as compared with a full-thickness tear of the graft in the aSCR group, which corresponded to Sugaya classification IV or V. RESULTS Postoperative clinical outcomes were significantly improved at the final follow-up in both groups. In the aSCR group, postoperative forward flexion, pVAS, and AHD were significantly improved as compared with the aRCR group (mean, 161° vs 148° [P = .02]; 1.03 vs 1.64 [P = .047]; 7.00 vs 5.23 mm [P < .001], respectively). The healing rate was 20 of 33 (60.6%) for aRCR and 29 of 33 (87.9%) for aSCR (P = .022). CONCLUSION aSCR and aRCR are effective and reliable treatment options for MRCT. However, when compared with aRCR, aSCR showed improved clinical outcomes, including pVAS score, postoperative ROM, and favorable radiological findings, including AHD and a higher healing rate.
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Affiliation(s)
- Jun-Bum Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Erica Kholinne
- Department of Orthopedic Surgery, St Carolus Hospital, Faculty of Medicine, Trisakti University, Jakarta, Indonesia
| | - Hui Ben
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Pil So
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hood Alsaqri
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Orthopaedic Surgery, Rustaq Hospital, Rustaq, Sultanate of Oman
| | - Hyun June Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Hanson JA, Lee S, Horan MP, Rakowski DR, Millett PJ. Superior Capsular Reconstruction Versus Latissimus Dorsi Tendon Transfer for Irreparable Rotator Cuff Tears: Minimum 5-year Outcomes. Orthop J Sports Med 2023; 11:23259671231166703. [PMID: 37213659 PMCID: PMC10196541 DOI: 10.1177/23259671231166703] [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: 01/24/2023] [Accepted: 02/06/2023] [Indexed: 05/23/2023] Open
Abstract
Background Arthroscopic superior capsular reconstruction (SCR) has been introduced as a successful alternative to latissimus dorsi tendon transfer (LDTT) for irreparable posterosuperior rotator cuff tears. Purpose To compare minimum 5-year clinical outcomes of SCR and LDTT for the treatment of irreparable posterosuperior rotator cuff tears in patients with minimal evidence of arthritis and intact or reparable subscapularis tears. Study Design Cohort study; Level of evidence, 3. Methods Patients who underwent SCR or LDTT and had undergone surgery ≥5 years earlier were included. The SCR technique used a dermal allograft customized to the defect. Surgical, demographic, and subjective data were collected prospectively and reviewed retrospectively. Patient-reported outcome (PRO) scores utilized were the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), the short version of the Disabilities of the Arm, Shoulder and Hand score (QuickDASH), 12-Item Short Form Health Survey Physical Component Summary (SF-12 PCS), and patient satisfaction. Further surgical procedures were documented, and treatment that progressed to reverse total shoulder arthroplasty (RTSA) or revision rotator cuff surgery was considered a failure. Kaplan-Meier survivorship analysis was performed. Results Thirty patients (n = 20 men; n = 10 women) with a mean follow-up of 6.3 years (range, 5-10.5 years) were included. A total of 13 patients underwent SCR and 17 patients underwent LDTT. The mean age of the SCR group was 56 years (range, 41.2-63.9 years), and the mean age of the LDTT group was 49 years (range, 34.7-57 years) (P = .006). One patient in the SCR group and 2 patients in the LDTT group progressed to RTSA. Two additional (11.8%) patients in the LDTT group had further surgery-1 had arthroscopic cuff repair and 1 had hardware removal with biopsies. The SCR group demonstrated significantly better ASES (94.1 ± 6.3 vs 72.3 ± 16.4; P = .001), SANE (85.6 ± 8 vs 48.7 ± 19.4; P = .001), QuickDASH (8.8 ± 8.7 vs 24.3 ± 16.5; P = .012), and SF-12 PCS (56.1 ± 2.3 vs 46.5 ± 6; P = .001) PROs at the final follow-up. There was no significant difference between groups in median satisfaction (SCR, 9; LDTT, 8 [P = .379]). At 5 years, survivorship rates were 91.7% and 81.3% for the SCR and LDTT groups, respectively (P = .421). Conclusion At the final follow-up, SCR yielded superior PROs compared with LDTT for the treatment of massive, irreparable posterosuperior rotator cuff tears despite similar patient satisfaction and survivorship between procedures.
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Affiliation(s)
| | - Simon Lee
- Steadman Philippon Research Institute,
Vail, Colorado, USA
- Northwestern Medicine, Chicago,
Illinois, USA
| | | | | | - Peter J. Millett
- Steadman Philippon Research Institute,
Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado,
USA
- Peter J. Millett, MD, MSc,
Steadman Philippon Research Institute and The Steadman Clinic, 181 West Meadow
Drive, Suite 400, Vail, CO 81657, USA (
) (Twitter: @millettmd)
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Hankins AC, Griffin JW, Taliaferro JP, Werner BC, Bonner KF. The Number of Surgeons Using Superior Capsular Reconstruction for Rotator Cuff Repair Is Declining. Arthrosc Sports Med Rehabil 2022; 4:e2089-e2098. [PMID: 36579047 PMCID: PMC9791834 DOI: 10.1016/j.asmr.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 10/10/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate surgeon preferences for graft use, including biologic augmentation and superior capsular reconstruction (SCR) associated with surgical treatment of rotator cuff repair (RCR). Methods A 26-question survey was completed by arthroscopic shoulder surgeons. Surgeon demographics were evaluated. Surgeons were queried about shoulder arthroscopic graft use and rationale then responses were analyzed based on demographics. Results In total, 260 surgeons completed the survey. Fifty-one percent of surgeons reported a decrease in the volume of SCR use in the past 5 years. Less than 3% of surgeons used SCR in >90% of irreparable RCR cases, compared with 38% using SCR in <10% of irreparable cases (P < .05). Surgeons performing >100 RCR annually (42%; P < .05) and those employed in the hospital setting (44%; P < .05) reported an overall increase in the use of SCR. More international surgeons (67%) decreased their use of SCR compared with U.S. surgeons (44%; P < .05). In contrast, bioinductive graft use is generally on the rise, with 48% of surgeons reporting increased use since first use, although used in <10% of cases by 54% of surgeons. Sixty-eight percent of surgeons performing >100 RCRs annually used bioinductive grafts (P < .05). Fewer international surgeons (30%) performed biologic augmentation (P < .05). Suboptimal published outcomes (40%) and no perceived patient benefit (40%) were most cited for decreased SCR use. Surgeons reporting increased use cited improved personal patient outcomes (72%). Conclusions Arthroscopic surgeons report decrease in volume of SCR use in the past 5 years. Surgeon's personal experience of patient outcome and suboptimal published results were the strongest factors impacting decision-making. In contrast, bioinductive graft use is increasing. However, most surgeons use these grafts in a relatively small percentage of cases. Clinical Relevance Evaluation of scientific data, personal experience, and influences on surgical practice will give a comprehensive understanding of current RCR practices.
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Affiliation(s)
| | - Justin W. Griffin
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A.,Jordan-Young Institute, Virginia Beach, Virginia, U.S.A
| | | | - Brian C. Werner
- Department of Orthopedic Surgery, University of Virginia, Charlottesville, Virginia, U.S.A
| | - Kevin F. Bonner
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A.,Jordan-Young Institute, Virginia Beach, Virginia, U.S.A.,Address correspondence to Kevin F. Bonner, M.D., 5716 Cleveland St., Suite 200, Virginia Beach, VA 23462.
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Lädermann A, Rashid M. Superior Capsular Reconstruction-Technical Marvel or Fading Fashion? Arthroscopy 2022; 38:2954-2956. [PMID: 36344054 DOI: 10.1016/j.arthro.2022.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Faculty of Medicine, University of Geneva, Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Mustafa Rashid
- Wrightington Hospital, Wigan, Lancashire, United Kingdom
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Wang L, Kang Y, Wei Y, Wang M, Gao H, Shi D, Yu S, Xie G, Jiang J, Zhao J. Rotator cuff tear reaching the superior half portion of the humeral head causes shoulder abduction malfunction. Knee Surg Sports Traumatol Arthrosc 2022; 31:1865-1872. [PMID: 35895089 DOI: 10.1007/s00167-022-07044-w] [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: 01/20/2022] [Accepted: 06/09/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the biomechanical properties governing posterosuperior rotator cuff (RC) tear progression and dynamic shoulder abduction function, in the absence of excess loading. METHODS Twelve freshly frozen cadaveric shoulders were evaluated via an established dynamic shoulder abduction stimulator. The shoulder abduction functions were primarily evaluated using subacromial contact pressure (SACP) during an abduction procedure, and subsequent middle deltoid force (MDF) under 5 conditions: (1) intact, (2) anterior 1/3 posterosuperior rotator cuff (PSRC) tear, (3) anterior 2/3 PSRC tear, (4) entire PSRC tear, and (5) global RC tear (tear involving the entire superior RC). RESULTS No obvious differences were observed in the peak MDF required for abduction, and in the peak SACP among the four PSRC tear statuses (49.8 ± 9.2 N, 0.39 ± 0.05 mPa [1/3 PSRC tear]; 49.3 ± 6.8 N, 0.40 ± 0.06 mPa [2/3 PSRC tear]; 51.6 ± 7.0 N, 0.44 ± 0.08 mPa [entire PSRC tear]), as well as intact statuses (48.3 ± 9.8 N, 0.40 ± 0.05 mPa). However, significant elevations in the peak MDF and peak SACP levels were observed among the four PSRC tear statuses and global RC tear (68.1 ± 9.3 N; 4.12 ± 1.50 mPa, P < 0.01). CONCLUSION In the absence of excess loading, the biomechanical function of the shoulder was not impaired by a simple PSRC tear. However, once the tear size reached the half superior portion of the humeral head, the humeral head migrated to the surface of the subacromion, and this action markedly decreased shoulder abduction function.
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Affiliation(s)
- Liren Wang
- Department of Sports Medicine, Department of Orthopedics, Shanghai Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, China.,Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, No. 227 South Chongqing Road, Shanghai, China
| | - Yuhao Kang
- Department of Sports Medicine, Department of Orthopedics, Shanghai Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, China.,Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, No. 227 South Chongqing Road, Shanghai, China
| | - Yiyao Wei
- Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, No. 227 South Chongqing Road, Shanghai, China.,School of Basic Medical Science, Fudan University, No. 130 Dongan Road, Shanghai, China
| | - Mingqi Wang
- Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, No. 227 South Chongqing Road, Shanghai, China.,School of Basic Medical Science, Fudan University, No. 130 Dongan Road, Shanghai, China
| | - Haihan Gao
- Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, No. 227 South Chongqing Road, Shanghai, China.,Shanghai Jiao Tong University School of Medicine, No. 227 South Chongqing Road, Shanghai, China
| | - Dingyi Shi
- Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, No. 227 South Chongqing Road, Shanghai, China.,Shanghai Jiao Tong University School of Medicine, No. 227 South Chongqing Road, Shanghai, China
| | - Suiran Yu
- School of Mechanical Engineering, Shanghai Jiao Tong University, No. 800 Dongchuan Road, Shanghai, China
| | - Guoming Xie
- Department of Sports Medicine, Department of Orthopedics, Shanghai Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, China
| | - Jia Jiang
- Department of Sports Medicine, Department of Orthopedics, Shanghai Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, China. .,Regenerative Sports Medicine Lab of the Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People' Hospital, No. 600 Yishan Road, Shanghai, 200233, China. .,Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, No. 227 South Chongqing Road, Shanghai, China.
| | - Jinzhong Zhao
- Department of Sports Medicine, Department of Orthopedics, Shanghai Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai, China. .,Regenerative Sports Medicine Lab of the Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People' Hospital, No. 600 Yishan Road, Shanghai, 200233, China. .,Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, No. 227 South Chongqing Road, Shanghai, China.
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Foster MJ, Hanson JA, Millett PJ. Editorial Commentary: Shoulder Superior Capsular Reconstruction Graft Tensioning Between 30° and 40° of Glenohumeral Abduction Is Recommended: The Balance Beam of Superior Capsular Reconstruction. Arthroscopy 2022; 38:1408-1410. [PMID: 35501009 DOI: 10.1016/j.arthro.2021.12.022] [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: 12/11/2021] [Accepted: 12/14/2021] [Indexed: 02/02/2023]
Abstract
Massive irreparable rotator cuff tears in young, active patients pose a challenging treatment dilemma. Since the relatively recent development of the superior capsular reconstruction (SCR) procedure, the technique has been increasingly used to stave off reverse total shoulder arthroplasty in this demographic. As a result of continued output of supportive literature, both biomechanically and clinically, SCR has been adopted by surgeons despite some technical aspects of the procedure not being fully elucidated. One notable topic of study is the ideal glenohumeral position in which to determine graft length and therefore graft tension. Tensioning inevitably affects glenohumeral joint kinematics, including superior humeral head translation, subacromial contact pressure, and graft healing potential. Although it is currently known that some degree of glenohumeral abduction is necessary for appropriate graft tensioning, and there are some biomechanical studies from our group and other groups that have looked at this, there is not a clinically supported position in which to measure graft length and therefore set graft tension. Well-designed biomechanical studies will serve as the foundation for what is performed clinically. On the basis of the best available evidence, tensioning the graft between 30° and 40° of glenohumeral abduction is recommended and has yielded encouraging clinical outcomes for SCR in our patients.
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