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Ikemoto RY, La Banca V, Costa TMT, Vigano AVP, Murachovsky J, Almeida LHO. Double tendon transfer for massive rotator cuff tear: A case report. Int J Surg Case Rep 2024; 120:109710. [PMID: 38810298 PMCID: PMC11153937 DOI: 10.1016/j.ijscr.2024.109710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Repairing massive rotator cuff tears (MRCTs) can often be technically challenging due to tendon retraction, bursal fibrosis, and muscular fatty infiltration that usually occurs, often resulting in poor outcomes and an unpredictable prognosis. Although some other surgical management options have been reported, there is a lack of literature supporting tendon transfers in the presence of combined anterior and posterior-superior irreparable rotator cuff tears. We describe a case where a combined transfer of the latissimus dorsi and lower trapezius tendons was employed to treat an MRCT affecting the anterior and posterior superior portions of the rotator cuff. CASE PRESENTATION A 64-year-old male presented significant pain and limited range of motion in the right shoulder following a traumatic anterior shoulder dislocation seven months prior. MRI showed retracted tears (> 5 cm) of the supraspinatus, infraspinatus, and subscapularis tendons with significant fatty infiltration (Goutallier IV). The patient underwent an open transfer of the lower trapezius tendon to the greater tuberosity and the latissimus dorsi to the lesser tuberosity. At the final follow-up, 2.5 years postoperatively, the patient exhibited a painless functional range of motion and could resume daily activities. CLINICAL DISCUSSION Although there are alternative surgical options available, the positive outcomes observed in the presented case may be attributed to the restoration of rotational strength and the re-establishment of force coupling across the shoulder. CONCLUSION This report describes the successful implementation of a surgical treatment option for managing MRCT affecting the anterior and posterior superior portions of the rotator cuff.
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Affiliation(s)
- Roberto Yukio Ikemoto
- Disciplina de Ortopedia - Faculdade de Medicina do ABC, Av. Lauro Gomes, 2000 Santo André, SP, Brazil; Hospital Ipiranga, Av. Nazaré, 28 São Paulo, SP, Brazil
| | - Vitor La Banca
- Disciplina de Ortopedia - Faculdade de Medicina do ABC, Av. Lauro Gomes, 2000 Santo André, SP, Brazil; Instituto Brasil de Tecnologias da Saúde (IBTS) R.Visc de Piraja, 407 Rio de Janeiro, RJ, Brazil.
| | - Thiago Martins Trece Costa
- Disciplina de Ortopedia - Faculdade de Medicina do ABC, Av. Lauro Gomes, 2000 Santo André, SP, Brazil; Hospital Ipiranga, Av. Nazaré, 28 São Paulo, SP, Brazil
| | - Ana Victoria Palagi Vigano
- Disciplina de Ortopedia - Faculdade de Medicina do ABC, Av. Lauro Gomes, 2000 Santo André, SP, Brazil; Hospital Ipiranga, Av. Nazaré, 28 São Paulo, SP, Brazil
| | - Joel Murachovsky
- Disciplina de Ortopedia - Faculdade de Medicina do ABC, Av. Lauro Gomes, 2000 Santo André, SP, Brazil
| | - Luiz Henrique Oliveira Almeida
- Disciplina de Ortopedia - Faculdade de Medicina do ABC, Av. Lauro Gomes, 2000 Santo André, SP, Brazil; Hospital Ipiranga, Av. Nazaré, 28 São Paulo, SP, Brazil
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Bashrum BS, Hwang NM, Thompson AA, Mayfield CK, Abu-Zahra M, Bolia IK, Biedermann BM, Petrigliano FA, Liu JN. Evaluation of spin in systematic reviews on the use of tendon transfer for massive irreparable rotator cuff tears. J Shoulder Elbow Surg 2024; 33:e377-e383. [PMID: 38122887 DOI: 10.1016/j.jse.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To identify, describe and account for the incidence of spin in systematic reviews and meta-analyses of tendon transfer for the treatment of massive, irreparable rotator cuff tears. The secondary objective was to characterize the studies in which spin was identified and to determine whether identifiable patterns exist among studies with spin. METHODS This study was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Each abstract was assessed for the presence of the 15 most common types of spin derived from a previously established methodology. General data that were extracted included study title, authors, publication year, journal, level of evidence, study design, funding source, reported adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, preregistration of the study protocol, and methodologic quality per A Measurement Tool to Assess Systematic Reviews Version 2 (AMSTAR 2). RESULTS The search yielded 53 articles, of which 13 were included in the final analysis. Articles were excluded if they were not published in a peer reviewed journal, not written in English, utilized cadaveric or nonhuman models, or lacked an abstract with accessible full text. 53.8% (7/13) of the included studies contained at least 1 type of spin in the abstract. Type 5 spin ("The conclusion claims beneficial effect of the experimental treatment despite a high risk of bias in primary studies") was the most common, appearing in 23.1% (3/13) of included abstracts. Nine of the spin categories did not appear in any of the included abstracts. A lower AMSTAR 2 score was significantly associated with the presence of spin in the abstract (P < .006). CONCLUSION Spin is highly prevalent in the abstracts of systematic reviews and meta-analyses concerning tendon transfer for massive rotator cuff tears. A lower overall AMSTAR 2 rating was associated with a higher incidence of spin. Future studies should continue to explore the prevalence of spin in orthopedic literature and identify any factors that may contribute to its presence.
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Affiliation(s)
- Bryan S Bashrum
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - N Mina Hwang
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Ashley A Thompson
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Cory K Mayfield
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Maya Abu-Zahra
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Brett M Biedermann
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Frank A Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Joseph N Liu
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA.
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Takeda Y, Fujii K, Suzue N, Kawasaki Y, Sumitomo J, Nishidono K, Fujii Y, Kano M. A modified Patte classification system for rotator cuff tendon retraction to predict reparability and tendon healing in arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 2024; 32:1579-1590. [PMID: 38545631 DOI: 10.1002/ksa.12162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/09/2024] [Accepted: 03/12/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE The purpose of this study was to propose a modified Patte classification system for tendon retraction, including the cut-off points for predicting reparability and rotator cuff healing after arthroscopic rotator cuff repair (ARCR) and assess its prediction accuracy and measurement reliability. METHODS This retrospective study included 463 consecutive patients scheduled to undergo ARCR for full-thickness supraspinatus tears. Receiver operating characteristic (ROC) curve analysis was used to determine the cut-off points for predicting reparability and tendon healing. The modified Patte classification system, in which these cut-off points were combined with the original Patte classification, classified the tendon retraction as stages I-V. The prediction accuracy of reparability and tendon healing was assessed using the area under the curve (AUC). Measurement reliability was determined using Cohen's κ statistics. RESULTS Of the 402 included patients, 32 rotator cuff tears were irreparable and 71 of the remaining 370 were diagnosed with healing failure. ROC analysis determined the cut-off point of reparability at the medial one-fifth and that of tendon healing at the medial one-third of the humeral head. The AUC of the modified Patte classification for predicting reparability and tendon healing was 0.897 (excellent) and 0.768 (acceptable), respectively. Intra-rater reliability was almost perfect (mean κ value: 0.875), and inter-rater reliability was substantial (0.797). CONCLUSION Diagnostic performance of the modified Patte classification system was excellent for reparability and acceptable for rotator cuff healing, with high measurement reliability. The modified Patte classification system can be easily implemented in clinical practice for planning surgical procedures and counselling patients in the day-by-day clinical work. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yoshitsugu Takeda
- Department of Orthopaedic Surgery, Tokushima Red Cross Hospital, Komatsushima, Tokushima, Japan
| | - Koji Fujii
- Department of Orthopaedic Surgery, Tokushima Red Cross Hospital, Komatsushima, Tokushima, Japan
| | - Naoto Suzue
- Department of Orthopaedic Surgery, Tokushima Red Cross Hospital, Komatsushima, Tokushima, Japan
| | - Yoshiteru Kawasaki
- Department of Orthopaedic Surgery, Tokushima Red Cross Hospital, Komatsushima, Tokushima, Japan
| | - Junichiro Sumitomo
- Department of Orthopaedic Surgery, Tokushima Red Cross Hospital, Komatsushima, Tokushima, Japan
| | - Keisuke Nishidono
- Department of Orthopaedic Surgery, Tokushima Red Cross Hospital, Komatsushima, Tokushima, Japan
| | - Yugen Fujii
- Department of Orthopaedic Surgery, Tokushima Red Cross Hospital, Komatsushima, Tokushima, Japan
| | - Masashi Kano
- Department of Orthopaedic Surgery, Kito Clinic, Naka, Tokushima, Japan
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Berthold DP, Rupp MC, Obopilwe E, Siebenlist S, Elhassan BT, Mazzocca AD, Muench LN. Anterior Latissimus Dorsi Transfer for Irreparable Subscapularis Tears Improves Shoulder Kinematics in a Dynamic Biomechanical Cadaveric Shoulder Model. Am J Sports Med 2024; 52:624-630. [PMID: 38294257 PMCID: PMC10905977 DOI: 10.1177/03635465231223514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 11/08/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND In young patients with irreparable subscapularis deficiency (SSC-D) and absence of severe osteoarthritis, anterior latissimus dorsi transfer (aLDT) has been proposed as a treatment option to restore the anteroposterior muscular force couple to regain sufficient shoulder function. However, evidence regarding the biomechanical effect of an aLDT on glenohumeral kinematics remains sparse. PURPOSE/HYPOTHESIS The purpose of this study was to investigate the effects of an aLDT on range of glenohumeral abduction motion, superior migration of the humeral head (SM), and cumulative deltoid force (cDF) in a simulated SSC-D model using a dynamic shoulder model. It was hypothesized that an aLDT would restore native shoulder kinematics by reestablishing the insufficient anteroposterior force couple. STUDY DESIGN Controlled laboratory study. METHODS Eight fresh-frozen cadaveric shoulders were tested using a validated shoulder simulator. Glenohumeral abduction angle (gAA), SM, and cDF were compared across 3 conditions: (1) native, (2) SSC-D, and (3) aLDT. gAA and SM were measured using 3-dimensional motion tracking, while cDF was recorded in real time during dynamic abduction motion by load cells connected to actuators. RESULTS The SSC-D significantly decreased gAA (Δ-9.8°; 95% CI, -14.1° to -5.5°; P < .001) and showed a significant increase in SM (Δ2.0 mm; 95% CI, 0.9 to 3.1 mm; P = .003), while cDF was similar (Δ7.8 N; 95% CI, -9.2 to 24.7 N; P = .586) when compared with the native state. Performing an aLDT resulted in a significantly increased gAA (Δ3.8°; 95% CI, 1.8° to 5.7°; P < .001), while cDF (Δ-36.1 N; 95% CI, -48.7 to -23.7 N; P < .001) was significantly reduced compared with the SSC-D. For the aLDT, no anterior subluxation was observed. However, the aLDT was not able to restore native gAA (Δ-6.1°; 95% CI, -8.9° to -3.2°; P < .001). CONCLUSION In this cadaveric study, performing an aLDT for an irreparable subscapularis insufficiency restored the anteroposterior force couple and prevented superior and anterior humeral head migration, thus improving glenohumeral kinematics. Furthermore, compensatory deltoid forces were reduced by performing an aLDT. CLINICAL RELEVANCE Given the favorable effect of the aLDT on shoulder kinematics in this dynamic shoulder model, performing an aLDT may be considered as a treatment option in patients with irreparable SSC-D.
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Affiliation(s)
- Daniel P. Berthold
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | | | - Elifho Obopilwe
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Sebastian Siebenlist
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
| | - Bassem T. Elhassan
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Augustus D. Mazzocca
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lukas N. Muench
- Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany
- Department of Trauma Surgery, Armed Klinikum München Süd, Munich, Germany
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李 红, 方 闰, 宁 仁. [Early effectiveness of arthroscopic superior fulcrum reconstruction in treatment of irreparable massive rotator cuff tear]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:1453-1458. [PMID: 38130186 PMCID: PMC10739671 DOI: 10.7507/1002-1892.202307070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 12/23/2023]
Abstract
Objective To investigate early effectiveness of arthroscopic superior fulcrum reconstruction in the treatment of irreparable massive rotator cuff tear (IMRCT). Methods A retrospective analysis was conducted on the clinical data of 24 patients with IMRCT who met the inclusion criteria between January 2020 and April 2022. Among them, there were 11 males and 13 females with an average age of 56.2 years (range, 42-68 years). There were 12 cases of falling injuries, 3 cases of traction injuries, and the other 9 cases had no obvious causes. The disease duration ranged from 1 to 25 months (median, 6 months). The rotator cuff tears were classified as Hamada grade 2 in 18 cases and grade 3 in 6 cases, and Goutallier grade 1 in 3 cases, grade 2 in 20 cases, and grade 3 in 1 case. All patients were treated with arthroscopic superior fulcrum reconstruction. Visual analogue scale (VAS) score, Constant-Murley score, the University of California at Los Angeles (UCLA) score, and the American Shoulder and Elbow Surgeons (ASES) score were recorded before operation and at 1, 3, 6, and 12 months after operation. Results The operations were all successfully completed. The incisions healed by first intention and no related complications occurred. All patients were followed up 12-33 months (mean, 24.6 months). The VAS, Constant-Murley, UCLA, and ASES scores at different time points after operation were superior to those before operation ( P<0.05). All of the above indicators further improved with time. Except for no significant difference in VAS and Constant-Murley scores between 6 and 12 months ( P>0.05), the differences between the other time points were significant ( P<0.05). At 12 months after operation, according to UCLA scoring standard, shoulder joint function was rated as excellent in 4 cases, good in 19 cases, and poor in 1 case, with an excellent and good rate of 96.0%. MRI showed that there was no graft re-tear and the transplanted tendon and bone tunnel healed. Conclusion The arthroscopic superior fulcrum reconstruction for IMRCT can effectively relieve the pain, improve the shoulder range of motion, and restore good shoulder function.
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Affiliation(s)
- 红岩 李
- 安徽医科大学第三附属医院(合肥市第一人民医院)骨科(合肥 230001)Department of Orthopedics, the Third Affiliated Hospital of Anhui Medical University (the First People’s Hospital of Hefei), Hefei Anhui, 230001, P. R. China
| | - 闰 方
- 安徽医科大学第三附属医院(合肥市第一人民医院)骨科(合肥 230001)Department of Orthopedics, the Third Affiliated Hospital of Anhui Medical University (the First People’s Hospital of Hefei), Hefei Anhui, 230001, P. R. China
| | - 仁德 宁
- 安徽医科大学第三附属医院(合肥市第一人民医院)骨科(合肥 230001)Department of Orthopedics, the Third Affiliated Hospital of Anhui Medical University (the First People’s Hospital of Hefei), Hefei Anhui, 230001, P. R. China
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Roukoz S, George S, Aoun M, Daher M. Combined latissimus dorsi transfer and deltoid flap for irreparable rotator cuff tear: A retrospective analysis. SICOT J 2023; 9:35. [PMID: 38059858 DOI: 10.1051/sicotj/2023034] [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: 10/18/2023] [Accepted: 11/12/2023] [Indexed: 12/08/2023] Open
Abstract
PURPOSE This study will evaluate the outcomes of the combined latissimus dorsi tendon transfer and deltoid flap for the management of irreparable posterosuperior rotator cuff tears. METHODS This is a retrospective study of 15 patients who have undergone double transfer surgery for their irreparable posterosuperior rotator cuff tears. These patients were followed up in three periods. Functional outcomes such as the constant score (CS), subjective shoulder value (SSV), and range of motion were assessed as well as radiographic outcomes such as the acromio-humeral distance. RESULTS Fifteen patients were included in the early and intermediate follow-up while only 8 remained at the latest follow-up. At the early follow-up the SSV (p = 0.001), CS (p = 0.021), and A-H distance (p = 0.008) showed a statistically significant improvement from their pre-operative values. At the latest follow-up, only the external rotation decreased from its value at the intermediate follow-up (p = 0.027). CONCLUSION The double transfer technique showed sustainable improvement of the functional outcomes except for the external rotation. However, the loss of external rotation did not affect the remaining outcomes. Trials comparing this technique to other surgical managements or MIRCTs are needed to confirm these results.
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Affiliation(s)
- Sami Roukoz
- Hotel Dieu de France, Orthopedics Department, Beirut, Lebanon
| | - Samuel George
- Hotel Dieu de France, Orthopedics Department, Beirut, Lebanon
| | - Marven Aoun
- Hotel Dieu de France, Orthopedics Department, Beirut, Lebanon
| | - Mohammad Daher
- Hotel Dieu de France, Orthopedics Department, Beirut, Lebanon
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Loren J, Lu CY(J, Yang CP, Hsu KY, Cheng YH, Sheu H, Chen CY, Tang HC, Chuang CA, Chiu CH(J. Arthroscopic Lower Trapezius Tendon Transfer for a Patient with Axillary Nerve Injury and Concomitant Rotator Cuff Tear: A Case Report and Technical Notes. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1817. [PMID: 37893536 PMCID: PMC10608587 DOI: 10.3390/medicina59101817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/10/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
Introduction: Concomitant nerve injuries with musculoskeletal injuries present a challenging problem. The goals of nerve reconstruction for the shoulder include shoulder abduction and external rotation. When patients fail to achieve acceptable shoulder external rotation and shoulder abduction, tendon transfers such as trapezius transfer offer a reliable option in the subsequent stage. Case Presentation: A 32-year-old male presented with weak external rotation in his left shoulder, after previous axillary nerve reconstruction. He received the ipsilateral lower trapezius transfer with the aim of improving the external rotation. Discussion: The lower trapezius restores a better joint reaction force in both the compressive-distractive and anterior-posterior balancing and provides a centering force through the restoration of the anterior-posterior force couple. Conclusion: We believe that the ipsilateral lower trapezius transfer to the infraspinatus is a good outcome and is effective in improving overall shoulder stability and the shoulder external rotation moment arm or at least maintaining in neutral position with the arm fully adducted in patients with post axillary nerve injuries post unsatisfactory nerve reconstruction to increase the quality of life and activities of daily living.
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Affiliation(s)
- Jeff Loren
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.L.); (C.-P.Y.); (C.-Y.C.)
- Department of Orthopedics & Traumatology, Royal Prima General Hospital, Medan 20118, Indonesia
| | - Chuieng-Yi (Johnny) Lu
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Cheng-Pang Yang
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.L.); (C.-P.Y.); (C.-Y.C.)
| | - Kuo-Yao Hsu
- Department of Orthopedic Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan; (K.-Y.H.); (Y.-H.C.)
| | - You-Hung Cheng
- Department of Orthopedic Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan; (K.-Y.H.); (Y.-H.C.)
| | - Huan Sheu
- Department of Orthopedic Surgery, Taoyuan Chang Gung Memorial Hospital, Taoyuan 333, Taiwan;
| | - Chao-Yu Chen
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.L.); (C.-P.Y.); (C.-Y.C.)
| | - Hao-Che Tang
- Department of Orthopedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; (H.-C.T.); (C.-A.C.)
| | - Chieh-An Chuang
- Department of Orthopedic Surgery, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan; (H.-C.T.); (C.-A.C.)
| | - Chih-Hao (Joe) Chiu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.L.); (C.-P.Y.); (C.-Y.C.)
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Sahu AK, Moran EK, Gandikota G. Role of ultrasound and MRI in the evaluation of postoperative rotator cuff. J Ultrason 2023; 23:e188-e201. [PMID: 38020508 PMCID: PMC10668931 DOI: 10.15557/jou.2023.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Rotator cuff tears are common shoulder injuries in patients above 40 years of age, causing pain, disability, and reduced quality of life. Most recurrent rotator cuff tears happen within three months. Surgical repair is often necessary in patients with large or symptomatic tears to restore shoulder function and relieve symptoms. However, 25% of patients experience pain and dysfunction even after successful surgery. Imaging plays an essential role in evaluating patients with postoperative rotator cuff pain. The ultrasound and magnetic resonance imaging are the most commonly used imaging modalities for evaluating rotator cuff. The ultrasound is sometimes the preferred first-line imaging modality, given its easy availability, lower cost, ability to perform dynamic tendon evaluation, and reduced post-surgical artifacts compared to magnetic resonance imaging. It may also be superior in terms of earlier diagnosis of smaller re-tears. Magnetic resonance imaging is better for assessing the extent of larger tears and for detecting other complications of rotator cuff surgery, such as hardware failure and infection. However, postoperative imaging of the rotator cuff can be challenging due to the presence of hardware and variable appearance of the repaired tendon, which can be confused with a re-tear. This review aims to provide an overview of the current practice and findings of postoperative imaging of the rotator cuff using magnetic resonance imaging and ultrasound. We discuss the advantages and limitations of each modality and the normal and abnormal imaging appearance of repaired rotator cuff tendon.
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Affiliation(s)
- Amit Kumar Sahu
- Department of Radiology, Max Superspeciality Hospital, New Delhi, India
| | | | - Girish Gandikota
- Department of Radiology, University of North Carolina, Chapel Hill, USA
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Luthringer TA, Fares MY, Rondon AJ, Vaughan AK, Khan AZ, Abboud JA. Subacromial Balloon Spacer Versus Partial Rotator Cuff Repair in the Treatment of Massive Irreparable Rotator Cuff Tears: Facility Personnel Allocation and Procedural Cost Analysis. Cureus 2023; 15:e41538. [PMID: 37554620 PMCID: PMC10404648 DOI: 10.7759/cureus.41538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/10/2023] Open
Abstract
Background The subacromial balloon is a novel technology that has shown promise in managing a select patient population with massive irreparable rotator cuff tears. The purpose of this study was to quantify the true facility cost difference between subacromial balloon placement (SBP) and partial rotator cuff repair (PCR). Methodology A prospective cohort of patients with massive irreparable rotator cuff tears randomized to SBP versus PCR between 2015 and 2018 was retrospectively reviewed. Demographic variables, medical comorbidities, and range-of-motion (ROM) outcomes for all patients were recorded. True facility costs with respect to personnel were calculated using a time-driven activity based-costing (TDABC) algorithm and were classified into personnel costs and supply costs. Results Seven patients were treated with PCR compared to nine treated with SBP. No significant differences were observed with respect to demographic characteristics. Postoperative mean external rotation was 37° in SBP patients significantly higher than that of PCR patients at 8° (P = 0.023). Personnel time and cost differences while in the operating room (OR) were significantly less for the SBP ($605.58) compared to PCR ($1362.76) (P < 0.001). Implant costs were higher for SBP when compared to PCR, whereas disposable equipment costs were higher for PCR when compared to SBP. The total mean true facility cost was $7658.00 for SBP, significantly higher than that of PCR at $3429.00 (P < 0.001). Conclusions Despite the substantial reduction in personnel costs seen with SBP, the true facility cost of SBP was significantly higher than that of PCR. As this novel technology is used more ubiquitously and its price is negotiated down, the cost savings seen in personnel and OR time will become more significant. Future prospective cost analyses should follow up on the changes in implant costs and account for potential anesthesia cost savings.
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Affiliation(s)
- Tyler A Luthringer
- Division of Hand and Upper Extremity, Midwest Orthopaedics at Rush, Rush University, Chicago, USA
| | - Mohamad Y Fares
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, USA
| | - Alexander J Rondon
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, USA
| | - Alayna K Vaughan
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, USA
| | - Adam Z Khan
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, USA
| | - Joseph A Abboud
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, USA
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Saccomanno MF, Colosio A, De Filippo F, Adriani M, Motta M, Cattaneo S, Milano G. Combined Arthroscopic-Assisted Lower Trapezius Tendon Transfer and Superior Capsule Reconstruction for Massive Irreparable Posterior-Superior Rotator Cuff Tears: Surgical Technique. Arthrosc Tech 2023; 12:e823-e830. [PMID: 37424661 PMCID: PMC10323695 DOI: 10.1016/j.eats.2023.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 02/11/2023] [Indexed: 07/11/2023] Open
Abstract
Primary or revision irreparable rotator cuff tears remain a challenge. Clear algorithms do not exist. Several joint-preserving options are available, but no technique has been definitely proven to be better than another. Although superior capsule reconstruction has been shown to be effective in restoring motion, lower trapezius transfer can provide strong external rotation and abduction moment. The aim of the present article was to describe an easy and reliable technique to combine both options in 1 surgery, aiming to maximize the functional outcome by getting motion and strength back.
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Affiliation(s)
- Maristella F. Saccomanno
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Alessandro Colosio
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Francesco De Filippo
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marco Adriani
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Marcello Motta
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Cattaneo
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
| | - Giuseppe Milano
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
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康 运, 郭 标, 许 健, 毕 文, 马 炜, 杨 东, 崔 红, 付 鹏, 刘 一, 田 进, 刘 义. [Effectiveness of arthroscopic long head of biceps tendon transposition combined with Swivelock anchor double fixation for massive and irreparable rotator cuff tears]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:1459-1464. [PMID: 36545852 PMCID: PMC9763067 DOI: 10.7507/1002-1892.202207102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/30/2022] [Accepted: 10/12/2022] [Indexed: 12/24/2022]
Abstract
Objective To investigate the effectiveness of arthroscopic long head of biceps tendon (LHBT) transposition combined with Swivelock anchor double fixation in treatment of massive and irreparable rotator cuff tears. Methods Between June 2019 and November 2021, 25 patients with massive and irreparable rotator cuff tears were treated by arthroscopic LHBT transposition combined with Swivelock anchor double fixation. There were 12 males and 13 females. The age ranged from 47 to 74 years (mean, 62.4 years). The disease duration ranged from 1 to 62 months (median, 7 months). The rotator cuff tears were classified as Hamada grade 2 in 25 cases and Goutallier grade 1 in 2 cases, grade 2 in 22 cases, and grade 3 in 1 case. Pre- and post-operative shoulder range of motion (ROM), visual analogue scale (VAS) score, University of California Los Angeles (UCLA) score, and Constant-Murley score were recorded. Postoperative complications were observed. The reconstructed tissue integrity was confirmed by MRI. Results All operations were successfully completed. The operation time was 120-330 minutes (mean, 189.6 minutes). All incisions healed by first intention. All patients were followed up 10-36 months (mean, 22.0 months). At last follow-up, the ROM in forward flexion, abduction, and external rotation, VAS score, UCLA score, and Constant-Murley score were superior to those before operation, and the differences were significant ( P<0.05). According to UCLA scoring standard, shoulder joint function was rated as excellent in 5 cases, good in 18 cases, and poor in 2 cases, with an excellent and good rate of 92.0%. No other complications occurred except shoulder joint adhesion in 2 cases. At last follow-up, MRI examination showed no retear of rotator cuff, and LHBT was intact. Conclusion For massive and irreparable rotator cuff tears, arthroscopic LHBT transposition combined with Swivelock anchor double fixation can increase the force of pressing the humeral head, effectively relieve the pain, improve the ROM of joints, maximize the recovery of shoulder function, and do not increase the number of anchor nails.
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Affiliation(s)
- 运康 康
- 安徽医科大学附属阜阳人民医院(阜阳市人民医院)骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang City People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 标 郭
- 安徽医科大学附属阜阳人民医院(阜阳市人民医院)骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang City People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 健 许
- 安徽医科大学附属阜阳人民医院(阜阳市人民医院)骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang City People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 文智 毕
- 安徽医科大学附属阜阳人民医院(阜阳市人民医院)骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang City People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 炜 马
- 安徽医科大学附属阜阳人民医院(阜阳市人民医院)骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang City People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 东强 杨
- 安徽医科大学附属阜阳人民医院(阜阳市人民医院)骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang City People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 红林 崔
- 安徽医科大学附属阜阳人民医院(阜阳市人民医院)骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang City People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 鹏飞 付
- 安徽医科大学附属阜阳人民医院(阜阳市人民医院)骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang City People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 一军 刘
- 安徽医科大学附属阜阳人民医院(阜阳市人民医院)骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang City People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 进翔 田
- 安徽医科大学附属阜阳人民医院(阜阳市人民医院)骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang City People’s Hospital), Fuyang Anhui, 236000, P. R. China
| | - 义峰 刘
- 安徽医科大学附属阜阳人民医院(阜阳市人民医院)骨科(安徽阜阳 236000)Department of Orthopedics, Fuyang People’s Hospital Affiliated to Anhui Medical University (Fuyang City People’s Hospital), Fuyang Anhui, 236000, P. R. China
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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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