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Pradhan A, Kumar K, Haddon A, Brownson P, Singh H. Surgical Management of Irreparable Rotator Cuff Tears: A Survey of Current Practice and Literature Review. Cureus 2024; 16:e67907. [PMID: 39328608 PMCID: PMC11425768 DOI: 10.7759/cureus.67907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2024] [Indexed: 09/28/2024] Open
Abstract
Introduction Irreparable rotator cuff tears (RCTs) are a complex challenge encountered by shoulder surgeons. Despite a range of repair strategies, the preferences and indications of these remain unclear. Our study aims to identify current practices, preference for graft choice and indications for capsular reconstruction amongst UK-based surgeons. Methods An online survey was sent to members of the British Elbow and Shoulder Society (BESS). Procedural preferences, operative frequency, indications/contra-indications for superior capsular reconstruction (SCR) and graft choice were ascertained. An independent t-test was used to determine statistical significance. Results One hundred and ten upper limb surgeons responded to the survey. Of this cohort, 90/110 (81.8%) would be able to perform a partial cuff repair, 89/110 (80.9%) could offer a reverse shoulder arthroplasty (RSA) and 82/110 (74.6%) could perform debridement only. Less commonly, 35/110 (31.8%) could offer an InspaceTM balloon device, 31/110 (28.2%) SCR and 16/110 (14.6%) a tendon transfer. None of the respondents had performed more than 10 InspaceTM balloons in the previous year. 72/105 (68.6%) had never performed a SCR and 86/105 (82%) had never performed a tendon transfer. Over 58/105 (55.2%) had performed >10 RSA in the previous year. The graft of choice for SCR was human dermal allograft 33/100 (33%) and this choice was most frequently guided by surgeon preference. Conclusion Our study demonstrates that various treatment options can be offered for the management of irreparable RCTs. The commonest procedure offered is a partial cuff repair followed by RSA. Newer, novel procedures such as InspaceTM balloon and tendon transfers are less commonly offered in UK-based practices and their indications for use are less well defined. Future high-powered, multi-centre studies are required to identify the role and outcomes of these procedures.
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Affiliation(s)
- Akhilesh Pradhan
- Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Kapil Kumar
- Trauma and Orthopaedics, Grampian Orthopaedic and Trauma Unit, Woodend General Hospital, NHS Grampian, Aberdeen, GBR
| | - Alexandra Haddon
- Trauma and Orthopaedics, Grampian Orthopaedic and Trauma Unit, Woodend General Hospital, NHS Grampian, Aberdeen, GBR
| | - Peter Brownson
- Trauma and Orthopaedics, Liverpool Upper Limb Unit, Liverpool University Teaching Hospitals NHS Foundation Trust, Liverpool, GBR
| | - Harvinder Singh
- Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, GBR
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Sung HP, Chen WC. Rate of graft retear is higher in over-the-top superior capsular reconstruction for massive posterosuperior rotator cuff tears with subscapularis tear. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39010712 DOI: 10.1002/ksa.12365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/17/2024]
Abstract
PURPOSE To compare side-to-side superior capsular reconstruction (SCR) with over-the-top SCR in terms of functional outcomes, pain relief and allograft survival rates. METHODS Patients who had undergone arthroscopic dermal allograft SCR for massive irreparable rotator cuff tears and clinical follow-up for ≥2 years were recruited. All patients underwent postoperative assessment with routine radiographic analysis for acromiohumeral distances, ultrasound imaging 1 and 3 months after SCR and magnetic resonance imaging (MRI) at least 12 months after SCR. The outcome measures were visual analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES), Constant and Single Assessment Numeric Evaluation (SANE) scores. RESULTS SCR was performed in 56 patients including side-to-side SCR in 32 and over-the-top SCR in 24. Postoperative MRI showed that the grafts were intact in 46 patients (82.1%; 26 who underwent side-to-side SCR and 20 who underwent over-the-top SCR). The proportion of nonhealing grafts in the over-the-top group was significantly higher with concomitant subscapularis tears (60% vs. 5.3%; p = 0.02). VAS scores and functional outcomes improved postoperatively in both groups and postoperative VAS (1.4 vs. 1.7; n.s.), Constant (74.8 vs. 76.0; n.s.), mean ASES (87.4 vs. 89.1; n.s.) and mean SANE (81.7 vs. 84.3; n.s.) scores did not differ significantly. CONCLUSION For massive rotator cuff tears, over-the-top and side-to-side SCR achieve similar pain relief and functional improvement, and the rate of healing allografts is high. However, over-the-top SCR is not recommended for massive posterosuperior rotator cuff tears with repairable subscapularis tendon tears due to a higher nonhealing rate. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Hsin-Pei Sung
- Department of Orthopedic Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Wei-Cheng Chen
- Department of Orthopedic Surgery, Mackay Memorial Hospital, Taipei, Taiwan
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Ardebol J, Menendez ME, Narbona P, Horinek JL, Pasqualini I, Denard PJ. Reverse shoulder arthroplasty for massive rotator cuff tears without glenohumeral arthritis can improve clinical outcomes despite history of prior rotator cuff repair: A systematic review. J ISAKOS 2024; 9:394-400. [PMID: 38403192 DOI: 10.1016/j.jisako.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/26/2023] [Accepted: 02/20/2024] [Indexed: 02/27/2024]
Abstract
IMPORTANCE Reverse shoulder arthroplasty (RSA) is often used to surgically address massive irreparable rotator cuff tears (MIRCT) without arthritis. The impact of prior attempted rotator cuff repair (RCR) on outcomes is unclear. OBJECTIVE The purpose of this systematic review was to compare functional outcomes, range of motion, and complications in patients with a MIRCT without arthritis who underwent RSA as a primary procedure versus after prior RCR. EVIDENCE REVIEW A systematic review was performed on RSA for a MIRCT. The search was conducted from February to March of 2022 using the MEDLINE database. Patient-reported outcome measures (PROs), range of motion (ROM), and complications were extracted. These outcomes were weighted and analysed based on whether the reverse was performed as the primary procedure or following a prior RCR. FINDINGS Seven studies were included in the analysis, consisting of 343 cases in the primary RSA group and 95 cases in the prior RCR group, with a mean follow-up of 40.8 months. There were no demographic differences between cohorts. Postoperative PROs and ROM were comparable between groups, although the prior RCR group had a higher maximal percentage of improvement (MPI%) for the Constant-Murley Score and Simple Shoulder Test. There was a higher risk for complications (relative risk [RR] 6.26) and revisions (RR 3.91) in the prior RCR group. The most common complications were acromial stress fractures and prosthetic dislocation. CONCLUSION AND RELEVANCE Patients undergoing RSA for MIRCT following a prior RCR have functional outcomes that are largely comparable to those who have a primary RSA, but they may be at higher risk of complications and revision. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | | | - Pablo Narbona
- Department of Shoulder Surgery and Arthroscopy, Sanatorio Allende, Córdoba, X5000, Argentina
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4
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Lian OM, Randsborg PH, Jakobsen RB, Khan Bukholm IR, Aae TF. Prevalence of malpractice claims after arthroscopic shoulder surgery: analysis of 69,097 procedures from a national registry in Norway. Patient Saf Surg 2023; 17:25. [PMID: 37853493 PMCID: PMC10585783 DOI: 10.1186/s13037-023-00378-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Systematic analysis of compensation claims following patient injuries is helpful in improving patient safety. The objective of the current study was to assess compensation claims after arthroscopic treatment of rotator cuff ruptures, impingement, and acromioclavicular joint osteoarthritis reported to the Norwegian System of Patient Injury Compensation and evaluate if there was regional variation on the risk of patient injuries leading to an accepted compensation claim. METHODS Data from the Norwegian System of Patient Injury Compensation and the Norwegian Patient Registry (NPR) from 2008 to 2018 were collected. Demographics (age and sex) and type of claim and reasons for accepted claims were obtained from the Norwegian System of Patient Injury Compensation, while the number of arthroscopic procedures was collected from NPR. The treating institutions were grouped on geography according to Norway's four regional Health Trusts and private institutions and the effect of geography on the probability of an accepted claim was estimated. RESULTS NPR registered 69,097 shoulder arthroscopies during the study period, of which 216 (0.3%) compensation claims were filed for patient injury. A total of 38% of the claims were accepted, representing 0.1% of the arthroscopic procedures. Infection (37.8%) was the most common reason for accepted claim, followed by no surgical indication (15.9%) and wrong surgical technique (12.2%). We found a statistically significantly increased odds ratio for a claim being accepted in both the smallest and largest regional Health Trusts compared to the other regional Health Trusts and private institutions. CONCLUSIONS Compensation claims due to patient injury following shoulder arthroscopy are rare (0.3% of patients file a claim, of which a third is accepted (0.1% of all shoulder arthroscopy patients)). The most common reason for accepted claim was infection followed by lack of indication.
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Affiliation(s)
- Ola Midtsaether Lian
- Department of Orthopaedic Surgery, Helse Møre and Romsdal HT, Kristiansund Hospital, Kristiansund, Norway
- Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Per-Henrik Randsborg
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Rune Bruhn Jakobsen
- Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
- Department of Health Management and Health Economics, Institute of Health and Society, The Medical Faculty, University of Oslo, Oslo, Norway
| | | | - Tommy Frøseth Aae
- Department of Orthopaedic Surgery, Helse Møre and Romsdal HT, Kristiansund Hospital, Kristiansund, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
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Mizuki Y, Senjyu T, Ito T, Ueda K, Uchimura T. Extreme Medialized Repair for Challenging Large and Massive Rotator Cuff Tears Reveals Healing and Significant Functional Improvement. Arthroscopy 2023; 39:2122-2130. [PMID: 37116547 DOI: 10.1016/j.arthro.2023.03.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/18/2023] [Accepted: 03/29/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE To evaluate range of motion, muscle strength, clinical outcomes, and radiographic results of the extreme medialized procedure on rotator cuff tears that were initially irreparable. METHODS From arthroscopic rotator cuff repair cases performed at our institution (June 2017 and August 2020), we retrospectively reviewed cases in which the rotator cuff was (1) unable to be withdrawn to the greater tuberosity, (2) repaired using the extreme medialized procedure, and (3) followed up for a minimum of 2 years. Patients with a history of previous surgery were excluded. Preoperative and postoperative scores were used for clinical evaluation. Imaging evaluation used 2-year postoperative magnetic resonance (MR) images. RESULTS Sixty-four patients met the criteria; mean age 68.2 ± 7.9 (range 51-82) years; mean follow-up period 26 ± 2 (24-37) months. Tear size: 45 ± 7.1 (30-70) mm in medial to lateral diameters, 40 ± 9.3 (30-60) mm in anteroposterior diameter; suture anchor number: 5.5 ± 1.2 (4-8). The visual analog scale score (50.7 to 11.8), the University of California, Los Angeles, score (12 to 31), constant score (45 to 31), and the American Shoulder and Elbow Surgeons score (53 to 31) at the final follow-up improved compared with preoperative values (all P < .0001). Preoperative and postoperative changes in range of motion also showed improvement in anterior elevation (107° to 151°, P < .0001), abduction (100° to 154°, P < .0001), external rotation (41° to 47°, P = .0238), and internal rotation (L1 to Th10, P < .0001). Muscle strength was also improved in abduction (from 1.9 kg to 5.0 kg, P < .0001) and external rotation (from 3.5 kg to 7.7 kg, P < .0001). MR imaging evaluation revealed 2 cases (3.1%) of retears that fell into type 4 Sugaya classification. CONCLUSIONS Extremely medialized repair of large and massive tears not able to be repaired using conventional techniques led to improved clinical outcomes compared to preoperative conditions. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
| | | | | | - Koki Ueda
- Sasebo Kyosai Hospital, Nagasaki, Japan
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6
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Fares MY, Abboud JA. Effective Management of Bilateral Massive Irreparable Rotator Cuff Tears through Implantation of Subacromial Balloon Spacers. J Orthop Case Rep 2023; 13:52-56. [PMID: 37398530 PMCID: PMC10308967 DOI: 10.13107/jocr.2023.v13.i06.3692] [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: 03/14/2023] [Revised: 04/17/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Massive irreparable rotator cuff tears are challenging pathologies with many treatment modalities and therapeutic approaches. In patients with certain indications, the subacromial balloon spacer can effectively alleviate pain and improve function, in a manner that may be superior to other management options. Case Report We report the case of a 64-year-old active male who had previously underwent a subacromial balloon placement in his right shoulder and an arthroscopic rotator cuff repair procedure on his left shoulder. He later presented with persistent pain and disability in his left shoulder and opted to undergo a second subacromial balloon placement on his left side. To the best of our knowledge, this is the first case of bilateral subacromial balloon placement procedure in the literature. Conclusion The subacromial balloon is a safe treatment modality for irreparable rotator cuff tears, and its introduction into bilateral shoulders can provide an easier recovery and rehabilitation when compared to other more invasive procedures.
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Affiliation(s)
- Mohamad Y. Fares
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Joseph A. Abboud
- Division of Shoulder and Elbow Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
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7
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Griffin JW, Runzo DM, Bonner KF. Tuberoplasty: Indications, Technique and Preliminary results. OPER TECHN SPORT MED 2023. [DOI: 10.1016/j.otsm.2023.150979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Effects of a Novel Proprioceptive Rehabilitation Device on Shoulder Joint Position Sense, Pain and Function. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091248. [PMID: 36143925 PMCID: PMC9505091 DOI: 10.3390/medicina58091248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/01/2022] [Accepted: 09/07/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Shoulder disorders are associated with pain, restricted range of motion and muscular strength, moderate disability and diminished proprioception. This study aimed to compare the effectiveness of an innovative technology-supported and a classical therapist-based proprioceptive training program in addition to conventional physiotherapy, on joint position sense (JPS), pain and function, in individuals with different musculoskeletal shoulder disorders, such as rotator cuff tear, subacromial impingement syndrome and superior labrum anterior and posterior tear. The innovative element of the proprioceptive training programme consists of the use of the Kinesimeter, a device created for both training and assessing shoulder JPS. Materials and Methods: The shoulder JPS test and the DASH outcome questionnaire were applied to fifty-five individuals (28 females, 27 males, mean age 56.31 ± 6.75), divided into three groups: 17 in the conventional physiotherapy group (control group); 19 in the conventional physiotherapy + classical proprioceptive training program group (CPT group); and 19 in the conventional physiotherapy + innovative proprioceptive training program group (KPT group). Assessments were performed before and after a four-week rehabilitation program, with five physiotherapy sessions per week. Results: When baseline and post-intervention results were compared, the value of the shoulder JPS and DASH outcome questionnaire improved significantly for the KPT and CPT groups (all p < 0.001). Both KPT and CPT groups showed statistically significant improvements in JPS, pain and function, compared to the control group which received no proprioceptive training (all p < 0.05). However, the KPT group showed no significant benefits compared to the CPT group. Conclusions: Our findings indicate that using the Kinesimeter device as a novel, innovative proprioceptive training tool has similar effects as the classical proprioceptive training programs among individuals with different non-operated musculoskeletal shoulder disorders such as: rotator cuff tear, subacromial impingement syndrome, and superior labrum anterior and posterior tear.
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9
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Wang L, Jiang J, Lin H, Zhu T, Cai J, Su W, Chen J, Xu J, Li Y, Wang J, Zhang K, Zhao J. Advances in Regenerative Sports Medicine Research. Front Bioeng Biotechnol 2022; 10:908751. [PMID: 35646865 PMCID: PMC9136559 DOI: 10.3389/fbioe.2022.908751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/21/2022] [Indexed: 01/08/2023] Open
Abstract
Regenerative sports medicine aims to address sports and aging-related conditions in the locomotor system using techniques that induce tissue regeneration. It also involves the treatment of meniscus and ligament injuries in the knee, Achilles’ tendon ruptures, rotator cuff tears, and cartilage and bone defects in various joints, as well as the regeneration of tendon–bone and cartilage–bone interfaces. There has been considerable progress in this field in recent years, resulting in promising steps toward the development of improved treatments as well as the identification of conundrums that require further targeted research. In this review the regeneration techniques currently considered optimal for each area of regenerative sports medicine have been reviewed and the time required for feasible clinical translation has been assessed. This review also provides insights into the direction of future efforts to minimize the gap between basic research and clinical applications.
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Affiliation(s)
- Liren Wang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Jiang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Regenerative Sports Medicine Lab of the Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People’ Hospital, Shanghai, China
| | - Hai Lin
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | - Tonghe Zhu
- School of Chemistry and Chemical Engineering, Shanghai Engineering Research Center of Pharmaceutical Intelligent Equipment, Shanghai Frontiers Science Research Center for Druggability of Cardiovascular Non-Coding RNA, Institute for Frontier Medical Technology, Shanghai University of Engineering Science, Shanghai, China
| | - Jiangyu Cai
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
| | - Wei Su
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Jiebo Chen
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Yamin Li
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Jing Wang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Kai Zhang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, China
- *Correspondence: Kai Zhang, ; Jinzhong Zhao,
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Regenerative Sports Medicine and Translational Youth Science and Technology Innovation Workroom, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Regenerative Sports Medicine Lab of the Institute of Microsurgery on Extremities, Shanghai Jiao Tong University Affiliated Sixth People’ Hospital, Shanghai, China
- *Correspondence: Kai Zhang, ; Jinzhong Zhao,
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Ma M, Pan Z, Lu L. Clinical effect of arthroscopic long head of biceps transfer and tenodesis on irreparable rotator cuff tear. J Orthop Surg Res 2022; 17:220. [PMID: 35399092 PMCID: PMC8996574 DOI: 10.1186/s13018-022-03121-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objective
To explore the clinical effect of arthroscopic long head of biceps transfer and tenodesis for on irreparable rotator cuff tear.
Methods
A total of 18 patients with irreparable rotator cuff tear who were treated in the Dongfang Hospital Affiliated to Tongji University School of Medicine from April 2018 to March 2020 were included in this study. They all underwent arthroscopic long head of biceps transfer and tenodesis. Shoulder joint motions (forward flexion, abduction, and external rotation angle) and magnetic resonance imaging (MRI) were performed. Moreover, visual analogue scale (VAS) and university of California Los Angeles (UCLA) score were conducted during follow-up.
Results
Preoperative symptoms lasted from 3 to 16 months, with an average duration of 10 months. All patients healed in the first stage without obvious complications were included. All patients were followed up for 4 to 14 months after the surgery, with an average duration of 11.1 months. The range of shoulder joint motions, including forward flexion (80.52° ± 31.19° vs. 149.47° ± 28.36°), abduction (65.13° ± 37.59° vs. 152.46° ± 28.64°) and lateral rotation (30.17° ± 15.15° vs. 71.49° ± 11.42°) was significantly improved after operation (P < 0.05). The VAS score was notably decreased after operation (8.46 ± 0.80 vs. 1.55 ± 0.70), but the UCLA score was markedly increased (15.27 ± 2.89 vs. 31.17 ± 2.36). MRI imaging showed that 15 patients had good tissue healing, with a healing rate of 83.3% (15/18).
Conclusion
Arthroscopy of the biceps long head tendon transposition can significantly relieve pain in patients with large rotator cuff tears, improve joint mobility, and restore joint function.
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Haleem A, Gohal C, Leroux T, Henry P, Alolabi B, Khan M. Primary arthroscopic repair of massive rotator cuff tears results in significant improvements with low rate of re-tear. Knee Surg Sports Traumatol Arthrosc 2021; 29:2134-2142. [PMID: 32748233 DOI: 10.1007/s00167-020-06190-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/27/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE To conduct a systematic review of outcomes following primary arthroscopic repair of chronic massive rotator cuff tears (RCTs) and to assess clinical outcomes and rates of repair failure. The authors' preferred treatment algorithm is also provided. METHODS Medline, Embase and PubMed were searched identifying articles pertaining to primary arthroscopic repair of chronic massive RCTs without the use of augmentation. Primary outcomes were patient-reported outcomes and the secondary outcome was the rate of repair failure. Outcome data were pooled and presented as well as assessment of study methodological quality. Data from studies reporting similar outcome measures were pooled when possible, and mean differences alongside confidence intervals and p values were reported, where appropriate. RESULTS Twenty-six studies (1405 participants) were included, with mean age of 62 years (range 52-69). The mean duration of symptoms pre-operatively was 31 months (range 6-40), and the mean follow-up time was 39 months (range 12-111). Complete repair was performed in 78% of patients and partial repair was performed in 22%. Both complete and partial repairs resulted in significant improvements with respect to pain, range of motion and functional outcome scores. The rate of repair failure for the total cohort was 36% at a mean follow-up of 31 months, and for the complete and partial repair subgroups the failure rate was 35% and 40%, respectively. CONCLUSIONS Arthroscopic repairs of chronic, massive RCTs, whether complete or partial, are associated with significant improvements in pain, function and objective outcome scores. The rate of repair failure is lower than previously reported, however, still high at 36%. The present paper finds that arthroscopic repair is still a viable treatment option for massive RCTs. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Ahmed Haleem
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Chetan Gohal
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Timothy Leroux
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Patrick Henry
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Bashar Alolabi
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Moin Khan
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
- Division of Orthopedic Surgery, University of Toronto, Toronto, ON, Canada.
- St. Joseph's Healthcare Hamilton, 50 Charlton Ave E., Mary Grace Wing, Room G807, Hamilton, ON, L8N 4A6, Canada.
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Terra BB, Sassine TJ, Ejnisman B, de Castro Pochini A, Belangero PS. Arthroscopic partial Superior Capsular Reconstruction using the Long Head of the Biceps Tendon-Technique Description. Arthrosc Tech 2021; 10:e669-e673. [PMID: 33738200 PMCID: PMC7953170 DOI: 10.1016/j.eats.2020.10.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/24/2020] [Indexed: 02/03/2023] Open
Abstract
Superior capsule reconstruction is a valuable intervention for some patients who present symptomatic irreparable posterosuperior rotator cuff tears. Superior capsule reconstruction techniques most commonly use either fascia lata autograft or dermal allograft. Both options have literature support but also present a few drawbacks such as donor site issues, potential allergic reactions, and high cost of the operation. The long head of biceps is a potential graft for rotator cuff tears and may be particularly useful in bridging the gap in irreparable massive rotator cuff tears, specifically as an alternative to more traditional superior capsular reconstruction. Long head of biceps transposition may offer unique and significant advantages over other techniques and can be an effective and valuable alternative in selected cases. The tendon's insertion into the glenoid is left intact, whereas laterally it is transferred to a more central humeral head position and sutured with anchors onto the footprint of the supraspinatus tendon acting as a superior static stabilizer of the shoulder joint. The purpose of this article is to propose a technical modification of superior capsular reconstruction using long head of the biceps tendon autograft.
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Affiliation(s)
| | | | - Benno Ejnisman
- Center of Sports Medicine of São Paulo Federal University
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Rooting Rotator Cuff Reconstruction for Irreparable Posterior-Superior Rotator Cuff Tear. Arthrosc Tech 2021; 10:e727-e737. [PMID: 33738208 PMCID: PMC7953171 DOI: 10.1016/j.eats.2020.10.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 10/26/2020] [Indexed: 02/03/2023] Open
Abstract
Irreparable posterior-superior rotator cuff tear is encountered quite often in clinical practice. Bridging the tendon defect with various materials is reasonable. However, optimal bridging structures and techniques are still being pursued. We introduce a rotator cuff bridging technique, rooting rotator cuff reconstruction. In this technique, autogenous tendon is used to make grafts. On the medial side, the graft tendons are suspended on the rotator cuff tendon. On the lateral side, the graft tendons are placed into tunnels through the tuberosities. The most critical steps of this technique are properly fabricating the humeral tunnels and suspending the graft tendons onto the rotator cuff tendon. We believe this technique will shed light on rotator cuff reconstruction.
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Kleim BD, Siebenlist S, Scheiderer B, Imhoff AB. [Irreparable rotator cuff tear-reverse shoulder arthroplasty and alternative procedures]. Unfallchirurg 2021; 124:117-124. [PMID: 33245367 DOI: 10.1007/s00113-020-00922-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Irreparable rotator cuff tears represent a significant everyday clinical challenge. A high degree of tendon retraction and muscle degeneration means that a direct reconstruction is impossible. Patients often suffer from pain and pseudoparalysis. In older patients this can reliably be resolved by the implantation of a semiconstrained inverse shoulder prosthesis; however, for younger patients joint-preserving techniques should be employed. Furthermore, for frail older patients who may not be suitable for a joint replacement operation, alternative treatment strategies are required. Management options include physiotherapy and pain relieving or reconstructive operations. Minimally invasive arthroscopic treatment approaches can lead to pain relief and slight functional improvements in selected patients; however, to restore the active movement of the joint a partial cuff repair, augmentation with a graft or replacement with muscle transfer is necessary. This article presents the various treatment options and the results reported in the literature. Through this a treatment algorithm is suggested in order to facilitate management decisions.
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Affiliation(s)
- B D Kleim
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - S Siebenlist
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - B Scheiderer
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - A B Imhoff
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
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Selim NM, Badawy ER. Consider Long Head of Biceps Tendon for Reconstruction of Massive, Irreparable Rotator Cuff Tear. Arthrosc Tech 2021; 10:e457-e467. [PMID: 33680779 PMCID: PMC7917143 DOI: 10.1016/j.eats.2020.10.024] [Citation(s) in RCA: 3] [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: 06/14/2020] [Accepted: 10/18/2020] [Indexed: 02/03/2023] Open
Abstract
Despite the different treatment options for irreparable and massive rotator cuff tears (RCTs), there is no optimal treatment. Thirty percent of total RCTs can be classified as irreparable because of the massive tear size and severe muscle atrophy. The reported treatment failure rate is approximately 40% for massive RCTs. RCTs may be treated conservatively or surgically depending on pain, disability, and functional demands. The surgical treatment options are many, but decision making is a challenge; the real challenge is to apply the correct procedure for the correct indication in each patient. The long head of the biceps tendon (LHBT) was used for augmentation to bridge the gap in immobile, massive RCTs. An arthroscopic biceps-incorporating technique was used for repair of large and massive RCTs, avoiding undue tension on the rotator cuff (RC). Recently, the LHBT was used for superior capsular reconstruction. This article describes the use of the LHBT for reconstruction of massive and irreparable RCTs through the following steps: (1) open exposure of the RCT, (2) debridement and subacromial decompression, (3) biceps tenotomy at the LHBT's origin on the glenoid, (4) LHBT and RC cuff mobilization, (5) passage of the LHBT through the mobilized RC and reflection onto itself, (6) tuberoplasty, and (7) fixation of the RC complex at the RC footprint.
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Affiliation(s)
- Naser M. Selim
- Knee Surgery–Arthroscopy and Sports Injuries Unit, Orthopedic Department, Mansoura University, Mansoura, Egypt
| | - Ehab R. Badawy
- Knee Surgery–Arthroscopy and Sports Injuries Unit, Orthopedic Department, Mansoura University, Mansoura, Egypt
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Alike Y, Hou JY, Tang YY, Yu ML, Long Y, Li FQ, Ali M, Yuan H, Yang R. Arthroscopic Superior Capsule Reconstruction and Rotator Cuff Repair to Restore Static and Dynamic Stability of the Shoulder. Orthop Surg 2020; 12:1503-1510. [PMID: 32851772 PMCID: PMC7670152 DOI: 10.1111/os.12768] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/09/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Treatment of massive irreparable rotator cuff tears (RCT) has shown limited clinical success and a variety of subsequent complications. Superior capsule reconstruction (SCR) has been proved to reestablish superior stability but does not restore the dynamic force or shoulder kinematics. There are numerous reports of the short-term failure of SCR grafts at the glenoid side, which relate to the non-biological healing of grafts. To restore both dynamic and static stability and to provide biologic augmentation, an integrated procedure for massive irreparable RCT using an Achilles tendon-bone allograft (ATBA) was developed. METHOD This was a retrospect study completed between October 2019 and April 2020. A 71-year-old woman with massive and irreparable rotator cuff tears was enrolled in our study. The ATBA was folded into a double-layer structure. The superior layer (proximal portion) served as a bridge patch to dynamic the glenohumeral joint, while the inferior layer (distal portion) served as the superior capsule to restore static stability of glenohumeral joint. To enhance biologic healing on the glenoid side, we fixed the calcaneus of the graft on the superior-posterior side of the superior glenoid rim. The recovery of shoulder function (including strength, range of motion, acromiohumeral interval, and fatty infiltration) was assessed at 6 months postoperation. RESULT At 6-month follow-up, the patient's strength had improved significantly (from abduction of grade 3 preoperatively to grade 4 at 6 months). Radiographic analysis showed an increase in the acromiohumeral interval from 3 to 7 mm. Magnetic resonance imaging revealed an intact graft, with the thickness of the ligament part maintained (at 6-7 mm). Most importantly, recovery of atrophy and fatty infiltration of the supraspinatus were observed. No graft tears were observed on the glenoid side. CONCLUSION This technique could provide a preferable treatment option by restoring shoulder kinematics and augmentating biological healing for patients with massive irreparable RCT.
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Affiliation(s)
- Yamuhanmode Alike
- Department of Emergency, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing-Yi Hou
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi-Yong Tang
- Department of Orthopaedic Surgery, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Meng-Lei Yu
- Department of Emergency, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi Long
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fang-Qi Li
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - MaslahIdiris Ali
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hao Yuan
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Yang
- Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Zhang H, Jiang C. The Elongation of Biceps Muscle Tendon Unit After Rerouting of the Long Head of Biceps Tendon as Superior Capsular Augmentation: A Quantitative Measurement. Arthrosc Sports Med Rehabil 2020; 2:e531-e537. [PMID: 33134991 PMCID: PMC7588644 DOI: 10.1016/j.asmr.2020.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 06/16/2020] [Indexed: 02/05/2023] Open
Abstract
Purpose The purpose of this study was to investigate the elongation of the biceps muscle tendon unit after rerouting of the long head of the biceps tendon without transection, with and without release of the transverse humeral ligament in a 3-dimensional model. Methods A total of 60 sets of computed tomography images of shoulders were acquired, and a point-cloud model was generated after 3-dimensional reconstruction. Simulation of rerouting of the long head of the biceps tendon was performed by assuming that the long head of the biceps tendon travels to the center of the greater tuberosity from the supraglenoid tubercle and then back to the bicipital groove distally, with or without the release of the transverse humeral ligament. The elongation of the biceps muscle tendon unit by both manners was measured and correlated with age, height, weight, body mass index, gender, and hand dominance. Results The mean length of the long head of the biceps tendon is 74.22 ± 3.06 mm, and the length is significantly longer, at 112.23 ± 4.92 mm (P = 0.0002) and 96.47 ± 2.58 mm (P = 0.0004). The absolute elongation of the biceps muscle tendon unit after rerouting of the long head of the biceps tendon, without or with transverse humeral ligament release, showed significant differences, which were 38.73 ± 3.03 mm and 22.28 ± 3.25 mm, respectively (P = 0.0008). No significant correlations were observed between the amount of the elongation and the subject's age, height, weight, or body mass index. No significant difference was observed in the amount of the elongation between differing gender and hand dominance. Conclusions Rerouting of the long head of the biceps tendon resulted in significant elongation of the biceps muscle tendon unit. Release of the transverse humeral ligament partially decreased this elongation. Clinical Relevance Rerouting of the long head of the biceps tendon may lead to overtension of the biceps. If it is adopted in clinical use, transverse humeral ligament release is recommended.
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Affiliation(s)
- Hailong Zhang
- Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Chunyan Jiang
- Department of Sports Medicine, Beijing Jishuitan Hospital, Beijing, China
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Wang L, Kang Y, Chen S, Mo X, Jiang J, Yan X, Zhu T, Zhao J. Macroporous 3D Scaffold with Self-Fitting Capability for Effectively Repairing Massive Rotator Cuff Tear. ACS Biomater Sci Eng 2020; 7:904-915. [PMID: 33715366 DOI: 10.1021/acsbiomaterials.0c00193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The postoperative retear rate of direct repair of massive rotator cuff tear has risen up to 40% because of the dissatisfied tendon-to-bone healing and poor regenerative potential of remnant rotator cuff tissue. A biological scaffold that connects the remnant rotator cuff tissue and bone might be a promising substitute. In the present study, we have developed a macroporous three-dimensional scaffold poly(ester-urethane)urea (PEUU), with self-fitting capability employing thermally induced phase separation (TIPS) technique. The scaffold provides oriented connected macropores for cells migration, and promoted tendon-to-bone healing on the basis of surgical repair. The scaffolds were characterized by scanning electron microscopy, stress-strain test and cell biocompatibility study. In vitro studies exhibited that PEUU scaffold with suitable elastic mechanical properties can better support proliferation and migration of rabbit bone mesenchymal stem cells (RBMSCs). After three months postreconstruction of massive rotator cuff tear in a rabbit model using PEUU scaffold, there was complete regeneration of rotator cuff with physical tendon-to-bone interface and continuous tendon tissue, as observed from histological analysis. Further, biomechanical testing demonstrated that rotator cuff induced by PEUU scaffold had no significant difference as compared to normal rotator cuff. This macroporous, mechanically matched scaffold is potentially suitable for the application in massive rotator cuff repair. In conclusion, this study demonstrates the high efficiency of the macroporous 3D scaffold with self-fitting capability in facilitating rotator cuff regeneration.
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Affiliation(s)
- Liren Wang
- Department of Sports Medicine, Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai 200233, PR China
| | - Yuhao Kang
- Department of Sports Medicine, Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai 200233, PR China
| | - Sihao Chen
- Multidisciplinary Center for Advanced Materials, Advanced Research Institute, Shanghai University of Engineering Science, No. 333 Longteng Road, Shanghai 201620, PR China
| | - Xiumei Mo
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, No. 2999 North Renmin Road, Shanghai 201620, PR China
| | - Jia Jiang
- Department of Sports Medicine, Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai 200233, PR China
| | - Xiaoyu Yan
- Department of Sports Medicine, Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai 200233, PR China
| | - Tonghe Zhu
- Department of Sports Medicine, Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai 200233, PR China
| | - Jinzhong Zhao
- Department of Sports Medicine, Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, No. 600 Yishan Road, Shanghai 200233, PR China
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Kim JW, Nam DJ. Arthroscopic Superior Capsular Reconstruction by the Mini-Open Modified Keyhole Technique Using an Achilles Tendon-Bone Allograft. Arthrosc Tech 2020; 9:e275-e281. [PMID: 32099782 PMCID: PMC7029195 DOI: 10.1016/j.eats.2019.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/13/2019] [Indexed: 02/06/2023] Open
Abstract
The treatment of massive and irreparable rotator cuff tears remains a challenge for shoulder surgeons. When treating patients with chronic rotator cuff tears, especially those with severe fatty degeneration, severe tendon retraction, or muscle atrophy, the risk of re-tear and persistent severe pain persists. Therefore, surgeons can choose from numerous options. Superior capsular reconstruction (SCR) was introduced as a technique to maintain the stability of the upper shoulder and stabilize the muscles without repairing the supraspinatus and infraspinatus. Various autograft and allograft techniques have been developed. SCR performed using an autograft has the disadvantage of requiring harvesting the tensor fascia lata. Although allografts reduce harvest time, they also increase donor-site morbidity and the time required for healing. To solve the healing problem, we have introduced an SCR technique through grafting with the Achilles tendon-bone. Although this is an unproven technique for patients with chronic irreparable rotator cuff tears, our short-term outcomes seem promising. Further studies and follow-ups are needed to determine the success of this technique.
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Affiliation(s)
- Jeong Woo Kim
- Address correspondence to Jeong Woo Kim, Department of Orthopedic Surgery, Wonkwang University Hospital, 344-2 Shinyong-dong, Iksan, Jeollabuk-do, Korea.
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