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Joo MS, Lim GH, Kim JW, Sim GW, Kim JW. Superior Capsular Reconstruction with the mini open key-hole Technique using Achilles allograft demonstrates favorable outcomes for patients with preoperative pseudoparalysis but worse outcome and strength with longer duration pseudoparalysis. Arthroscopy 2024:S0749-8063(24)00517-6. [PMID: 39069019 DOI: 10.1016/j.arthro.2024.07.020] [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: 02/13/2024] [Revised: 07/11/2024] [Accepted: 07/13/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE The purpose of this study was to analyze whether unique SCR with key-hole technique using Achilles allograft can improve pseudoparalysis in patients with irreparable rotator cuff tears and additionally to identify preoperative factors that influence clinical outcomes. METHODS Between January 2018 and October 2021, patient data from SCR with our institution's unique key-hole technique using Achilles were retrospectively collected (minimum 2-years follow up). The patients were categorized into pseudoparalysis group (P group) and no pseudoparalysis group (NP group). Active range of motion (ROM) of shoulder, clinical scores (constant and pain visual analog scale scores) and muscle strength was assessed preoperatively and at 2-years postoperatively. And the correlation between preoperative and postoperative clinical data was analyzed through simple linear regression in the P group. RESULTS 69 patients who underwent SCR with key-hole technique using Achilles, were included in the study. Group P and NP had 24 and 45 cases, respectively. Preoperative ROM (FE, ER), constant score and muscle strength (FE, ER) were significantly lower in P group than NP group. At 2-year follow-up the active ROM (FE, p<0.001, ER, p<0.001), constant score, VAS, muscle strength (FE, p<0.001, ER, p<0.001) were improved in the P group. In P group, pseudoparalysis recovered in 21 out of 24 patients (87.5%) at 2-year after surgery. The minimum clinically important difference of patient reported outcomes (Constant Score / VAS) were 8.15/1.05 for the P group and 9.47/0.92 for the NP group. Among the 3 cases of recovery failed, 2 cases were due to graft failure, and 1 case had delayed recovery. Prolonged preoperative pseudoparalysis and weaker preoperative external rotation strength were associated with worse clinical outcomes. CONCLUSIONS Superior capsular reconstruction with mini open key-hole technique using Achilles allograft demonstrates favorable outcomes for patients with preoperative pseudoparalysis. However, for SCR with the pseudoparalyis patients the careful attention is needed because the longer pseudoparalysis duration and the weaker external rotation strength could have the tendency of worse postoperative outcomes.
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Affiliation(s)
- Min-Su Joo
- Department of Orthopedic surgery, Wonkwang university school of medicine, Iksan, Korea
| | - Gyeong-Hoon Lim
- Department of Orthopedic surgery, Wonkwang university school of medicine, Iksan, Korea
| | - Jae-Won Kim
- Department of Orthopedic surgery, Wonkwang university school of medicine, Iksan, Korea
| | - Gi-Woong Sim
- Department of Orthopedic surgery, Wonkwang university school of medicine, Iksan, Korea
| | - Jeong-Woo Kim
- Department of Orthopedic surgery, Wonkwang university school of medicine, Iksan, Korea.
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Pasqualini I, Brinkman JC, Tokish JM, Denard PJ. Surgical Management of Massive Irreparable Cuff Tears: Superior Capsule Reconstruction and Rotator Cable Reconstruction. Curr Rev Musculoskelet Med 2024; 17:101-109. [PMID: 38340293 PMCID: PMC10917707 DOI: 10.1007/s12178-024-09887-x] [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] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE OF REVIEW Massive irreparable rotator cuff tears (MIRCTs) present treatment challenges. Recently, superior capsule reconstruction (SCR) and anterior cable reconstruction have emerged as surgical options, but no single approach is superior. This review provides an overview of SCR and cable reconstruction techniques, including biomechanical studies, clinical outcomes, and surgical considerations. RECENT FINDINGS Biomechanical studies show SCR with autografts or allografts improves glenohumeral stability and mechanics. Clinical outcomes of SCR demonstrate improved range of motion, function scores, and pain relief in short-term studies. Anterior cable reconstruction reduces superior humeral head translation and subacromial pressures in biomechanical models. Early clinical studies report improved rotator cuff healing and outcomes for cable reconstruction in specific irreparable tear patterns. SCR and cable reconstruction are viable surgical options for MIRCTs based on early encouraging results. However, higher-level comparative studies with long-term follow-up are still needed. Careful consideration of tear pattern, patient factors, and surgical goals is required to optimize treatment of MIRCTs. Further research is necessary to determine the optimal role for these procedures.
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Affiliation(s)
| | | | - John M Tokish
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
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Marigi EM, Jackowski JR, Elahi MA, Barlow J, Morrey ME, Camp CL, Sanchez-Sotelo J. Improved Yet Varied Clinical Outcomes Observed With Comparison of Arthroscopic Superior Capsular Reconstruction Versus Arthroscopy-Assisted Lower Trapezius Transfer for Patients With Irreparable Rotator Cuff Tears. Arthroscopy 2023; 39:2133-2141. [PMID: 37142136 DOI: 10.1016/j.arthro.2023.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 05/06/2023]
Abstract
PURPOSE To evaluate the outcomes of arthroscopic superior capsular reconstruction (SCR) and arthroscopy-assisted lower trapezius tendon transfer (LTT) for posterosuperior irreparable rotator cuff tears (IRCTs). METHODS Over an almost 6-year period (October 2015 to March 2021), all patients who underwent IRCT surgery with a minimum 12-month follow-up period were identified. For patients with a substantial active external rotation (ER) deficit or lag sign, LTT was preferentially selected. Patient-reported outcome scores included the visual analog scale (VAS) pain score, strength score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Single Assessment Numeric Evaluation (SANE) score, and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. RESULTS We included 32 SCR patients and 72 LTT patients. Preoperatively, LTT patients had more advanced teres minor fatty infiltration (0.3 vs 1.1, P = .009), a higher global fatty infiltration index (1.5 vs 1.9, P = .035), and a higher presence of the ER lag sign (15.6% vs 48.6%, P < .001). At a mean follow-up of 2.9 ± 1.3 years (range, 1.0-6.3 years), no differences in patient-reported outcome scores were observed. Postoperatively, SCR patients had a lower VAS score (0.3 vs 1.1, P = .017), higher forward elevation (FE) (156° vs 143°, P = .004), and higher FE strength (4.8 vs 4.5, P = .005) and showed greater improvements in the VAS score (6.8 vs 5.1, P = .009), FE (56° vs 31°, P = .004), and FE strength (1.0 vs 0.4, P < .001). LTT patients showed greater improvement in ER (17° vs 29°, P = .026). There was no statistically significant between-cohort difference in complication rate (9.4% vs 12.5%, P = .645) or reoperation rate (3.1% vs 10%, P = .231). CONCLUSIONS With adequate selection criteria, both SCR and LTT provided improved clinical outcomes for posterosuperior IRCTs. Additionally, SCR led to better pain relief and restoration of FE whereas LTT provided more reliable improvement in ER. LEVEL OF EVIDENCE Level III, treatment study with retrospective cohort comparison.
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Affiliation(s)
- Erick M Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Jacob R Jackowski
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | | | - Jonathan Barlow
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Mark E Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Christopher L Camp
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
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Crook BS, Lorenzana DJ, Danilkowicz R, Herbst K, Wittstein JR, Toth AP, Lassiter T, Lau BC. Early clinical and patient-reported outcomes for arthroscopic and mini-open superior capsular reconstruction are similar for irreparable rotator cuff tears. J ISAKOS 2023; 8:338-344. [PMID: 37414217 DOI: 10.1016/j.jisako.2023.06.005] [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: 06/07/2022] [Revised: 06/12/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVES The purpose of this study was to report and compare postoperative range of motion (ROM), patient-reported outcomes, and failure rates following superior capsular reconstruction (SCR) and to compare outcomes between arthroscopic and mini-open techniques. METHODS All SCR procedures utilising dermal allograft with a minimum of 6 months of follow-up at multiple institutions between November 2015 and October 2019 were retrospectively reviewed. Preoperative patient demographics, imaging measurements, surgical technique (arthroscopic versus mini-open), and outcomes including pain scores, conversion to reverse shoulder arthroplasty, subsequent surgery, and postoperative ROM were recorded. Outcomes for arthroscopic versus mini-open approaches were compared via t-test, Fisher's exact test, or chi square test, as appropriate, with differences of p < 0.05 considered significant. RESULTS 180 total patients were included, including 98 who underwent arthroscopic SCR and 82 who underwent mini-open SCR. Final follow-up was at a mean of 32 months (standard deviation = 11 months). SCR improved pain (visual analog scale = 4.4 pre-operatively vs. 1.4 post-operatively, p < 0.0001) and ROMin active forward flexion (136° pre-operatively vs. 150° post-operatively, p = 0.0012). No difference in post-operative pain visual analog scores was found between mini-open and arthroscopic cohorts (1.3 vs. 1.6, p = 0.3432) at a mean of 14 months post-operatively. At a mean of 32 months post-operatively, there were no differences in ASES, QuickDASH, SST, WORC, or SANE scores between open and arthroscopic cohorts. There was no difference in rates of failure between mini-open and arthroscopic cohorts (15.9% vs. 17.3%, p = 0.789). CONCLUSIONS This study confirmed that SCR improves pain and ROM in the short term. Mini-open SCR appears to provide similar improvements in pain and ROM compared with arthroscopic SCR, as well as patient-reported outcomes at 3 years. No difference in failure rates was detected between the 2 procedures. LEVEL OF EVIDENCE Level 3 evidence.
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Kizilay YO, Güneş Z, Turan K, Aktekin CN, Uysal Y, Kezer M, Camurcu Y. Volumetric Analysis of Subacromial Space After Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears. Indian J Orthop 2023; 57:967-974. [PMID: 37214362 PMCID: PMC10192490 DOI: 10.1007/s43465-023-00881-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/24/2023] [Indexed: 05/24/2023]
Abstract
Purpose Subacromial volume measurement on magnetic resonance images is relatively new. It has been shown that decreased subacromial volume increases after surgical repair of full-thickness rotator cuff tears. There is no study examining subacromial volume changes after superior capsular reconstruction (SCR). The purpose of this study was to compare subacromial volume changes on magnetic resonance images (MRI) after superior capsular reconstruction performed for primary irreparable rotator cuff tears. Methods Patients who underwent an SCR procedure between 2017 and 2019 with a minimum 2-year postoperative follow-up were included in this retrospective study. Subacromial volume was measured on MRI using software. The preoperative and postoperative acromiohumeral distance, Constant Scores, graft thickness, and Hamada grades of the patients were evaluated. Results A total of 18 patients with a mean age of 59.7 years (range: 49-74 years) underwent an SCR for massive irreparable cuff tear. The mean preoperative subacromial volume was 3.54 ± 0.39 cm3 (range 2.88-4.36 cm3), which increased to 4.46 ± 0.39 cm3 (range 3.75-5.32 cm3) postoperatively (p = < 0.001). The increase in subacromial volume and acromiohumeral distance did not correlate with Constant scores and graft thickness. We observed a significantly higher subacromial volume increase among Hamada grade 1 patients, compared to those with Hamada grade 2 (p = 0.011). Conclusions We observed that subacromial volume significantly increased after superior capsular reconstruction. However, the increase in subacromial volume did not correlate with clinical scores, acromiohumeral distance changes, or graft thickness.Level of evidence: Level III - Retrospective Cohort Study.
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Affiliation(s)
- Yusuf Onur Kizilay
- Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul Atlas University, Anadolu Caddesi 40, Kagithane, 34408 Istanbul, Turkey
| | - Zafer Güneş
- Ankara, Turkey Department of Orthopedics and Traumatology, Ankara Training and Research Hospital
| | - Kayhan Turan
- Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul Atlas University, Istanbul, Turkey
| | - Cem Nuri Aktekin
- Ankara, Turkey Faculty of Medicine, Department of Orthopedics and Traumatology, Ankara Yıldırım Beyazıt University
| | - Yunus Uysal
- Department of Orthopedics and Traumatology, Bursa Osmangazi Aritmi Hospital, Bursa, Turkey
| | - Murat Kezer
- Department of Orthopedics and Traumatology, Bursa Osmangazi Aritmi Hospital, Bursa, Turkey
| | - Yalkin Camurcu
- Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul Atlas University, Istanbul, Turkey
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Ganokroj P, Peebles AM, Vopat ML, Provencher MT. Superior Capsular Reconstruction for Irreparable Rotator Cuff Tear. Clin Sports Med 2023; 42:109-124. [DOI: 10.1016/j.csm.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Alfaqih MA, Morrison WB. Postoperative MR Imaging of the Rotator Cuff. Magn Reson Imaging Clin N Am 2022; 30:617-627. [DOI: 10.1016/j.mric.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vaudreuil NJ, Dooney T, Lee TQ, Limpisvasti O. Shoulder Surgeon Techniques and Preferences in Treatment of Massive Rotator Cuff Tears: Current Practices for Rotator Cuff Repair and Superior Capsule Reconstruction. JSES Int 2022; 6:978-983. [DOI: 10.1016/j.jseint.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Cromheecke M, Garret J, Deranlot J, Bonnevialle N, Gaudin S, Lädermann A, Nourissat G. Low healing rates and moderate functional outcome after arthroscopic superior capsular reconstruction using a porcine xenograft. Knee Surg Sports Traumatol Arthrosc 2022; 30:2528-2534. [PMID: 35199186 DOI: 10.1007/s00167-022-06916-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 02/07/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE In the absence of arthropathy, symptomatic massive irreparable rotator cuff tears contribute to a therapeutic challenge for orthopedic surgeons. The concept of superior capsular reconstruction (SCR) was introduced as an option for these challenging cases. The purposes of this study were to evaluate the clinical outcome scores when using a decellularized porcine xenograft and to evaluate the graft healing and incorporation. METHODS A multicentric retrospective study of consecutive SCR's performed between 2016 and 2019 by four surgeons in four centers. Preoperative and postoperative Constant score, Subjective shoulder value (SSV) and Visual analog scale for pain (VAS) were recorded. Graft healing was evaluated by ultrasound or magnetic resonance imaging (MRI). RESULTS A total of 28 shoulders were retrospectively analyzed with an average follow-up of 24 ± 9 months. One infection and four revisions (14%) to reversed shoulder arthroplasty (RSA) were reported at the final follow-up. The absolute Constant score showed a moderate, but significant improvement from 40 ± 12 to 57 ± 20 (P = 0.001). A significant improvement in pain scores was observed (P < 0.001). For patients undergoing SCR as a primary surgery, an average postoperative Constant score of 62 ± 16 was observed. This was in contrast to 43 ± 22 for patients who underwent SCR after failed rotator cuff repair. Although a strong trend in absolute differences was observed in regard to the Constant score, they did not reach statistical significance. For all other recorded outcome scores, a significant difference was reported between these groups. Graft healing was observed in (7/22) 30% of the patients. In the case of graft incorporation, an absolute constant score of 70 ± 9 was observed compared to 48 ± 21 in the graft failure group (P = 0.003). All cases with graft healing were considered to have a successful clinical outcome. This compared to only (7/15) 47% in the case of graft failure. CONCLUSIONS In these series, SCR with a dermal xenograft successfully alleviated pain, but provided only a moderate improvement in functional outcome. In the case of graft healing, satisfactory clinical outcomes and patient satisfaction were observed. The present study indicates the benefit of performing SCR as a primary surgery, yet warns against using SCR as a salvage option for failed rotator cuff repair. In this group, the use of dermal xenografts is limited by the low healing rates and high complication rate. LEVEL OF EVIDENCE IV. Retrospective case series, treatment study.
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Affiliation(s)
- Michiel Cromheecke
- Clinique du parc de Lyon, 155 boulevard Stalingrad, 69006, Lyon, France. .,AZ Maria Middelares, Buitenring-Sint-Denijs 30, 9000, Ghent, Belgium.
| | - Jérôme Garret
- Clinique du parc de Lyon, 155 boulevard Stalingrad, 69006, Lyon, France
| | | | - Nicolas Bonnevialle
- Hôpital Pierre Paul Riquet, Allée Jean Dausset, 31059, Toulouse Cedex 09, France.,Institut de Recherche Riquet (I2R), Place du Docteur Baylac, 31059, Toulouse, France
| | - Samuel Gaudin
- Clinique du parc de Lyon, 155 boulevard Stalingrad, 69006, Lyon, France
| | - 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
| | - Geoffroy Nourissat
- Clinique des Maussins - Ramsay Santé, 69 rue de Romainville, 75019, Paris, France
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Cheppalli NS, Purudappa PP, Metikala S, Reddy KI, Singla A, Patel HA, Kamineni S. Superior Capsular Reconstruction Using the Biceps Tendon in the Treatment of Irreparable Massive Rotator Cuff Tears Improves Patient-Reported Outcome Scores: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e1235-e1243. [PMID: 35747666 PMCID: PMC9210484 DOI: 10.1016/j.asmr.2022.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/08/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To systematically evaluate the clinical outcomes of superior capsular reconstruction (SCR) using the long head of the biceps tendon for irreparable massive rotator cuff tears. Methods Multiple electronic databases were searched for studies treating massive and/or irreparable rotator cuff tears with SCR using the biceps tendon while retaining its proximal attachment to the superior glenoid. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) flowchart was created. All the included studies were assessed for quality with the Modified Coleman Methodology Score. Multiple variables including patient demographic characteristics, functional scores, visual analog scale (VAS) scores, and complications were extracted and analyzed. Results Seven studies were included in this review, with a total of 133 patients. The age range of patients was 39 to 82 years, and the duration of follow-up ranged from 6 to 40.7 months. Various validated scoring systems were used for functional outcome evaluation in all studies; all of them showed postoperative improvement greater than the minimal clinically important difference. The VAS score improvement ranged from 3.8 to 7.1. Five studies reported improvement in shoulder forward elevation, with a range of 22° to 95°. Three studies reported retear rates of 21%, 37%, and 66% on postoperative magnetic resonance imaging scans. Two studies reported complications, with the first study reporting revision surgery in 4 of 35 patients and the second study reporting 1 infection and 1 case of deltoid detachment (open procedure) among 17 patients. Conclusions SCR using the long head of the biceps tendon is a safe and effective procedure. VAS and patient-reported outcome scores showed significant improvement with minimal short-term complications. Level of Evidence Level IV, systematic review of Level III and IV studies.
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Follow-up on a Biological Revision Technique for Large, Recurrent, Retracted, Rotator Cuff Tears. J Am Acad Orthop Surg 2022; 30:e487-e494. [PMID: 34989716 DOI: 10.5435/jaaos-d-21-00556] [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: 05/12/2021] [Accepted: 11/03/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Revision of large recurrent rotator cuff tears by simple repair has a structural failure rate of 40% to 90%. The author presents a minimum 2-year follow-up study of revision rotator cuff reconstructions using a bridging patch graft composed of autogenous biceps tendon saturated with concentrated autologous iliac bone marrow, to determine how the technique compares to the reported outcome of simple repair as a treatment alternative. METHODS The principal entrance criterion was a symptomatic rotator cuff retear with retraction creating a 3- to 5-cm defect. Twenty-five consecutive patients (with an average age of 62 years) were enrolled. Twenty-two (88%) were available for follow-up at 24 to 120 months (mean 68 months) for interview and examination. Questionnaires using Constant, American Shoulder and Elbow Surgeons, and University of California at Los Angeles (UCLA) Shoulder scores were completed. In the terminal 15 patients, the presence of viable marrow mesenchymal cells fixed to the tendon graft at the time of implantation was determined by histological verification. Rotator cuff integrity was evaluated by ultrasonography examination. The Wilcoxon rank-sum test was used to compare nonparametric preoperative with postoperative questionnaire outcome scores. RESULTS Twenty of 22 patients (91%) demonstrated an intact tendon construct. Two of 22 patients (9%) demonstrated structural failure. Viable mesenchymal cells were identified on all graft specimens in high concentration. All patients showed improved results: The mean Constant score increased from 13 to 76; American Shoulder and Elbow Surgeons from 17 to 81; UCLA from 6 to 29 (P < 0.001). DISCUSSION The autogenous graft/marrow technique consistently and successfully reconstructed a large, recurrent rotator cuff tear in a clinical setting where the primary cuff repair had failed. The observation that an autogenous tendon graft saturated with concentrated marrow has the biological potential to reconstruct a difficult soft-tissue defect in the shoulder strongly implies its potential as a reconstructive tool for other soft-tissue defects.
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Superior Capsular Reconstruction: A Salvage Option for Massive Irreparable Rotator Cuff Tears with Pseudoparalysis or Subscapularis Insufficiency. Arthroscopy 2022; 38:253-261. [PMID: 34052375 DOI: 10.1016/j.arthro.2021.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We sought to examine superior capsular reconstruction (SCR) outcomes after minimum 2-year follow-up and determine risk factors that were predictive of outcomes. METHODS Forty consecutive patients (mean age 57.3 years, 87.5% male) who underwent SCR for massive irreparable rotator cuff tears (RCT) met the inclusion criteria. Minimum 2-year follow-up was obtained for 32 patients (80% follow-up). Patient demographics and preoperative clinical findings were collected. Postoperative data, including complications, patient satisfaction, strength and range-of-motion (ROM), and patient-reported outcomes were collected. RESULTS The Hamada score was ≤2 in 88% with average acromiohumeral interval distance of 6.8 mm. Preoperatively, 6 patients had external rotation lag (19%) and 6 had pseudoparalysis (19%). Intraoperative assessment of the subscapularis demonstrated true insufficiency in 38%. There was significant improvement in forward elevation (FE) (31° increase; P = .007) and strength in all planes (all P < .05). Patient-reported outcomes significantly improved (American Shoulder and Elbow Surgeon [ASES] 34-point increase; visual analog scale [VAS] 2.9-point decrease; single alpha-numeric evaluation [SANE] 48-point increase; all P < .05). Twenty-six patients (81%) were completely or somewhat satisfied with surgery. At time of final follow-up, 3/32 patients (9%) failed SCR and converted to reverse total shoulder arthroplasty. There were 4 (13%) reported complications (2 patients had postoperative falls; 1 patient had persistent severe pain; 1 had persistent stiffness). One patient was deceased. Patients with pseudoparalysis (n = 6) had significant improvement in post-operative FE (28 vs 154°; P < .0001) and SANE score (P = .016) with 66% patient satisfaction. However, outcome scores overall remained lower than SCR without pseudoparalysis. Regarding subscapularis insufficiency (n = 12), significant improvement was seen in postoperative FE (108 vs 158°; P = .019) and patient-reported outcome scores (P < .005). In patients converted from SCR to reverse total shoulder arthroplasty (n = 3), there were no distinguishing characteristics present. CONCLUSION Superior capsular reconstruction is an effective salvage operation for massive irreparable RCT. Patients with pseudoparalysis or subscapularis insufficiency demonstrate significant postoperative improvement in FE and patient-reported outcomes. LEVEL OF EVIDENCE IV, retrospective cohort.
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Labib M, Amirouche F, Pradhan S, Bobko A, Koh J. A Biomechanical Analysis of Shoulder Muscle Excursions During Abduction, After the Treatment of Massive Irreparable Rotator Cuff Tears Using Superior Capsular Reconstruction (SCR), Bursal Acromial Reconstruction (BAR), and SCR with BAR. J Shoulder Elb Arthroplast 2022; 6:24715492221109001. [PMID: 35782774 PMCID: PMC9240589 DOI: 10.1177/24715492221109001] [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: 03/20/2022] [Revised: 05/19/2022] [Accepted: 06/02/2022] [Indexed: 01/17/2023] Open
Abstract
Introduction Current understanding of the biomechanical effects of treatment options for irreparable rotator cuff (RC) tears is lacking. This study examines how shoulder muscle lengths and excursions are affected by superior capsular reconstruction (SCR), bursal acromial reconstruction (BAR), and SCR with BAR, following a complete supraspinatus tear. Method Six fresh-frozen cadaveric shoulders were examined. Deltoid and RC muscle lengths were measured at 0, 30, 45, 60, and 90° of shoulder abduction under six conditions: (1) intact, (2) partially torn supraspinatus, (3) completely torn supraspinatus, (4) SCR, (5) SCR with BAR, and (6) BAR. Muscle excursions from 0–90° of abduction were then calculated. Results Subscapularis muscle lengths after SCR, BAR, and SCR with BAR were significantly greater (post-hoc Tukey HSD test; p < .01) compared to the other conditions. Supraspinatus, infraspinatus, teres minor, and deltoid lengths were not significantly different (ANOVA test; p > .01) between the conditions. All muscle excursions remained statistically similar between the conditions (ANOVA test; p > .01). Conclusion These findings demonstrate that the use of SCR, BAR, or SCR with BAR for a complete supraspinatus tear, may increase subscapularis muscle length while maintaining other shoulder muscle lengths. An increase in subscapularis length can allow for more effective subscapularis muscle strengthening and increased compensatory function in the long term. Additionally, all shoulder muscle excursions are preserved after partial or complete supraspinatus tears and after SCR, BAR, or SCR with BAR. Therefore, these surgical treatments can initially normalize shoulder muscle function during 0–90° of abduction, after an irreparable supraspinatus tear.
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Affiliation(s)
- Michael Labib
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Farid Amirouche
- Department of Orthopaedics, University of Illinois, Chicago, IL, USA
- Department of Orthopaedics, NorthShore University HealthSystem, Evanston, IL, USA
| | - Sonia Pradhan
- Department of Orthopaedics, University of Illinois, Chicago, IL, USA
| | - Aimee Bobko
- Department of Orthopaedics, University of Illinois, Chicago, IL, USA
| | - Jason Koh
- Department of Orthopaedics, NorthShore University HealthSystem, Evanston, IL, USA
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Hanson CD, Thompson JC, Checketts JX, Beason DP, Pille C, Lemak L. Increased Bite Distance From the Edge Lowers Risk of Pullout of Simple Sutures from Acellular Dermal Allograft. Arthrosc Sports Med Rehabil 2021; 3:e1513-e1516. [PMID: 34712988 PMCID: PMC8527321 DOI: 10.1016/j.asmr.2021.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 06/29/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose To investigate whether pullout strength in the acellular dermal allograft matrix (ADM) used for superior capsule reconstruction depends on the distance from the edge of the graft. Methods ADM used for superior capsule reconstruction was obtained and cut into 30 squares. Two sutures were placed through the center of each graft by using a loaded Keith needle and forming a simple stitch. The grafts were divided into 3 groups of 10 grafts with a distance of 5 mm, 10 mm or 15 mm from the closest edge of the graft, respectively. The grafts were then preloaded to 5 N and pulled to failure at a rate of 12 mm/s on an MTS 858 MiniBionix servohydraulic mechanical test frame. The load to failure was recorded as well as the stiffness of each graft. Results The mean load to failure was 34.5 N (SD 7.89) for the 5 mm grafts, 31.7 N (SD 5.99) for the 10 mm grafts, and 66.2 N (SD 18.4) for the 15 mm grafts. There was a significant difference (< 0.0001) between the large grafts (15 mm) and the 2 smaller grafts (10 mm, 5 mm). There was no significant difference in stiffness between the groups of graft (P 0.40). Conclusion Placing the suture at least 15 mm from the edge of the graft increases the graft's ultimate yield strength to suture pullout. Clinical Relevance The depths of the suture in ADM could improve pullout strength for constructs of superior capsular reconstructions.
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Affiliation(s)
- Chad D Hanson
- Oklahoma State University Medical Center, Department of Orthopaedic Surgery, Tulsa, Oklahoma
| | - Jay C Thompson
- Oklahoma State University Medical Center, Department of Orthopaedic Surgery, Tulsa, Oklahoma
| | - Jake X Checketts
- Oklahoma State University Medical Center, Department of Orthopaedic Surgery, Tulsa, Oklahoma
| | - David P Beason
- American Sports Medicine Institute, Lemak Health, Birmingham, Alabama, U.S.A
| | - Craig Pille
- American Sports Medicine Institute, Lemak Health, Birmingham, Alabama, U.S.A
| | - Lawrence Lemak
- American Sports Medicine Institute, Lemak Health, Birmingham, Alabama, U.S.A
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15
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Wong I, Sparavalo S, King JP, Coady CM. Bridging Allograft Reconstruction Is Superior to Maximal Repair for the Treatment of Chronic, Massive Rotator Cuff Tears: Results of a Prospective, Randomized Controlled Trial. Am J Sports Med 2021; 49:3173-3183. [PMID: 34494901 PMCID: PMC8485417 DOI: 10.1177/03635465211039846] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite advances in surgical techniques, the use of maximal repair to treat large or massive rotator cuff tears results in a high retear rate postoperatively. Currently, no randomized controlled trials have compared the outcomes of maximal repair with interposition dermal allograft bridging reconstruction. HYPOTHESIS We hypothesized that large or massive rotator cuff tendon tears reconstructed using bridging dermal allograft would have better clinical outcomes 2 years postoperatively, as measured using the Western Ontario Rotator Cuff (WORC) index, than would those receiving the current gold standard treatment of debridement and maximal repair alone. We also expected that patients treated via bridging reconstruction using dermal allograft would have fewer postoperative failures as assessed using postoperative magnetic resonance imaging scans. STUDY DESIGN Randomized controlled trial; Level of evidence 1. METHODS A sample size of 30 patients (determined using a priori sample size calculation) with massive, retracted rotator cuff tears were randomly allocated to 1 of 2 groups: maximal repair or bridging reconstruction using dermal allograft. All patients completed questionnaires (WORC and Disabilities of the Arm, Shoulder and Hand [DASH]) preoperatively and postoperatively at 3 months, 6 months, 1 year, and 2 years. The primary outcome of this study was the WORC index at 2 years. Secondary outcomes included healing rate, progression of rotator cuff arthropathy, and postoperative acromiohumeral distance in both groups. RESULTS Patients treated via bridging reconstruction using dermal allograft had better postoperative WORC and DASH scores (23.93 ± 24.55 and 15.77 ± 19.27, respectively) compared with patients who received maximal repair alone (53.36 ± 31.93 and 34.32 ± 23.31, respectively). We also noted increased progression to rotator cuff arthropathy in the maximal repair group with an increased retear rate when compared with the reconstruction group (87% and 21%, respectively; P < .001). The acromiohumeral distance was maintained in the reconstruction group but significantly decreased in the maximal repair group. CONCLUSION Rotator cuff bridging reconstruction using a dermal allograft demonstrated improved patient-reported outcomes as measured using the WORC index 2 years postoperatively. This technique also showed favorable structural healing rates and decreased progression to arthropathy compared with maximal repair. TRIAL REGISTRATION ClinicalTrials.gov (NCT01987973).
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Affiliation(s)
- Ivan Wong
- Dalhousie University, Halifax, Nova
Scotia, Canada,Ivan Wong, MD, MACM, Dip
Sports Med, Department of Surgery, Faculty of Medicine, Dalhousie University,
5955 Veteran’s Memorial Lane, Room 2106 VMB, Halifax, NS B3H2E1, Canada (
)
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16
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Khan M. Editorial Commentary: Superior Capsular Reconstruction: Indications and Proper Technique Results in Good Outcomes but Reports of Complications. Arthroscopy 2021; 37:2973-2974. [PMID: 34481632 DOI: 10.1016/j.arthro.2021.05.047] [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: 05/09/2021] [Accepted: 05/12/2021] [Indexed: 02/02/2023]
Abstract
Superior capsular reconstruction is a minimally invasive option to treat massive irreparable rotator cuff tears. In the appropriately selected patient, available data suggest that while the procedure generally results in improved function, there is a not insignificant risk of complications. Moreover, the rate of complications is likely underestimated given that outcomes are typically published by those with significant technical expertise. The literature supports improved outcomes in patients without significant degenerative change (less than Hamada 3) along with an intact or repairable subscapularis. Graft failure is the most common complication, and appropriate graft selection (ideally at least 4 mm thick) and careful preparation are essential. Additionally, surgeons could consider 3 anchors on the glenoid to provide secure fixation and a double-row transosseous equivalent construct on the humerus. To prevent suture pullout or excessive tension on the graft, it is important to maintain a sufficient border of graft and measure the graft in 30° of forward elevation and 30° of abduction. Additional fixation with posterior side-to-side repair of the graft to the infraspinatus has been reported to improve biomechanical properties of the construct. Existing research is skewed toward low-level evidence at high risk of bias and the reported results of high-volume surgeons. High-quality pragmatic trials are required to truly understand the optimal indications and real-world outcomes of the superior capsular reconstruction.
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17
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Saithna A. Editorial Commentary: Human Dermal Allograft Is Preferable to Fascia Lata Autograft Based on Similar Outcomes Without Donor-Site Morbidity. Arthroscopy 2021; 37:2797-2799. [PMID: 34481620 DOI: 10.1016/j.arthro.2021.05.037] [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: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 02/02/2023]
Abstract
Superior capsular reconstruction (SCR) is increasingly considered a "game-changer" for young patients with irreparable rotator cuff tears. Popular graft choices include fascia lata autograft (FLA) and human dermal allograft (HDA), with the latter strongly preferred in North America and Europe. Despite that, there seems to be a general perception that FLAs are associated with better healing rates due to better biology. However, critical analysis of the literature demonstrates abundant limitations that preclude strong conclusions about whether one graft type is optimal. Furthermore, recent studies have demonstrated that HDAs used for SCR have good healing potential and are also associated with generally good short-term clinical outcomes. A clinical pearl is that humeral sided repair failures are not uncommon, and double-row repair techniques should be thoughtfully considered. The main downside of FLAs is the associated donor site morbidity. Given the lack of proven advantage of FLAs, the impetus to move away from the current trend to use HDAs is low.
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18
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Gomes N, Fonte H, Santos S, Sousa D. Subacromial resurfacing with fascia lata autograft for irreparable cuff tears : JEO 2021 expert opinion short report & surgical technique with video. J Exp Orthop 2021; 8:64. [PMID: 34402998 PMCID: PMC8371057 DOI: 10.1186/s40634-021-00359-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/02/2021] [Indexed: 11/11/2022] Open
Abstract
Massive and irreparable rotator cuff tears remain a major challenge for orthopaedic surgeons and several surgical options have been accepted for different patterns of irreparable cuff tears. However, the high-cost and technical complexity of some surgeries and the inconsistent clinical results of others, leave room for the search for surgical options that can offer a good balance between technical simplicity, a lower cost and an acceptable clinical result.The rationale behind some available techniques includes lowering the humeral head, which enables a more efficient balance of the force couples around the shoulder during rehabilitation. The interpositional arthroplasty with a biodegradable balloon, the Superior Capsule Reconstruction and, more recently, subacromial resurfacing with a dermal allograft have been presented as valid options to address that purpose.This technical note presents Subacromial Resurfacing with fascia lata as an option for the treatment of irreparable rotator cuff tears in the elderly population. Its low-cost and reasonable technical demand, along with the need for further elucidation of the ideal indications and technical optimization of other available techniques may open up room for the success of this option.
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Affiliation(s)
- Nuno Gomes
- Hospital da Luz Arrábida, Porto, Portugal
- Hospital das Forças Armadas, Porto, Portugal
- Centro Hospitalar Póvoa de Varzim - Vila do Conde, Póvoa de Varzim, Portugal
| | - Helder Fonte
- Hospital das Forças Armadas, Porto, Portugal
- Centro Hospitalar do Porto, Porto, Portugal
| | - Sara Santos
- Hospital das Forças Armadas, Porto, Portugal
- Centro Hospitalar de S. João, Porto, Portugal
| | - Duarte Sousa
- Centro Hospitalar Póvoa de Varzim - Vila do Conde, Póvoa de Varzim, Portugal
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Griffin JW, Runzo D, Bonner KF. Arthroscopic Biologic Interpositional Tuberosity Graft for the Treatment of Irreparable Rotator Cuff Tears. Arthrosc Tech 2021; 10:e1729-e1735. [PMID: 34336571 PMCID: PMC8322624 DOI: 10.1016/j.eats.2021.03.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/15/2021] [Indexed: 02/03/2023] Open
Abstract
Massive, irreparable rotator cuff tears in younger, more active patients present a unique treatment challenge to shoulder surgeons. In the past few years, new techniques continue to emerge to address this challenging problem. The superior capsular reconstruction technique has been accepted as an option for addressing this problem. While initial results are encouraging, pitfalls remain regarding technical challenges, healing and protracted rehabilitation due to delayed motion protocols. We present an alternative approach to the massive, irreparable rotator cuff tears using a biologic interpositional humeral -based graft.
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Affiliation(s)
- Justin W. Griffin
- Jordan-Young Institute for Orthopaedic Surgery & Sports Medicine, Virginia Beach, Virginia, U.S.A.,Eastern Virginia Medical School, Norfolk, Virginia, U.S.A.,Address correspondence to Justin W. Griffin, M.D., Jordan-Young Institute for Orthopaedic Surgery & Sports Medicine, 5716 Cleveland St, #200, Virginia Beach, VA 23462, U.S.A.
| | - Dustin Runzo
- Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Kevin F. Bonner
- Jordan-Young Institute for Orthopaedic Surgery & Sports Medicine, Virginia Beach, Virginia, U.S.A.,Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
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20
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Ferrando A, Kingston R, Delaney RA. Superior capsular reconstruction using a porcine dermal xenograft for irreparable rotator cuff tears: outcomes at minimum two-year follow-up. J Shoulder Elbow Surg 2021; 30:1053-1059. [PMID: 32890682 DOI: 10.1016/j.jse.2020.08.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE To evaluate midterm outcomes of arthroscopic superior capsular reconstruction (SCR) using a decellularized porcine dermal xenograft in patients with massive, irreparable rotator cuff tears and to determine the influence of concomitant, repairable subscapularis tears. METHODS This is a retrospective study of 56 patients with a minimum 2-year follow-up. Preoperative and postoperative range of motion, American Shoulder and Elbow Surgeons score, Subjective Shoulder Value, and visual analog score for pain were measured. Postoperative data were collected at 3, 6, 12, 24, and 36 months. RESULTS Of the 56 patients who underwent arthroscopic SCR, there were 39 men and 17 women. The mean age at operation was 65 ± 9 years, and the mean follow-up was 34 ± 8 months. The mean preoperative American Shoulder and Elbow Surgeons improved from 41 ± 19 to 78 ± 18 at 24 weeks, to 86± 16 at 12 months, and to 90±9 at 24 months, P < .0001. Similarly, the mean preoperative Subjective Shoulder Value improved from 39 ± 17 to 74 ± 18 at 24 weeks, to 80 ± 18 at 12 months, and to 80 ± 11 at 24 months, P < .0001. The mean preoperative visual analog score improved from 6.5 ± 2.1 to 1.4 ± 2.2 at 24 weeks, to 0.7± 1.1 at 12 months, and to 0.2 ± 0.4 at 24 months, P < .0001. There were no differences in outcome scores between patients with intact vs. repaired subscapularis. Similarly, no statistically significant differences were found in forward flexion or external rotation after SCR between patients with an intact vs. repaired subscapularis. Failure of the SCR graft was observed on magnetic resonance imaging in 14 patients, 4 of whom opted for revision to reverse shoulder arthroplasty. Eleven patients were truly pseudoparalytic before surgery; in 5 cases, pseudoparalysis was reversed after SCR. CONCLUSIONS SCR can alleviate pain and disability from irreparable rotator cuff tears and provide significant improvements in shoulder function; however, the xenograft technique resulted in inconsistent reversal of true pseudoparalysis. No difference was found between patients who required concomitant subscapularis repair vs. those who did not.
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Affiliation(s)
- Albert Ferrando
- Departamento de Traumatología y Cirugía Ortopédica, Hospital Universitari Sant Joan de Reus, Reus, Spain.
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21
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Editorial Commentary: Optimizing Indications for Shoulder Superior Capsular Reconstruction: Choose the Right Patient at the Right Time! Arthroscopy 2021; 37:468-469. [PMID: 33546785 DOI: 10.1016/j.arthro.2020.12.178] [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: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 02/02/2023]
Abstract
Superior capsular reconstruction has gained popularity for the management of massive, irreparable rotator cuff tears in young patients with minimal glenohumeral arthritis. Short-term outcomes show significant improvements in pain and function. However, the failure rate has been reported to range from 3% to 36%, with higher failure rates in women and patients with subscapularis tears, a greater body mass index, lower preoperative forward flexion, a lower preoperative acromiohumeral distance, subscapularis atrophy, and advanced rotator cuff arthropathy. Inadequate restoration of the acromiohumeral distance and poor integrity of posterior remnant tissue postoperatively have also been associated with an increased risk of retear. Currently accepted indications include younger patients (aged < 65-70 years) with irreparable, massive rotator cuff tears involving the supraspinatus and infraspinatus with minimal arthritis, an intact or repairable subscapularis, and a functional deltoid without bony deficiency, stiffness, or advanced arthropathy.
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22
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Campbell AL, Baron SL, Pham H, Gyftopoulos S, Meislin R, Samim M. MRI of superior capsular reconstruction graft and associated short-term clinical outcomes in patients with massive irreparable rotator cuff tears. Clin Imaging 2020; 70:74-80. [PMID: 33129183 DOI: 10.1016/j.clinimag.2020.10.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/29/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess MRI appearance of the dermal allograft and its correlation with clinical outcome following superior capsular reconstruction (SCR). MATERIALS AND METHODS This is a retrospective study of patients who underwent SCR between 2015 and 2018. Patients with postoperative MRI and clinical follow-up were included. Exclusion criteria were preoperative shoulder instability, advanced glenohumeral arthritis, and lack of postoperative MRI or clinical follow-up. Radiographs and MRIs were evaluated for graft integrity and position, acromiohumeral interval, superior subluxation distance (SSD), and glenohumeral cartilage loss. Correlation between imaging and clinical outcome measures were assessed. RESULTS 24 shoulders (23 patients) met the inclusion criteria at a mean clinical and MRI follow-up of 9.1 months. There were 12 intact grafts (50%) and 12 torn grafts (50%), most commonly at the glenoid attachment (8/12). Patients with graft tear had greater SSD (mean 10.5 ± 6.1 mm) than those without tear (mean 6.1 ± 3.8 mm) (p = 0.028). SSD > 7.9 mm had a 79% sensitivity and 91% specificity for graft tear. The intact grafts were more commonly covering the superior humeral head (91.7%) compared with the torn grafts (41.7%) (p = 0.027). There was improvement of clinical outcome measures including American Shoulder and Elbow Surgeons score (p = 0.005) and forward elevation (p = 0.021) although there was no correlation between clinical outcome and integrity of the graft. CONCLUSION SCR results in significant short-term clinical improvement even in the presence of graft tear on postoperative MRIs on current study. Gap between graft and the anchors, non-superior position of the graft, and humeral head superior subluxation can be associated with tear.
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Affiliation(s)
- Abigail L Campbell
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY 10003, United States of America
| | - Samuel L Baron
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY 10003, United States of America
| | - Hien Pham
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY 10003, United States of America
| | - Soterios Gyftopoulos
- Department of Radiology, NYU Langone Orthopedic Hospital, 301 East 17th Street, Rm 600, New York, NY 10003, United States of America.
| | - Robert Meislin
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY 10003, United States of America.
| | - Mohammad Samim
- Department of Radiology, NYU Langone Orthopedic Hospital, 301 East 17th Street, Rm 600, New York, NY 10003, United States of America.
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