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Fernández-Matías R, García-Pérez F, Requejo-Salinas N, Gavín-González C, Martínez-Martín J, García-Valencia H, Flórez-García MT. Content reporting and effectiveness of therapeutic exercise in the management of massive rotator cuff tears: A systematic review with 490 patients. Shoulder Elbow 2023; 15:92-107. [PMID: 37974611 PMCID: PMC10649485 DOI: 10.1177/17585732221140113] [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: 05/31/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/19/2023]
Abstract
Background Massive rotator cuff tears (MRCT) account for a substantial fraction of tears above the age of 60 years. However, there are no clear criteria for prescription parameters within therapeutic exercise treatments. The aim of this study was to evaluate the effects and characteristics of therapeutic exercise treatments in patients with MRCT. Methods A systematic search was conducted in MEDLINE/PubMed, Web of Science, SPORTDiscus, SciELO, Scopus and EMBASE from inception to August 2022. Studies were included if they evaluated the effects of exercise on patients with MRCT. The risk of bias was evaluated and the Consensus on Exercise Reporting Template (CERT) was also used. A narrative synthesis without meta-analysis was performed. Results One randomized controlled trial, two non-randomized studies, six non-controlled studies, one case series and four retrospective studies were included. They ranged from serious to moderate risk of bias. The CERT reflected a poor description of the exercise programmes. Studies showed a pattern of improvements in most patient-reported outcome measures (PROM) surpassing the MCID, and active elevation range of motion. Conclusions There is limited evidence that exercise and co-interventions are effective in the management of some patients with MRCT, based on a systematic review without meta-analysis. Future research should improve content reporting. Level of evidence IV.
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Affiliation(s)
- Rubén Fernández-Matías
- Research Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain
- Physiotherapy and Rehabilitation Unit, Hospital Universitario Fundación Alcorcon, Madrid, Spain
| | - Fernando García-Pérez
- Physiotherapy and Rehabilitation Unit, Hospital Universitario Fundación Alcorcon, Madrid, Spain
| | - Néstor Requejo-Salinas
- Department of Physical Therapy, Superior Center for University Studies La Salle, Autonomous University of Madrid, Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Movement Sciences (INCIMOV). Superior Center for University Studies La Salle. Autonomous University of Madrid, Madrid, Spain
| | - Carlos Gavín-González
- Orthopedic Surgery and Traumatology Unit, Hospital Universitario Fundación Alcorcon, Madrid, Spain
| | - Javier Martínez-Martín
- Orthopedic Surgery and Traumatology Unit, Hospital Universitario Fundación Alcorcon, Madrid, Spain
| | - Homero García-Valencia
- Orthopedic Surgery and Traumatology Unit, Hospital Universitario Fundación Alcorcon, Madrid, Spain
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Martinho T, Zbinden J, Ono Y, Amiri A, Collin P, Lädermann A. Long Head of the Biceps Pediculated Autograft Augmentation of Arthroscopic Subscapularis Repair. Arthrosc Tech 2023; 12:e1391-e1398. [PMID: 37654870 PMCID: PMC10466290 DOI: 10.1016/j.eats.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/12/2023] [Indexed: 09/02/2023] Open
Abstract
Subscapularis (SSc) repairs are not free of failure and continues to pose a challenging problem. Although various biological and structural augmentation methods are available for the posterosuperior rotator cuff, few options have been explored for the anterior one. In the Technical Note, we describe an all-arthroscopic technique in which we use the long head of the biceps tendon (LHBT) as a pediculated autograft to reinforce an SSc repair. After SSc repair and LHBT tenodesis, the intra-articular portion of the LHBT is placed on the upper part of the SSc tendon at the rotator interval. Repurposing the otherwise-discarded tendon brings several biological and mechanical advantages at a lower cost without donor-site morbidity.
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Affiliation(s)
- Tiago Martinho
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jeanni Zbinden
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
| | - Yohei Ono
- Hokkaido Shoulder Clinic, Hokkaido, Japan
| | - Arash Amiri
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
| | | | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
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Elbayar J, Ott NA, Jordan SE. Rotator Cable Reconstruction: A Technique to Restore the Rotator Cable in the Setting of Large Cuff Tears. Arthrosc Tech 2023; 12:e653-e656. [PMID: 37323773 PMCID: PMC10265473 DOI: 10.1016/j.eats.2022.12.023] [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: 09/20/2022] [Accepted: 12/31/2022] [Indexed: 06/17/2023] Open
Abstract
The rotator cable is an essential biomechanical structure in the shoulder that is commonly injured in the setting of large rotator cuff tears. Surgical techniques designed to reconstruct the cable have followed advancements in our understanding of the biomechanics and anatomic importance of this structure. Owing to its role in load sharing and stress shielding of the rotator cuff crescent, rotator cable reconstruction offers the potential to reduce retear rates and promote longevity of rotator cuff repairs. The purpose of this article is to describe a technique to augment rotator cuff repair with cable reconstruction.
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Affiliation(s)
| | - Nicholas A. Ott
- Andrews Research and Education Foundation, Gulf Breeze, Florida, U.S.A
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Cheppalli NS, Purudappa PP, Metikala S, Goel A, Singla A, Sambandam S. Using Biceps Tendon Autograft as a Patch in the Treatment of Massive Irreparable Rotator Cuff Tears Improves Patient-reported Outcome Scores: A Systematic Review. Arthrosc Sports Med Rehabil 2023; 5:e529-e536. [PMID: 37101869 PMCID: PMC10123426 DOI: 10.1016/j.asmr.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/27/2023] [Indexed: 03/06/2023] Open
Abstract
Purpose To review the clinical studies describing the use of ipsilateral biceps tendon autograft for bridging irreparable massive rotator cuff tears (MRCTs). Methods A systematic review was conducted of MEDLINE, Embase, Cochrane, CINAHL, and Scopus databases using search terms "massive rotator cuff tear," "irreparable rotator cuff tear," and "long head of the biceps tendon." Only clinical human studies in which the biceps tendon was used as a bridging graft in MRCTs were included. All review studies, technique papers, and studies describing the use of biceps tendon as superior capsular reconstruction equivalent or rotator cable were excluded. Results A total of 45 studies were initially identified, of which only 6 studies met the inclusion criterion. All studies were retrospective in nature, with a total of 176 patients. All studies reported a clinically significant improvement in postoperative functional outcomes, although this was not compared to a control group in all the studies. Pain was assessed using the visual analog scale (VAS) in 4 studies, and all reported an improvement in postoperative VAS ranging from 5 to 6 points. One study reported an improvement in pain scale from Japanese Orthopedic Association from 13.1 to 22.5 (9 points). One study did not report a VAS score as this study was published before the VAS score was developed. All the reported studies saw improvements in range of motion. Conclusions The use of the long head of the biceps tendon as an interposition/bridging patch to augment the MRCT repair can reduce the VAS score, improve elevation and external rotation, and improve clinical and functional outcomes. Level of Evidence IV, systematic review of Level III and IV studies.
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Affiliation(s)
- Naga Suresh Cheppalli
- Department of Orthopedic and Rehabilitation University of New Mexico, Raymond Murphy Medical Centre, Albuquerque, New Mexico
| | | | | | - Akshay Goel
- Department of Orthopaedics, Marshall University, Joan C. Edwards School of Medicine, Huntington, West Virginia
- Address correspondence to Akshay Goel, M.D., Department of Orthopaedics, Marshall University, Joan C. Edwards School of Medicine, 1600 Medical Center Dr., Huntington, WV 25701
| | - Amit Singla
- St. Barnabas Hospital, Albert Einstein College of Medicine, Bronx, New York
| | - Senthil Sambandam
- University of Texas Southwestern and Dallas VAMC, Dallas, Texas, U.S.A
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Endell D, Rüttershoff K, Scheibel M. Biceps Smash Technique: Biceps Tendon Autograft Augmentation for Arthroscopic Rotator Cuff Reconstruction. Arthrosc Tech 2023; 12:e383-e386. [PMID: 37013015 PMCID: PMC10066417 DOI: 10.1016/j.eats.2022.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/06/2022] [Indexed: 04/05/2023] Open
Abstract
The proportion of postoperative retears after arthroscopic rotator cuff reconstruction remains constant despite advancement of suture techniques and improved anchor implants. The commonly degenerative nature of rotator cuff tears can carry the risk of compromised tissue. Several techniques have been developed to biologically enhance rotator cuff repair, and a considerable number of autologous, allogeneic, and xenogenous augmentation methods have been described. This article introduces the biceps smash technique, an arthroscopic augmentation procedure for posterosuperior rotator cuff reconstruction using an autograft patch of the long head of the biceps tendon.
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Affiliation(s)
- David Endell
- Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
- Address correspondence to David Endell, M.D., Shoulder and Elbow Surgery, Schulthess Clinic, Lengghalde 2, 8008 Zurich, Switzerland
| | - Katja Rüttershoff
- Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Markus Scheibel
- Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
- Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany
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Lubowitz JH, Brand JC, Rossi MJ. Early Treatment of Shoulder Pathology Is Necessary but Not Enough Is Being Performed. Arthroscopy 2022; 38:2943-2953. [PMID: 36344053 DOI: 10.1016/j.arthro.2022.08.031] [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: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 11/06/2022]
Abstract
Delayed treatment of shoulder instability results in bone loss requiring more-complicated surgery, in turn resulting in less-optimal outcomes. Similarly, delayed treatment of repairable rotator cuff tears results in irreparable tears requiring more-complicated surgery and resulting in less-optimal outcomes. Delayed treatment of shoulder pathology is a problem. Solutions include education and research investigation.
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Tokish JM, Shaha JS, Denard PJ, Mercuri JJ, Colbath G. Compressed Biceps Autograft Augmentation of Arthroscopic Rotator Cuff Repair. Arthrosc Tech 2022; 11:e2113-e2118. [PMID: 36457381 PMCID: PMC9706130 DOI: 10.1016/j.eats.2022.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/06/2022] [Accepted: 08/05/2022] [Indexed: 11/07/2022] Open
Abstract
Rotator cuff repair failure rates continue to be a challenging problem. Various methods of biological and structural augmentation of the rotator cuff have been explored to improve tendon healing after repair. We describe a technique in which biceps tendon autograft is harvested after tenodesis. The biceps tendon is then compressed into a patch that is placed over the repaired rotator cuff tendon. Repurposing the portion of the tendon that is otherwise discarded offers several advantages over other augmentations that have been used, including the biological potential of live autograft tenocytes in the patch, lower cost, and no donor-site morbidity.
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Affiliation(s)
- John M. Tokish
- Mayo Clinic Arizona, Phoenix, Arizona, USA,Address correspondence to John M. Tokish, M.D., Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ 85054, USA
| | | | | | - Jeremy J. Mercuri
- Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Department of Bioengineering, Clemson University, Clemson, South Carolina, USA
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Editorial Commentary: If the Massive Rotator Cuff Tear is Irreparable, Just Fix the Rotator Cable. Arthroscopy 2021; 37:1411-1413. [PMID: 33896496 DOI: 10.1016/j.arthro.2021.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/13/2021] [Indexed: 02/02/2023]
Abstract
Large and massive rotator cuff tears are not always reparable and present a difficult clinical problem. If surgery is warranted surgical options range from arthroscopic debridement, partial repairs, degradable spacers, tendon transfers, and more superior capsular reconstruction. The rotator cable is formed by the deep layer of the coracohumeral ligament and the crescent structure running from the anterior insertion site of the supraspinatus to the inferior border of the infraspinatus. The role of the rotator cable is not clear but seems to play a role in reducing tendon stress and influence glenohumeral kinematics. In this laboratory-based cadaver study the anterior cable was reconstructed with semitendinosus allograft treating large "irreparable" rotator cuff defects. Reconstruction resulted in reduced superior migration and subacromial contact forces without inhibiting range of motion.
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Baldwin M, Nagra NS, Greenall G, Carr AJ, Beard D, Rees JL, Rangan A, Merritt N, Dritsaki M, Hopewell S, Cook JA. Use of implantable meshes for augmented rotator cuff repair: a systematic review and meta-analysis. BMJ Open 2020; 10:e039552. [PMID: 33293307 PMCID: PMC7722806 DOI: 10.1136/bmjopen-2020-039552] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/03/2020] [Accepted: 10/14/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To appraise studies reporting on clinical effectiveness and safety of surgical meshes used to augment rotator cuff repairs (RCRs). DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase and Cochrane databases were searched between April 2006 and April 2020. ELIGIBILITY CRITERIA All studies evaluating adults (≥18 years) undergoing RCR were considered. There were no language restrictions. DATA EXTRACTION AND SYNTHESIS Screening, data extraction and quality appraisal were conducted by two independent reviewers. Meta-analysis was conducted using a random-effects models if ≥2 comparative studies reported the same outcome measure. Risk of bias assessment was undertaken for randomised (RoB2, Cochrane) and comparative studies (ROBINS-I, Cochrane). RESULTS We included 60 studies, consisting of 7 randomised controlled trials, 13 observational comparative studies and 40 observational case series. All comparative studies reported on shoulder-specific functional outcome scores, 18 on the radiographic occurrence of re-tear and 14 on pain score metrics. All studies contained some risk of bias.Compared with non-augmented repair, a small improvement in shoulder-specific function or pain scores was observed for synthetic patches with a mean improvement of 6.7 points on the University of California Los Angles (UCLA) shoulder score (95% CI 0.1 to 13.4) and 0.46 point reduction on the Visual Analogue Scale (95% CI -0.74 to -0.17), respectively. A reduced likelihood of radiologically observed re-tear was observed for synthetic (risk ratio (RR) 0.41, 95% CI 0.27 to 0.61) and allograft (RR 0.34, 95% CI 0.18 to 0.65) patches. A total of 49 studies reported on the occurrence of complications. Slightly higher crude complication rates were observed following patch-augmented repair (2.1%) than standard repair (1.6%). CONCLUSIONS While several studies suggest a decreased failure rate and small improvements in shoulder function and pain following augmented RCR, a paucity of rigorous clinical evaluation, for both effectiveness and safety, prevents firm recommendations. PROSPERO REGISTRATION NUMBER CRD42017057908.
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Affiliation(s)
- Mathew Baldwin
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, Oxfordshire, UK
| | - N S Nagra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, Oxfordshire, UK
| | - Gemma Greenall
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, Oxfordshire, UK
| | - Andrew J Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, Oxfordshire, UK
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, Oxfordshire, UK
| | - J L Rees
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, Oxfordshire, UK
| | - Amar Rangan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, Oxfordshire, UK
- Department of Orthopaedics, James Cook University Hospital, Middlesbrough, Middlesbrough, UK
| | - Naomi Merritt
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, Oxfordshire, UK
| | - Melina Dritsaki
- Centre for Statistics in Medicine, Oxford University, Oxford, Oxfordshire, UK
| | - Sally Hopewell
- Centre for Statistics in Medicine, Oxford University, Oxford, Oxfordshire, UK
| | - Jonathan Alistair Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, Oxfordshire, UK
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