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Kelly JJ, Saifman S, Riley TO, Collins AP, Peters C, Ferreira RD, Service BC. Bridging Reconstruction Versus Reverse Total Shoulder Arthroplasty for the Management of Massive, Irreparable Rotator Cuff Tears: A Systematic Review and Meta-analysis. Sports Med Arthrosc Rev 2025; 33:75-81. [PMID: 40424170 DOI: 10.1097/jsa.0000000000000419] [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] [Indexed: 05/29/2025]
Abstract
Bridging allograft reconstruction (BAR) and reverse shoulder arthroplasty (RSA) are 2 approaches for managing massive, irreparable rotator cuff tears, both yielding satisfactory functional results. A systematic review of 28 studies encompassing 1125 cases treated with either technique revealed significant improvement in range of motion and functional scores across all patients. However, BAR led to a notably greater improvement in external rotation. RSA exhibited significantly higher complication rates (18.6%) and an increased likelihood of reoperation (7.9%). Patients younger than 70 undergoing RSA faced higher complication and reoperation risks at 26% and 12.5%, respectively. In summary, BAR offers comparable functional outcomes with fewer complications compared with RSA for managing massive, irreparable rotator cuff tears. Patients under age 70 being considered for RSA should understand their heightened risks.
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Affiliation(s)
- John J Kelly
- Department of Orthopedic Surgery, Orlando Health Jewett Orthopedic Institute
| | | | | | | | - Cara Peters
- University of Central Florida College of Medicine
| | - Rogerio D Ferreira
- Department of Orthopedic Surgery, Orlando Health Jewett Orthopedic Institute
| | - Benjamin C Service
- Department of Orthopedic Surgery, Orlando Health Jewett Orthopedic Institute
- University of Central Florida College of Medicine
- Florida State University College of Medicine, Orlando, FL
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2
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Bechler U, Hubert J, Rosenfeld J, Goedecke E, Beil FT. [Rotator cuff lesion-Is cuff repair indicated in patients with rheumatic diseases?]. Z Rheumatol 2025:10.1007/s00393-025-01648-6. [PMID: 40402166 DOI: 10.1007/s00393-025-01648-6] [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: 03/19/2025] [Indexed: 05/23/2025]
Abstract
Rheumatic diseases, particularly in the context of rheumatoid arthritis (RA), frequently affect the shoulder joint and lead to lesions of the rotator cuffs, which are associated with chronic pain and restricted movement. Systemic inflammation endangers the integrity of the rotator cuff, while pharmacotherapy can impair tissue repair; however, the function of rotator cuffs is decisive for the selection of diagnostic and therapeutic measures. In cases of failure of conservative treatment surgical reconstruction represents an option in order to relieve pain and restore the biomechanical function. However, the decision for surgical treatment in RA patients is complex due to increased risks of complications, such as delayed healing, infections and re-rupture. This article examines the benefits and probability of success of the surgical reconstruction of rotator cuffs in the context of rheumatic diseases and should form a foundation for making clinical decisions and treatment recommendations.
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Affiliation(s)
- Ulrich Bechler
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Jan Hubert
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Julius Rosenfeld
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Eva Goedecke
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Frank Timo Beil
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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Joaquin T, Bellaire C, Perraut G, Argintar E. BicepBrace biceps tendon augmentation improves outcomes one year following surgery. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2025; 35:159. [PMID: 40232575 DOI: 10.1007/s00590-025-04285-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Accepted: 03/30/2025] [Indexed: 04/16/2025]
Abstract
PURPOSE This study emphasizes the clinical utility of our newly published "BicepBrace" technique by comparing its preliminary outcomes with standard treatment within the short term follow-up of 12 months following massive rotator cuff repair surgery. METHODS A retrospective chart review of all the rotator cuff repairs by E.H.A. over a two year span was completed under institutional review board approval. Inclusion criteria included all adult patients who received primary massive rotator cuff repair within the time frame of June 15, 2021 and June 15, 2023. Exclusion criteria included non-massive rotator cuff repair, revision surgery, or rotator cuff repairs that were paired with total shoulder arthroplasty. These massive rotator cuff repairs were then evaluated for clinical failure necessitating revision surgery within 12 months of original repair. Statistical analyses were performed using t tests and chi square tests. RESULTS In total, 102 rotator cuff repairs were identified within the study timeframe. In total, 24 of these cases met criteria to be labeled as massive tears. In total, 13 of these massive tears were treated by standard technique and 11 of them were treated with our BicepBrace biceps tendon transfer technique. In total, 4 of the patients in the standard technique group were deemed clinical failures necessitating revision surgery (failure rate of 30.8%). Only one of the BicepBrace patients were deemed clinical failures (failure rate of 9.1%). CONCLUSION In the setting of a massive rotator cuff tear, the BicepBrace technique-utilizing the long head of the biceps tendon for superior cuff augmentation-may enhance the survivability of the repair within one year of surgery. This relatively new approach offers a promising alternative to standard techniques, particularly for certain patient populations.
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Wang KY, Kishan A, Abboud JA, Verma NN, Srikumaran U. Balloon Spacer Implant Is an "Intermediate Value" Innovation Relative to Partial Repair for Full-Thickness Massive Rotator Cuff Repairs: A Cost-Utility Analysis. Arthroscopy 2025; 41:635-644.e4. [PMID: 38925232 DOI: 10.1016/j.arthro.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 05/28/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE To evaluate the cost-utility of a balloon spacer implant relative to partial repair (PR) for the surgical treatment of full-thickness massive rotator cuff tears (MRCTs). METHODS A decision-analytic model comparing balloon spacer with PR was developed using data from a prospective, randomized, single-blinded, multicenter-controlled trial of 184 randomized patients. Our model was constructed on the basis of the various event pathways a patient could have after the procedure. The probability that each patient progressed to a given outcome and the quality-adjusted life years (QALY) associated with each outcome were derived from the clinical trial data. Incremental cost utility ratio (ICUR) and incremental net monetary benefit were calculated on the basis of a probabilistic sensitivity analysis using Monte Carlo simulations of 1,000 hypothetical patients progressing through the decision-analytic model. One-way sensitivity and threshold analyses were performed by varying cost, event probability, and QALY estimates. RESULTS The balloon spacer had an ICUR of $106,851 (95% confidence interval $96,317-$119,143) relative to PR for surgical treatment of MRCT. Across all patients, the balloon spacer was associated with greater 2-year QALY gain compared with PR (0.20 ± 0.02 for balloon spacer vs 0.18 ± 0.02 for PR), but with substantially greater total 2-year cost ($9,701 ± $939 for balloon spacer vs $6,315 ± $627 for PR). PR was associated with a positive incremental net monetary benefit of $1,802 (95% confidence interval $1,653-$1,951) over balloon spacer at the $50,000/QALY willingness-to-pay threshold. CONCLUSIONS Compared with PR, the balloon spacer is an "intermediate-value" innovation for treatment of MRCT over a 2-year postoperative period with an ICUR value that falls within the $50,000 to $150,000 willingness-to-pay threshold. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Kevin Y Wang
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.; Department of Orthopaedic Surgery, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Arman Kishan
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Joseph A Abboud
- Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Nikhil N Verma
- Department of Orthopaedic Surgery, Rush Medical College, Chicago, Illinois, U.S.A
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A..
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Sun Y, Chen J, Wang Y, Xiang X. Arthroscopic Patch Bridging Using Fascia Lata for Irreparable Rotator Cuff Tears. Arthrosc Tech 2025; 14:103000. [PMID: 40041316 PMCID: PMC11873483 DOI: 10.1016/j.eats.2024.103000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/25/2024] [Indexed: 03/06/2025] Open
Abstract
We describe an arthroscopic technique for irreparable rotator cuff tears using patch bridging reconstruction with fascia lata autograft. Compared with conventional rotator cuff repair, this technique reconstitutes the rotator cuff as a dynamic structure, preserves the rotator cuff remnant, reduces excessive tension of the rotator cuff, and preserves the shoulder joint. The fascia lata patch itself is low cost and avoids risks of transmission of blood-borne infectious diseases and rejection. Although the bridging reconstruction is a complex operation with a long learning curve, we believe patch bridging using fascia lata is a highly effective and reproducible surgical protocol for appropriate irreparable rotator cuff tear patients.
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Affiliation(s)
- Youqiang Sun
- Department of Sports Medicine, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jianfa Chen
- Department of Sports Medicine, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuanyuan Wang
- Department of Sports Medicine, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaobing Xiang
- Department of Sports Medicine, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Menze J, Rojas JT, Ferguson SJ, De Pieri E, Gerber K, Zumstein MA. Lower trapezius and latissimus dorsi transfer relieve teres minor activity into the physiological range in Collin D irreparable posterosuperior massive rotator cuff tears: a biomechanical analysis. J Shoulder Elbow Surg 2024; 33:2586-2595. [PMID: 38642877 DOI: 10.1016/j.jse.2024.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/21/2024] [Accepted: 03/03/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Tendon transfers are established techniques to regain external rotation mobility in patients with an irreparable, posterosuperior massive rotator cuff tear (MRCT). Posterosuperior MRCT with intact teres minor (type D MRCT) can lead to excessive teres minor loading to maintain external rotation. We hypothesize that tendon transfers are effective in relieving teres minor loading in type D MRCTs. Our aim was to biomechanically assess muscle synergism with latissimus dorsi (LD transfer) and lower trapezius (LT transfer) tendon transfer during external rotation at different abduction heights. METHODS Using musculoskeletal modeling, we analyzed and compared the moment arm, muscle torque, and muscle activity between a healthy and type D MRCT pathologic model with and without the LD- or LT transfer at infraspinatus and teres minor insertion sites. Output measures were analyzed during external rotation at different abduction angles and 10-50 N resistance against external rotation. We assessed its impact on teres minor loading in a type D MRCT. Morphologic variations were parameterized using the critical shoulder angle and the acromiohumeral distance to address variations among patients. RESULTS Both transfer types reduced teres minor torque and activity significantly, reaching physiological state at 40 N external resistance (P < .001), with insertion to infraspinatus site being more effective than teres minor site (P < .001). External rotation moment arms of LD transfer were larger than LT transfer at 90° abduction (25.1 ± 0.8 mm vs. 21.2 ± 0.6 mm, P < .001) and vice versa at 0° abduction (17.4 ± 0.5 mm vs. 24.0 ± 0.2 mm, P < .001). Although the healthy infraspinatus was the main external rotator in all abduction angles (50%-70% torque), a type D MRCT resulted in a 70%-90% increase of teres minor torque and an up to 7-fold increase in its activity leading to excessive loadings beyond 10 N resistance against external rotation. Varying the critical shoulder angle and the acromiohumeral distance led to minor variations in muscle moment arm and muscle activity. CONCLUSION We identified biomechanical efficacy of both tendon transfers in type D MRCT regarding teres minor load relief and superior performance of the transfers at the infraspinatus insertion site.
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Affiliation(s)
- Johanna Menze
- School of Precision and Biomedical Engineering, University of Bern, Bern, Switzerland; Institute for Biomechanics, ETH Zürich, Zürich, Switzerland
| | - J Tomás Rojas
- Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopaedics Sonnenhof, Bern, Switzerland; Department of Orthopaedics and Trauma Surgery, Hospital San José-Clínica Santa María, Santiago, Chile
| | | | - Enrico De Pieri
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Kate Gerber
- School of Precision and Biomedical Engineering, University of Bern, Bern, Switzerland
| | - Matthias A Zumstein
- Shoulder, Elbow and Orthopaedic Sports Medicine, Orthopaedics Sonnenhof, Bern, Switzerland; Faculty of Medicine, University of Bern, Bern, Switzerland; Faculty of Medicine, Health & Human Sciences, Macquarie University, Sydney, NSW, Australia.
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Fahy K, Galvin R, Lewis J, McCreesh K. 'If he thought that I was going to go and hurt myself, he had another thing coming': Treatment experiences of those with large to massive rotator cuff tears and the perspectives of healthcare practitioners. Clin Rehabil 2024; 38:824-836. [PMID: 38418399 PMCID: PMC11059833 DOI: 10.1177/02692155241235338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 02/07/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To explore the treatment experiences of those diagnosed with large to massive rotator cuff tears and the perspectives of healthcare practitioners providing their care. DESIGN A qualitative descriptive study using reflexive thematic analysis. SETTING In-person focus groups were undertaken in a clinical setting (private practice [n = 1]; public outpatient [n = 2]). Semi-structured interviews were conducted online via Microsoft Teams. PARTICIPANTS Patients diagnosed with these tears (n = 12) and healthcare practitioners (n = 11). RESULTS Two interlinking themes were identified based on the care received and provided for patients with symptomatic large to massive rotator cuff tears:1) Positive treatment experiences and management: Education, clear communication and reassurance around prognosis were the foundation of positive patient-clinician care. Sub-themes of pain relief, exercise prescription and confidence in their pathway underpinned this experience. This proficiency in care was affirmed by some healthcare practitioners who spoke about the importance of confidence and experience in their management plan even in times of poor progress.2) Negative treatment experiences and management: Uncertainty, delays and exacerbation of pain flawed the patient-clinician care. Sub-themes of inappropriate pain relief, inappropriate exercise prescription and uncertainty impacted their care. Some healthcare practitioners acknowledged knowledge gaps led to uncertainty especially when choosing the next step of care and were quick to escalate care to deflect this uncertainty. CONCLUSIONS The findings suggest discordance exists between the patient's experiences and expectations when the delivery of care was by less experienced and confident healthcare practitioners in the management of this condition. This highlights the need for improved education and support for healthcare practitioners.
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Affiliation(s)
- Kathryn Fahy
- School of Allied Health, University of Limerick, Limerick, Munster, Ireland
| | - Rose Galvin
- Department of Clinical Therapies, University of Limerick Faculty of Education and Health Sciences, Limerick, Munster, Ireland
| | - Jeremy Lewis
- Therapy Department, Central London Community Healthcare National Health Service Trust, Central London Community Healthcare National Health Service Trust, London, UK
| | - Karen McCreesh
- School of Allied Health, University of Limerick Faculty of Education and Health Sciences, Limerick, Munster, Ireland
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McClatchy SG, Parsell DE, Hobgood ER, Field LD. Augmentation of Massive Rotator Cuff Repairs Using Biceps Transposition Without Tenotomy Improves Clinical and Patient-Reported Outcomes: The Biological Superior Capsular Reconstruction Technique. Arthroscopy 2024; 40:47-54. [PMID: 37355182 DOI: 10.1016/j.arthro.2023.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To evaluate the outcomes of a consecutive series of patients after transposition of the biceps without tenotomy (biological superior capsular reconstruction [bio-SCR] technique) to augment massive rotator cuff repairs. METHODS Thirty massive rotator cuff tears repaired and augmented using the bio-SCR technique between June 2018 and July 2021 were identified and retrospectively reviewed. American Shoulder and Elbow Surgeons (ASES) scores, visual analog scale pain scores, supraspinatus and infraspinatus strength, and range of motion were collected preoperatively and postoperatively. RESULTS The average age of patients undergoing bio-SCR augmentation was 67.0 years (range, 28.4-81.9 years), and the mean clinical follow-up period was 2.9 years (range, 1.8-4.5 years). The average ASES score improved from 33.2 preoperatively to 80.8 at 6 months postoperatively, 92.0 at 1 year, and 87.0 at 2 years (P < .001). The minimal clinically important difference for the ASES score was exceeded at all postoperative intervals. Active forward flexion improved from 120.6° to 156.8° (P < .001). The pain score improved from 7.1 to 0.9 (P < .001). Postoperatively, 1 complication (3.3%) occurred: a proximal biceps rupture. CONCLUSIONS Incorporating a transposed biceps tendon into the repair of a massive rotator cuff tear using the bio-SCR technique resulted in significant clinical improvements with a low complication rate. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
| | - Douglas E Parsell
- Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, U.S.A
| | | | - Larry D Field
- Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, U.S.A..
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Zhang J, Tang X, Zhang Q, Wang X, Guo Z, He Y. Mid-Term Outcomes of Arthroscopic Rotator Cuff Repair in Patients with Rheumatoid Arthritis. Orthop Surg 2023; 15:2116-2123. [PMID: 37232062 PMCID: PMC10432454 DOI: 10.1111/os.13757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/28/2023] [Accepted: 04/04/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVE The effectiveness of arthroscopic rotator cuff repair (ARCR) on rheumatoid arthritis (RA) patients remains a controversial topic. This study investigates the mid-term outcomes of ARCR in RA patients and identifies the factors influencing clinical efficacy. METHODS This retrospective study enrolled RA patients with small or medium rotator cuff tears (RCTs) between February 2014 and February 2019. Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons (ASES), and Constant-Murley scores were collected at each follow-up time. Ultimately, magnetic resonance imaging (MRI) and X-ray were employed to assess rotator cuff integrity and progression of shoulder bone destruction, respectively. Statistical methods used two-way repeated-measures ANOVA or generalized estimation equations. RESULTS A total of 157 patients were identified and divided into ARCR (n = 75) and conservative treatment (n = 82) groups. ARCR group continued to be divided into small tear (n = 35) and medium tear (n = 40) groups. At the final, all scores were better in ARCR group than in the conservative treatment group (p < 0.05). A radiographic evaluation of the final follow-up demonstrated that the progression rate in ARCR group (18.67%) was significantly lower than that of the conservative treatment group (39.02%, p < 0.05). In the comparison of the small tear and medium tear groups, all scores increased significantly after surgery (p < 0.05), and the final follow-up scores were better than preoperative scores (p < 0.05) but worse than those of the 6-month postoperative follow-up (p < 0.05). Comparison between the two groups revealed that all scores of the small tear group were significantly better than those of the medium tear group at 6-month postoperative follow-up (p < 0.05). Although the scores of small tear group remained better than those of the medium group at the final postoperative follow-up, the difference was not statistically significant (p > 0.05). Radiographic assessment of the final follow-up demonstrated that the progression rate in the small tear group (8.57%) was significantly lower than that in the medium group (27.50%, p < 0.05), and the retear rate of small tear group (14.29%) was significantly lower than that of the medium tear group (35.00%, p < 0.05). CONCLUSION ARCR could effectively improve the quality of life for RA patients with small or medium RCTs, at least in the medium term. Despite the progression of joint destruction in some patients, postoperative retear rates were comparable to those in the general population. ARCR is more likely to benefit RA patients than conservative treatment.
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Affiliation(s)
- Jie‐chao Zhang
- Department of Orthopaedic SurgeryGuanghua Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Xiao‐ye Tang
- Department of Orthopaedic SurgeryGuanghua Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Qian Zhang
- Department of Orthopaedic SurgeryWuxi Ninth People's Hospital Affiliated to Soochow UniversityWuxiChina
| | - Xue‐peng Wang
- Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Zi‐cheng Guo
- Shanghai University of Traditional Chinese MedicineShanghaiChina
| | - Yong He
- Department of Orthopaedic SurgeryGuanghua Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina
- Institute of Arthritis Research in Integrative MedicineShanghai Academy of Traditional Chinese MedicineShanghaiChina
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Interpositional Balloon: A New Frontier. OPER TECHN SPORT MED 2023. [DOI: 10.1016/j.otsm.2023.150983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Method for the treatment of patients with massive tears of the rotator cuff. КЛИНИЧЕСКАЯ ПРАКТИКА 2022. [DOI: 10.17816/clinpract108163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Rotator cuff tears are the most common cause of shoulder pain and dysfunction in older patients. Tear with retraction greater than 5cm or with the involvement of two and more tendons are considered massive. According to the literature, the incidence of massive injuries of the rotator cuff ranges from 10 to 40%. The formation of massive injuries is a long process leading to a pronounced pain syndrome, loss of function and, as a result, to pseudo-paralysis of the affected limb. There is no consensus concerning the treatment of this category of patients. Conservative methods of treatment are applicable for patients with a low activity. Among the surgical methods of treatment, the preference is given to the proximal capsule reconstruction, subacromial balloon arthroplasty, reverse arthroplasty and muscle-tendon transfers. However, today there is no single tactic of surgical treatment of patients with rotator cuff massive tears. We propose a new surgical method for this shoulder joint pathology arthroscopically-associated transposition of the tendon of the latissimus dorsi muscle using an autograft of the long peroneal muscle tendon. As a description of the new method, we present a successful clinical case of the treatment of a patient with chronic massive rotator cuff injury of the right shoulder and secondary upper subluxation of the right humerus head. This method allows to increase the efficiency of treatment of a massive tear of the rotator cuff tendons, to restore the correct biomechanics of the shoulder joint, to reduce the pain and to restore the function of the affected limb.
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Furuhata R, Matsumura N, Oki S, Nishikawa T, Kimura H, Suzuki T, Nakamura M, Iwamoto T. Risk factors of radiographic severity of massive rotator cuff tear. Sci Rep 2022; 12:13567. [PMID: 35945235 PMCID: PMC9363414 DOI: 10.1038/s41598-022-17624-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/28/2022] [Indexed: 11/09/2022] Open
Abstract
As massive rotator cuff tears progress, various radiographic changes occur; however, the factors associated with radiographic changes remain largely unknown. This study aimed to determine the factors that affect radiographic severity in massive rotator cuff tears using multivariate analyses. We retrospectively reviewed 210 shoulders with chronic massive rotator cuff tears. The dependent variables were superior migration of the humeral head (Hamada grades 2-3), narrowing of the glenohumeral joint (grade 4), and humeral head collapse (grade 5). Baseline variables that were significant in univariate analyses were included in multivariate models. There were 91, 59, 43, and 17 shoulders classified as Hamada grades 1, 2-3, 4, and 5, respectively. Multivariate analysis showed that infraspinatus tear (P = 0.015) and long head of biceps (LHB) tendon rupture (P = 0.007) were associated with superior migration of humeral head. Superior subscapularis tear (P = 0.003) and LHB tendon rupture (P < 0.001) were associated with narrowing of glenohumeral joint. Female sex (P = 0.006) and superior subscapularis tear (P = 0.006) were associated with humeral head collapse. This study identified the rupture of infraspinatus and LHB as risk factors of superior migration of humeral head, and the rupture of subscapularis and LHB and female sex as risk factors of cuff tear arthropathy.
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Affiliation(s)
- Ryogo Furuhata
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Noboru Matsumura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Satoshi Oki
- Department of Orthopaedic Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya-shi, Tochigi, Japan
| | - Takahiro Nishikawa
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroo Kimura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Taku Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takuji Iwamoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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13
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Gurnani N, van Deurzen DFP, Willems WJ, Janssen TWJ, Veeger DHEJ. Shoulder muscle activity after latissimus dorsi transfer in active elevation. JSES Int 2022; 6:970-977. [DOI: 10.1016/j.jseint.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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14
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Endell D, Child C, Freislederer F, Moroder P, Scheibel M. [Anatomy and diagnostics of subscapularis tendon lesions]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022; 125:647-658. [PMID: 35819495 DOI: 10.1007/s00113-022-01207-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
Among lesions of the rotator cuff, subscapularis tendon tears are one of the less common injuries and mostly occur in combination with additional lesions of the posterosuperior rotator cuff and the long biceps tendon. If a subscapularis tendon rupture is suspected in the initial clinical testing, the primary diagnostics should include modern cross-sectional magnetic resonance imaging to assess the tendon lesion and to detect concomitant pathologies. Nevertheless, subscapularis tendon lesions are often initially overlooked and first correctly diagnosed during shoulder arthroscopy.
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Affiliation(s)
- David Endell
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz.
| | - Christopher Child
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz
| | - Florian Freislederer
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz
| | - Philipp Moroder
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz
| | - Markus Scheibel
- Klinik für Schulter- und Ellbogenchirurgie, Schulthess Klinik Zürich, Lengghalde 2, 8008, Zürich, Schweiz
- Centrum für Muskuloskeletale Chirurgie (CMSC), Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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Verma N, Srikumaran U, Roden CM, Rogusky EJ, Lapner P, Neill H, Abboud JA. InSpace Implant Compared with Partial Repair for the Treatment of Full-Thickness Massive Rotator Cuff Tears: A Multicenter, Single-Blinded, Randomized Controlled Trial. J Bone Joint Surg Am 2022; 104:1250-1262. [PMID: 35777921 DOI: 10.2106/jbjs.21.00667] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to prospectively evaluate the efficacy and safety of a subacromial balloon spacer (InSpace implant; Stryker) compared with arthroscopic partial repair in patients with irreparable, posterosuperior massive rotator cuff tears. METHODS Patients ≥40 years of age with symptomatic, irreparable, posterosuperior, massive rotator cuff tears and an intact subscapularis who underwent failed nonoperative management were included in this randomized controlled trial comparing the InSpace implant with partial repair. Clinical outcome data were collected at baseline through a 24-month follow-up. The primary outcome was improvement in the American Shoulder and Elbow Surgeons (ASES) scores. The secondary outcomes included change from baseline in the Western Ontario Rotator Cuff (WORC) score, the visual analog scale (VAS) pain score, the Constant-Murley shoulder score, the EuroQol-5 Dimensions-5-Level (EQ-5D-5L) score, active range of motion, and operative time. Complications and reoperations for each group were also recorded. RESULTS Twenty sites randomized 184 patients: 93 in the InSpace group and 91 in the partial repair group. Significant and clinically relevant improvements in the ASES score from baseline were noted in both groups at Month 12 and were maintained at Month 24. Overall, 83% of patients in the InSpace group and 81% of patients in the partial repair group achieved the ASES minimally clinically important difference threshold, and 82% of patients in the InSpace group and 79% of patients in the partial repair group achieved the substantial clinical benefit threshold. Forward elevation was significantly greater in the InSpace group compared with the partial repair group at Day 10 (p = 0.04), Week 6 (p = 0.0001), Month 12 (p = 0.005), and Month 24 (p = 0.003). The operative time was significantly shorter in the InSpace group (p < 0.0001). No device-related surgical complications were noted, and 4 reoperations after InSpace implantation and 3 reoperations after partial repair were required. CONCLUSIONS The InSpace implant is an appropriate alternative to partial repair in patients with irreparable posterosuperior massive rotator cuff tears and an intact subscapularis. Notable benefits include early functional recovery and pain relief combined with a shorter operative time. LEVEL OF EVIDENCE Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nikhil Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Uma Srikumaran
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Colleen M Roden
- Department of Regulatory Affairs and Clinical Sciences, Stryker, San Jose, California
| | - Edwin J Rogusky
- Department of Orthopedics, University Orthopedics Center, State College, Pennsylvania
| | - Peter Lapner
- Division of Orthopedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Heather Neill
- Department of Clinical Operations, OrthoSpace, Nashville, Tennessee
| | - Joseph A Abboud
- Division of Shoulder and Elbow Surgery, The Sidney Kimmel Medical College, Thomas Jefferson University, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
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Gurnani N, Willems WJ, van Deurzen DFP, Weening AA, Bouwer J, Janssen TWJ, Veeger DHEJ. Shoulder kinematics and muscle activity following latissimus dorsi transfer for massive irreparable posterosuperior rotator cuff tears in shoulders with pseudoparalysis. J Shoulder Elbow Surg 2022; 31:1357-1367. [PMID: 35172211 DOI: 10.1016/j.jse.2022.01.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the thoracohumeral (TH) and glenohumeral (GH) motion with muscle activity after latissimus dorsi transfer (LDT) in a shoulder with a massive irreparable posterosuperior rotator cuff tear (MIRT) and pseudoparalysis compared with the asymptomatic contralateral shoulder (ACS). METHODS We recruited and evaluated 13 patients after LDT in a shoulder with preoperative clinical pseudoparalysis and an MIRT on magnetic resonance imaging, with a minimum follow-up period of 1 year, and with a Hamada stage of 3 or less. Three-dimensional electromagnetic tracking was used to assess shoulder active range of motion in both the LDT shoulder and the ACS. The maximal active elevation of the shoulder (MAES) was assessed and consisted of forward flexion, scapular abduction, and abduction in the coronal plane. Maximal active internal rotation and external rotation were assessed separately. Surface electromyography (EMG) was performed to track activation of the latissimus dorsi (LD) and deltoid muscles during shoulder motion. EMG was scaled to its maximal isometric voluntary contraction recorded in specified strength tests. RESULTS In MAES, TH motion of the LDT shoulder was not significantly different from that of the ACS (F1,12 = 1.174, P = .300) but the GH contribution was significantly lower in the LDT shoulder for all motions (F1,12 = 11.230, P = .006). External rotation was significantly greater in the ACS (26° ± 10° in LDT shoulder vs. 42° ± 11° in ACS, P < .001). The LD percentage EMG maximum showed no significant difference between the LDT shoulder and ACS during MAES (F1,11 = 0.005, P = .946). During maximal active external rotation of the shoulder, the LDT shoulder showed a higher percentage EMG maximum than the ACS (3.0% ± 2.9% for LDT shoulder vs. 1.2% ± 2.0% for ACS, P = .006). CONCLUSIONS TH motion improved after LDT in an MIRT with pseudoparalysis and was not different from the ACS except for external rotation. However, GH motion was significantly lower after LDT than in the ACS in active-elevation range of motion. The LD was active after LDT but not more than in the ACS except for active external rotation, which we did not consider relevant as the activity did not rise above 3% EMG maximum. The favorable clinical results of LDT do not seem to be related to a change in LD activation and might be explained by its effect in preventing proximal migration of the humeral head in active elevation.
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Affiliation(s)
- Navin Gurnani
- Department of Orthopaedic Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands.
| | - W Jaap Willems
- Department of Orthopaedic Surgery, DC Expert Centre, Amsterdam, the Netherlands
| | | | - Alexander A Weening
- Department of Orthopaedic Surgery, Diakonesse Hospital, Utrecht, the Netherlands
| | - Joran Bouwer
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Thomas W J Janssen
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - DirkJan H E J Veeger
- Faculty of Behavioural and Movement Sciences, Delft University of Technology, Delft, the Netherlands
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Kaisidis A, Pantos P, Bochlos D. The subacromial spacer system for irreparable posterosuperior rotator cuff tears: A retrospective study of 47 patients with a two-year follow-up. Shoulder Elbow 2022; 14:76-82. [PMID: 35845623 PMCID: PMC9284253 DOI: 10.1177/1758573220960468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Numerous surgical options are available for the management of massive irreparable rotator cuff tears, but there are no current definitive guidelines concerning the optimal treatment modality. The purpose of this study was to evaluate the efficacy and safety of a biodegradable subacromial spacer (InSpace) implantation in patients with irreparable rotator cuff tears. METHODS A retrospective study was conducted involving 47 patients treated with the InSpace balloon between 2016 and 2018. Shoulder function was assessed using Constant Score. Pain was scored using a visual analogue scale, with scores ranging from 0 to 10. RESULTS At an average follow-up of 24.6 months (range 12-38), the Constant Score had improved from 39.4 to 71.5 points (p < 0.0001). The range of motion, a main component of Constant Score, was improved after two years, from 27.6 to 42.2 points (p < .001). The visual analogue scale score decreased from 6.32 at baseline to a mean score of 2.7 points (p < 0.0001). DISCUSSION Arthroscopic deployment of the InSpace device was found to be a safe, reliable treatment option in patients with painful irreparable rotator cuff tears, with meaningful improvement in shoulder function without serious complications.
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Affiliation(s)
| | - Panagiotis Pantos
- Panagiotis Pantos, Clinic Maingau, Rotes
Kreuz, Schoeffelstrasse 2-14, Frankfurt, Hessen 60318, Germany.
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18
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McCormick JR, Menendez ME, Hodakowski AJ, Garrigues GE. Superior Capsule Reconstruction and Lower Trapezius Transfer for Irreparable Posterior-Superior Rotator Cuff Tear: A Case Report. JBJS Case Connect 2022; 12:01709767-202206000-00051. [PMID: 35696719 DOI: 10.2106/jbjs.cc.22.00098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CASE A 49-year-old right-hand-dominant male weightlifter was referred with persistent left shoulder pain, weakness, and range of motion limitations after failed arthroscopic rotator cuff repair and subsequent arthroscopic debridement for a massive posterior-superior supraspinatus and infraspinatus tear. The patient underwent a superior capsular reconstruction (SCR) with lower trapezius (LT) transfer to re-establish rotator cuff function. CONCLUSION LT transfer in addition to SCR may be a promising modality to treat massive, irreparable posterior-superior rotator cuff tears in young adults. LT transfer can optimize external rotation, whereas SCR may more adequately address pain and forward elevation.
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Affiliation(s)
| | - Mariano E Menendez
- Rush University Medical Center, Department of Orthopedic Surgery, Chicago, Illinois
| | | | - Grant E Garrigues
- Rush University Medical Center, Department of Orthopedic Surgery, Chicago, Illinois
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19
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Pereira VC, Barreto J, Tomé S, Cunha J, Amaro J, Moreira J, Miranda A, Branco CA. Clinical and Functional Results of Reverse Total Shoulder Arthroplasty and Postoperative Rehabilitation Protocol. Cureus 2022; 14:e23322. [PMID: 35464596 PMCID: PMC9015697 DOI: 10.7759/cureus.23322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose This retrospective study aims to analyze the clinical and functional results obtained over a seven-year period of performing reverse total shoulder arthroplasty (RTSA) and the subsequent postoperative rehabilitation protocol. Methods We analyzed data from 80 patients who were evaluated at a preoperative, as well as monthly postoperative outpatient consultation, until the discharge from the rehabilitation program, using Constant Score (CS). Results A comparison of preoperative and postoperative (after rehabilitation protocol) results revealed an improved functional score of absolute CS (20.8 increase), normal relative CS (29.1 increase), and individual relative CS (31.7 increase) with statistical significance (p<0.05). From the analysis of CS subscores, there was a positive evolution of the pain subscore, as well as flexion, abduction, and external rotation combined with abduction range of motion (ROM). Contrarily, there was a negative evolution of the combined internal rotation, extension, and adduction ROM, as well as deltoid muscle strength. No statistically significant correlations were found between age and postoperative CS, as well as between the time interval from surgery to the beginning of outpatient rehabilitation and CS evolution. Conclusion Our study demonstrates that RTSA is an effective therapeutic option that, if combined with a well-structured rehabilitation program, can improve pain, mobility, and upper limb functionality.
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20
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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: 2.0] [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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21
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Kane GE, LeVasseur CM, Hughes JD, Gabrielli AS, Popchak A, Anderst W, Lin A. Improved Outcomes Following Arthroscopic Superior Capsular Reconstruction May Not Be Associated With Changes in Shoulder Kinematics: An In Vivo Study. Arthroscopy 2022; 38:267-275. [PMID: 34237396 DOI: 10.1016/j.arthro.2021.06.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/21/2021] [Accepted: 06/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the in vivo effects of superior capsule reconstruction (SCR) on glenohumeral kinematics during abduction and to compare those kinematics results with patient-reported outcomes, range of motion, and strength. METHODS Dynamic biplane radiography was used to image 10 patients with irreparable rotator cuff tears while performing scapular plane abduction pre- and 1-year post-surgery. Shoulder kinematics were determined by matching subject-specific computed tomography-based bone models to the radiographs using a validated tracking technique. RESULTS No change was detected in static acromiohumeral distance (-0.7 ± 2.1 mm; P = .35); however, average dynamic acromiohumeral distance decreased (2.7 ± 1.2 mm to 2.3 ± 1.0 mm; P = .035) from pre- to 1-year post-surgery, respectively. The humeral head position was 0.5 ± 0.5 mm more superior 1-year post-surgery compared with pre-surgery (P = .01). Glenohumeral abduction increased from pre-surgery (150 ± 20°) to 1-year post-surgery (165 ± 10°) (P = .04) and all patient-reported outcomes improved from pre-surgery to 1-year post-surgery (all P < .002). A more posterior shift in humeral head position was associated with improved American Shoulder and Elbow Surgeons Shoulder Score from pre-surgery to 1-year post-surgery (r = 0.71, P = .02). CONCLUSIONS These data suggest that SCR may not depress the humeral head during functional abduction, as previously postulated, and postoperative improvements in subjective and clinical outcomes may be affected by mechanisms other than changes in shoulder kinematics. CLINICAL RELEVANCE In vivo kinematics changes after SCR are small and do not correspond to previously postulated changes.
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Affiliation(s)
- Gillian E Kane
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Clarissa M LeVasseur
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A..
| | - Jonathan D Hughes
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Alexandra S Gabrielli
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Adam Popchak
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - William Anderst
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Albert Lin
- Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
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22
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Arthroscopic Superior Capsular Reconstruction with Achilles Tendon Allograft for Massive and Revision Rotator Cuff Tears. Arthrosc Tech 2022; 11:e263-e271. [PMID: 35155122 PMCID: PMC8821895 DOI: 10.1016/j.eats.2021.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/21/2021] [Indexed: 02/03/2023] Open
Abstract
Massive irreparable rotator cuff tears (RCT) in younger and active patients remain a significant clinical challenge to orthopaedic surgeons. Superior capsular reconstruction (SCR) has been presented as a way to restore the restraining effect of the superior joint capsule and the balanced force couples necessary for dynamic shoulder function; furthermore, it does not exclude future treatment options. The purpose of this article is to show a technical modification of the SCR in massive and revision RCT using Achilles tendon allograft as an effective static restraint to prevent superior migration of the humeral head due to its thickness and robustness, and performing a side-to-side repair on the greater tuberosity between the graft and the residual infraspinatus tendon to completely restore the superior stability of the shoulder joint.
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23
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Furuhata R, Matsumura N, Oki S, Kimura H, Suzuki T, Iwamoto T, Matsumoto M, Nakamura M. Risk Factors for Loss of Active Shoulder Range of Motion in Massive Rotator Cuff Tears. Orthop J Sports Med 2022; 10:23259671211071077. [PMID: 35097147 PMCID: PMC8796088 DOI: 10.1177/23259671211071077] [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: 10/05/2021] [Accepted: 10/28/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Patients with massive rotator cuff tears often exhibit loss of active range of shoulder motion, which can interfere with activities of daily living. The risk factors for loss of motion remain largely unknown. Purpose: To clarify the predictive factors that affect the range of motion in chronic massive rotator cuff tears using multivariate analyses. Study Design: Case-control study; Level of evidence, 3. Methods: The authors retrospectively reviewed 204 consecutive patients who were evaluated at their institution with chronic massive rotator cuff tears. In this study, the dependent variable was determined to be active anterior elevation limited to ≤90° or external rotation (ER) with the arm at the side limited to ≤0°. Explanatory variables included age; sex; affected side; duration of symptoms; smoking history; existence of diabetes, hypertension, or rheumatoid arthritis; involved tendons; presence of a 3-tendon tear; rupture of the long head of biceps tendon; superior migration of the humeral head; and cuff tear arthropathy. Baseline variables that were observed to be significant in the univariate analyses were included in multivariate models, which used logistic regression to identify independent predictors of loss of motion. Results: Overall, 73 patients (35.8%) exhibited limited anterior elevation, and 27 (13.2%) exhibited limited ER. Multivariate analyses showed that inferior subscapularis tear (odds ratio [OR], 14.66; 95% CI, 2.95-72.93; P = .001), smoking (OR, 4.13; 95% CI, 1.94-8.79; P < .001), superior migration of humeral head (OR, 3.92; 95% CI, 1.80-8.53; P = .001), and 3-tendon tear (OR, 3.29; 95% CI, 1.32-8.20; P = .011) were significantly associated with the loss of anterior elevation. Teres minor tear (OR, 73.37; 95% CI, 9.54-564.28; P < .001) and superior migration of the humeral head (OR, 3.55; 95% CI, 1.04-12.19; P = .044) were significantly associated with loss of ER. Conclusion: In the current study, a history of smoking, type of torn tendons, and superior migration of the humeral head were associated with loss of active shoulder motion. In particular, the status of inferior subscapularis or teres minor contributed to the onset of pseudoparalysis in massive rotator cuff tears.
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Affiliation(s)
- Ryogo Furuhata
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Noboru Matsumura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Satoshi Oki
- Department of Orthopaedic Surgery, Saiseikai Utsunomiya Hospital, Utsunomiya-shi, Tochigi, Japan
| | - Hiroo Kimura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Taku Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Takuji Iwamoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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24
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Superior capsular reconstruction for management of massive irreparable rotator cuff tears: current concepts. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Imai S. Graft-Augmented Repair of Irreparable Massive Rotator Cuff Tears with Latissimus Dorsi Transfer to Treat Pseudoparesis. JB JS Open Access 2021; 6:JBJSOA-D-21-00044. [PMID: 34859173 PMCID: PMC8631387 DOI: 10.2106/jbjs.oa.21.00044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Irreparable massive rotator cuff tears are characterized by a poor prognosis with high failure rates following repair. Numerous strategies, such as partial repair, graft interposition, latissimus dorsi (LD) transfer, balloon arthroplasty, and superior capsular reconstruction, have been proposed. We have adopted a graft-augmented LD-transfer procedure, in which partial repair, graft interposition, and LD transfer are performed simultaneously.
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Affiliation(s)
- Shinji Imai
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Shiga, Japan
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26
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Bogdanov J, Lan R, Chu TN, Bolia IK, Weber AE, Petrigliano FA. Fatty degeneration of the rotator cuff: pathogenesis, clinical implications, and future treatment. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:301-308. [PMID: 37588720 PMCID: PMC10426606 DOI: 10.1016/j.xrrt.2021.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Chronic rotator cuff pathology is often complicated by fatty degeneration of the rotator cuff (FDRC) muscles, an insidious process associated with poor prognosis with or without surgical intervention. Currently there is no treatment for FDRC, and many studies have described a natural course for this disease almost always resulting in further degeneration and morbidity. Recapitulating FDRC using animal injury models, and using imaging-based studies of human FDRC, the pathophysiology of this disease continues to be further characterized. Researchers studying mesenchymal stem cell-derived progenitor cells and known fibrogenic and adipogenic signaling pathways implicated in FDRC seek to clarify the underlying processes driving these changes. While new cell- and molecular-based therapies are being developed, currently the strongest available avenue for improved management of FDRC is the use of novel imaging techniques which allow for more accurate and personalized staging of fatty degeneration. This narrative review summarizes the evidence on the molecular and pathophysiologic mechanisms of FDRC and provides a clinical update on the diagnosis and management of this condition based on the existing knowledge. We also sought to examine the role of newer biologic therapies in the management of RC fatty degeneration and to identify areas of future research.
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Affiliation(s)
- Jacob Bogdanov
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Rae Lan
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Timothy N. Chu
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Ioanna K. Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Alexander E. Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Frank A. Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
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Liu C, Jiang S, Wu Y, Liu L, Su S, Liang T, He R, Guo Z, Zhang Y, Lin Z, Niu W, Zhu L, Xu T, Wang K. The Regenerative Role of Gelatin in PLLA Electrospun Membranes for the Treatment of Chronic Massive Rotator Cuff Injuries. Macromol Biosci 2021; 22:e2100281. [PMID: 34708919 DOI: 10.1002/mabi.202100281] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/25/2021] [Indexed: 11/08/2022]
Abstract
Failing to regenerate native tendon tissue in chronic massive rotator cuff tears (CMRCTs) results in high retear rates after surgery. Gelatin is a hydrolyzed form of collagen which is bioactive and biocompatible. This study intends to investigate the suitability of integrating gelatin to poly (l-lactic acid) (PLLA) fibrous membranes for promoting the healing of CMRCTs. PLLA/Gelatin electrospun membranes (PGEM) are fabricated using electrospinning technology. The fourier transform infrared, static contact angles are tested sequentially. Cytocompatibility is evaluated with rat tendon fibroblasts and human umbilical endothelial cells (HUEVCs) lines. CMRCTs rat models are established and assigned into three groups (the sham group, the repaired group, and the augmentation group) to perform histomorphological and biomechanical evaluations. Gelatin is successfully integrated into PLLA fibrous membranes by the electrospinning technique. In vitro studies indicate that PGEM shows a great cytocompatibility for rat tendon fibroblasts and HUEVCs. In vivo studies find that applications of PGEM significantly promote well-aligned collagen I fibers formation and enhance biomechanical properties of the repaired tendon in CMRCTs rat models. In summary, gelatin promotes tendon fibroblasts and HUEVCs adhesion, migration, and proliferation on the PLLA fibrous membranes, and PGEM may provide a great prospect for clinical application.
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Affiliation(s)
- Chang Liu
- Department of Joint and Trauma Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China.,East China Institute of Digital Medical Engineering, Shangrao, 334000, China
| | - Shihai Jiang
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, 04103, Germany
| | - Yu Wu
- Department of Plastic and Aesthetic Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China.,East China Institute of Digital Medical Engineering, Shangrao, 334000, China
| | - Libiao Liu
- East China Institute of Digital Medical Engineering, Shangrao, 334000, China.,Biomanufacturing and Rapid Forming Technology Key Laboratory of Beijing, Department of Mechanical Engineering, Key Laboratory for Advanced Materials Processing Technology, Ministry of Education, Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, China
| | - Shouwen Su
- Department of Joint and Trauma Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Tangzhao Liang
- Department of Joint and Trauma Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Ronghan He
- Department of Joint and Trauma Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Zeyue Guo
- East China Institute of Digital Medical Engineering, Shangrao, 334000, China
| | - Yuanyuan Zhang
- Department of Obstetrics and Gynaecology, Maternal and Child Health Care Hospital of Jiaozuo, Jiaozuo, 454000, China
| | - Zhidong Lin
- East China Institute of Digital Medical Engineering, Shangrao, 334000, China.,Department of Orthopedics, The Second Affiliated Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Wei Niu
- Department of Orthopedics, The Second Affiliated Hospital of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, 510006, China
| | - Lei Zhu
- Department of Plastic and Aesthetic Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
| | - Tao Xu
- Biomanufacturing and Rapid Forming Technology Key Laboratory of Beijing, Department of Mechanical Engineering, Key Laboratory for Advanced Materials Processing Technology, Ministry of Education, Department of Mechanical Engineering, Tsinghua University, Beijing, 100084, China.,Department of Precision Medicine and Healthcare, Tsinghua-Berkeley Shenzhen Institute, Shenzhen, 518055, China
| | - Kun Wang
- Department of Joint and Trauma Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China
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Davey MS, Kaar K. Clinical outcomes at medium-term follow-up of sub-acromial balloon spacer insertion in the operative management of massive rotator cuff tears. Ir J Med Sci 2021; 191:1687-1691. [PMID: 34480320 DOI: 10.1007/s11845-021-02760-7] [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: 07/27/2021] [Accepted: 08/25/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The management of massive rotator cuff tears (RCTs) remains a debated topic amongst orthopaedic surgeons, with a wide spectrum of treatment options available. In recent years, the use of sub-acromial balloon spacers has emerged as an option in the management of massive RCTs. The purpose of this study is to evaluate the clinical outcomes of patients with massive RCTs who underwent arthroscopic sub-acromial balloon spacer insertion at medium-term follow-up. METHODS All consecutive patients in our institution who had undergone sub-acromial balloon spacer insertion under the senior author from 2015 to 2020 were identified and followed up via telephone survey. Patient demographics, patient-reported outcomes, complications and subsequent surgeries were all analysed using the SPSS. RESULTS Overall, 45 patients (31 males) including 36 retired (80.0%) patients, with a mean age of 70.3 ± 7.0 (40-83) years, and mean follow-up of 37.1 ± 16.4 (12-62) months were included. At final follow-up, the mean ASES score was 73.4 ± 21.8 (25-100), the mean SSV was 76.4 ± 16.0 (45-100), baseline VAS score was 0.3 ± 1.1 (0.0-6.0) and functional VAS score was 2.6 ± 2.3 (0.0-8.0), with a total of 89.9% of patients (n = 40) being satisfied at final follow-up. This series reported no intra-operative complications (0.0%), with 4 patients (8.9%) required subsequent procedures to the ispilateral shoulder post-sub-acromial balloon insertion. CONCLUSION In selected patient cohorts, the use of sub-acromial balloon spacer insertion represents a minimally invasive, viable surgical option in the management of massive rotator cuff tears, with satisfactory patient-reported outcomes, high rates of satisfaction and a low complication rate reported at medium-term follow-up. LEVEL OF EVIDENCE III; Retrospective Cohort Study.
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Affiliation(s)
- Martin S Davey
- Department of Trauma & Orthopaedics, Galway University Hospitals, Galway, Ireland.
- Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Ken Kaar
- Department of Trauma & Orthopaedics, Galway University Hospitals, Galway, Ireland
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29
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Gupta R, Rao R, Johnston TR, Uong J, Yang DS, Lee TQ. Muscle stem cells and rotator cuff injury. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:186-193. [PMID: 37588948 PMCID: PMC10426486 DOI: 10.1016/j.xrrt.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
The incidence of reinjury after treatment of rotator cuff tears (RCTs) remains very high despite the variety of nonoperative treatments and the high volume of surgical interventions performed. Muscle stem cells (MuSCs), also known as satellite cells, have risen to the forefront of rotator cuff tear research as a potential adjuvant therapy to aid unsatisfactory surgical outcomes. MuSCs are adult stem cells exhibiting the capacity to proliferate and self-renew, both symmetrically and asymmetrically. As part of this niche, they have been shown to adopt an activated phenotype in response to musculoskeletal injury and decrease their cellular populations during aging, implicating them as key players in both pathologic and normal physiological processes. While commonly connected to the regenerative phase of muscle healing, MuSCs also have the potential to differentiate into adverse morphologies. For instance, if MuSCs differentiate into adipocytes, the ensuing fatty infiltration serves as an obstacle to proper muscle healing and has been associated with the failure of surgical management of RCTs. With the potential to both harm and heal, we have identified MuSCs as a key player in RCT repair. To better understand this dichotomy, the following review will identify key studies regarding the morphology, function, and behavior of MuSCs with respect to RCTs and healing.
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Affiliation(s)
- Ranjan Gupta
- Department of Orthopaedics, University of California, Irvine, CA, USA
| | - Rohan Rao
- Department of Orthopaedics, University of California, Irvine, CA, USA
| | - Tyler R. Johnston
- Department of Orthopaedics, University of California, Irvine, CA, USA
| | - Jennifer Uong
- Department of Orthopaedics, University of California, Irvine, CA, USA
| | - Daniel S. Yang
- Department of Orthopaedics, University of California, Irvine, CA, USA
| | - Thay Q. Lee
- Congress Medical Foundation, Pasadena, CA, USA
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Gutiérrez-Espinoza HJ, Lorenzo-García P, Valenzuela-Fuenzalida J, Araya-Quintanilla F. Functional outcomes after physiotherapy program in patients with massive and irreparable rotator cuff tear. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021; 65:248-254. [PMID: 37099420 DOI: 10.1016/j.recote.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/09/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the short term and 1-year follow-up functional effects of a physiotherapy programme in patients over 60 years of age with massive and irreparable Rotator Cuff (RC) tear. METHODS A total of 96 patients with massive and irreparable RC tear were prospectively recruited. All patients were treated with a 12-week physiotherapy programme. Three evaluations were performed, at the beginning, at the end of the treatment and at one year of follow-up. The Constant-Murley questionnaire was used to assess shoulder function, the DASH questionnaire for upper limb function, and the Visual Analogue Scale (VAS) for pain intensity. RESULTS At the end of the treatment, all the variables showed a clinically and statistically significant difference (p<.05). At one year of follow-up, the Constant-Murley showed an increase of 26.5 points (Cohen's d=1.7; 95% CI: 23.5-29.5; p<.001), DASH showed a decrease of 31.4 points (Cohen's d=2.2; 95% CI: 28.5-34.3; p<.001), and the VAS showed a decrease of 3.9cm (Cohen's d=3.6; 95% CI: 3.6-4.1; p<.001). CONCLUSION In the short term and 1-year follow-up, a physiotherapy programme showed clinically and statistically significant results in all functional variables in patients older than 60 years with massive and irreparable RC tear.
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Affiliation(s)
- H J Gutiérrez-Espinoza
- Centro de Investigación de Rehabilitación en Salud (CIRES), Universidad de las Américas, Santiago, Chile; Escuela de Kinesiología, Universidad Gabriela Mistral, Santiago, Chile.
| | - P Lorenzo-García
- Centro de Estudios Sociosanitarios, Universidad de Castilla-La Mancha, Cuenca, Spain
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31
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Kim DH, Min SG, Lee HS, Lee HJ, Park KH, Chung SW, Dehdashtian A, Yoon JP. Clinical outcome of rotator cuff repair in patients with mild to moderate glenohumeral osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2021; 29:998-1005. [PMID: 33095332 DOI: 10.1007/s00167-020-06307-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 09/28/2020] [Indexed: 01/29/2023]
Abstract
PURPOSE Osteoarthritis (OA) in the glenohumeral joint is a concomitant lesion with rotator cuff tear that commonly occurs in older patients. The authors aimed to evaluate the effect of associated OA on the treatment outcome of rotator cuff repair. METHODS A total of three hundred and forty-eight patients who underwent full-thickness arthroscopic rotator cuff repair were retrospectively reviewed, and the data were prospectively collected. The severity of OA was evaluated using the Samilson and Prieto method preoperatively and the Outerbridge classification intraoperatively. The patients were divided into the small-to-medium group and large-to-massive group according to rotator cuff tear size and were evaluated for presence or absence of OA. The postoperative clinical outcomes were assessed using the visual analog scale for pain, simple shoulder test (SST), University of California-Los Angeles, Constant, and American Shoulder and Elbow Surgeons (ASES) scoring systems at baseline and at final follow-up. RESULTS Forty-five patients were diagnosed with glenohumeral OA (12.9%). Overall, no significant differences were observed in demographic and baseline data between the two groups according to the presence or absence of OA. The clinical symptoms of both groups significantly improved at the final follow-up. At the final follow-up, no significant differences were found in the VAS for pain, SST, UCLA, Constant, and ASES scores between the two groups. In the large-to-massive tear group, patients with OA had significantly inferior clinical results compared with those without OA. CONCLUSION The clinical outcome scores improved after rotator cuff repair regardless of the presence of concomitant OA. However, glenohumeral OA should be considered as a potential negative prognostic factor in patients with large-to-massive rotator cuff tears. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Dong Hyun Kim
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Seung Gi Min
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ho Seok Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Hyun Joo Lee
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Kyeong Hyeon Park
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Seok Won Chung
- Department of Orthopaedic Surgery, School of Medicine, Konkuk University, Seoul, South Korea
| | - Amir Dehdashtian
- Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jong Pil Yoon
- Department of Orthopaedic Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea.
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Plachel F, Siegert P, Moroder P, Pauzenberger L, Laky B, Anderl W, Heuberer P. Treatment of non-arthritic pseudoparetic shoulders with irreparable massive rotator cuff tears: arthroscopic procedures yield comparable midterm results to reverse arthroplasty. BMC Musculoskelet Disord 2021; 22:190. [PMID: 33593357 PMCID: PMC7885458 DOI: 10.1186/s12891-021-04050-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/04/2021] [Indexed: 11/29/2022] Open
Abstract
Background Irreparable massive rotator cuff tears (IMRCTs) are a well-known cause for functional limitation and difficult to treat. Although several joint-preserving as well as joint-replacing procedures were found to provide pain relief and gain of function, midterm results are scarce, particularly in pseudoparetic shoulder joints unaccompanied by severe osteoarthritis. The purpose of this study was to compare the midterm functional outcomes of arthroscopic procedures to those of reverse total shoulder arthroplasty (RTSA) in pseudoparetic shoulders with IMRCTs unaccompanied by severe osteoarthritis. Methods All patients who underwent either joint-preserving (group A) or joint-replacing (group B) procedures for IMRCT unaccompanied by severe osteoarthritis with a pseudoparetic shoulder function were retrospectively included. Clinical assessment included the Constant Score (CS), the Subjective Shoulder Value (SSV) and the Visual Analog Score (VAS) at baseline and at latest follow-up. Furthermore, the complication and revision rates were assessed. Results Overall, a total 56 patients were included of whom each 28 patients formed group A (male, 36%) and B (male, 53%) with a mean patient age at time of surgery of 70 ± 7 years and 72 ± 7 years, respectively. The mean follow-up period was 56 ± 17 months. At final follow-up, the total CS (group A: 66 ± 14 points; group B 54 ± 15 points) was significantly increased after arthroscopic treatment when compared to RTSA (p=0.011). However, no significant differences were detected with SSV (p=0.583) and VAS (p=0.536). Although complication rate (11% versus 18%) was not significantly different (p=0.705), number of revision surgeries was significantly higher in group B when compared to group A (p=0.041). Conclusions In non-arthritic pseudoparetic shoulders, both joint-preserving and joint-replacing procedures yielded good clinical midterm outcomes for the treatment of degenerative IMRCTs. Despite of comparable functional and satisfactory functional improvement, increased complication rates and surgical invasiveness outweigh the benefits of primary RTSA and therefore reserve this procedure to a second-line treatment in pseudoparetic patients without any signs of severe cuff arthropathy.
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Affiliation(s)
- Fabian Plachel
- Center for Musculoskeletal Surgery, Charité - Universitaetsmedizin, Berlin, Germany.,Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria
| | - Paul Siegert
- Center for Musculoskeletal Surgery, Charité - Universitaetsmedizin, Berlin, Germany
| | - Philipp Moroder
- Center for Musculoskeletal Surgery, Charité - Universitaetsmedizin, Berlin, Germany
| | - Leo Pauzenberger
- Department of Orthopedics, St. Vincent Hospital Vienna, Hartmanngasse 15/9, 1050, Vienna, Austria
| | - Brenda Laky
- Department of Orthopedics, St. Vincent Hospital Vienna, Hartmanngasse 15/9, 1050, Vienna, Austria.,Austrian Research Group for Regenerative and Orthopedic Medicine, Hartmanngasse 15/9, 1050, Vienna, Austria
| | - Werner Anderl
- Department of Orthopedics, St. Vincent Hospital Vienna, Hartmanngasse 15/9, 1050, Vienna, Austria.,Austrian Research Group for Regenerative and Orthopedic Medicine, Hartmanngasse 15/9, 1050, Vienna, Austria
| | - Philipp Heuberer
- Department of Orthopedics, St. Vincent Hospital Vienna, Hartmanngasse 15/9, 1050, Vienna, Austria. .,Austrian Research Group for Regenerative and Orthopedic Medicine, Hartmanngasse 15/9, 1050, Vienna, Austria.
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33
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Resultados funcionales de un programa de fisioterapia en pacientes con rotura masiva e irreparable del manguito rotador. Rev Esp Cir Ortop Traumatol (Engl Ed) 2021. [DOI: 10.1016/j.recot.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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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: 0.8] [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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35
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Merlet MC, Guinet V, Rousseau T, van Rooij F, Saffarini M, Dujardin F, Courage O. Arthroscopic Side-to-Side Repair of Massive Rotator Cuff Tears Maintains Adequate Functional Improvement at 12 to 14 Years' Follow-up. Am J Sports Med 2021; 49:298-304. [PMID: 33523752 DOI: 10.1177/0363546520985224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rotator cuff tears are common shoulder injuries that often cause pain and loss of function. Nonanatomic side-to-side techniques facilitate repair by minimizing tensions within tendons to improve healing and optimize the thickness of sutured tissues. PURPOSE/HYPOTHESIS The purpose was to evaluate long-term clinical and radiographic outcomes of arthroscopic side-to-side repair of massive rotator cuff tears (mRCTs). The hypothesis was that, at a minimum follow-up of 12 years, arthroscopic side-to-side repair maintains clinically important improvements. STUDY DESIGN Case series; Level of evidence, 4. METHODS The authors reviewed records of all patients who underwent arthroscopic repair of mRCTs over 2 consecutive years. A total of 30 adult patients met the eligibility criteria and underwent side-to-side repair. Patients were evaluated clinically using the Constant score (CS) and ultrasound to assess retears at 3 timepoints after surgery: 2 to 4 years, 5 to 7 years, and 12 to 14 years. RESULTS At first follow-up (3.2 ± 0.5 years), all 30 patients had clinical and ultrasound assessment, which revealed 13 retears (43%). At second follow-up (6.2 ± 0.5 years), all 30 patients had clinical and ultrasound assessment, which revealed 2 new retears (total 50%). At final follow-up (13.0 ± 0.7 years), only 21 patients had clinical assessment (1 died and 8 could not be reached), and only 19 patients had ultrasound assessment, which revealed 6 new retears (total 79%). Both absolute CS and age-/sex-adjusted CS improved significantly from baseline values at first follow-up (73.5 and 96.6, respectively), and remained stable at second follow-up (69.0 and 91.9, respectively), and final follow-up (64.4 and 87.0, respectively). Compared to shoulders with intact repairs, those with retears tended to have lower absolute CS at all follow-up visits, although differences were not statistically significant. CONCLUSION Patients with mRCTs maintain satisfactory clinical scores at 12 to 14 years after arthroscopic side-to-side repair despite a high incidence of retears. Repair is a safe and effective treatment for mRCTs, providing a less invasive and less complex alternative to reverse shoulder arthroplasty and tendon transfer procedures.
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Affiliation(s)
- Marie Caroline Merlet
- Ramsay Sante, Hopital Prive de l'Estuaire, Le Havre, France.,Department of Orthopaedic Surgery, Rouen University Hospital, Rouen, France
| | - Virginie Guinet
- Ramsay Sante, Hopital Prive de l'Estuaire, Le Havre, France.,Department of Orthopaedic Surgery, Rouen University Hospital, Rouen, France
| | - Thomas Rousseau
- Ramsay Sante, Hopital Prive de l'Estuaire, Le Havre, France.,Department of Orthopaedic Surgery, Rouen University Hospital, Rouen, France
| | | | | | - Franck Dujardin
- Department of Orthopaedic Surgery, Rouen University Hospital, Rouen, France
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36
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Lee SJ, Min YK, Chung IK, Kang SW, Banks SA. Comparison of Dynamic In Vivo Shoulder Kinematics Before and After Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears. Orthop J Sports Med 2021; 9:2325967120970502. [PMID: 33553442 PMCID: PMC7844458 DOI: 10.1177/2325967120970502] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/07/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Superior capsular reconstruction (SCR) is an alternative surgical option for young active patients with irreparable rotator cuff tears without arthritis. Although cadaveric studies have shown superior stability of the humerus, it remains unclear whether the humerus migrates superiorly after SCR in vivo. Purpose: To analyze the change in glenohumeral translation in patients before and after SCR. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 patients who underwent SCR by a single surgeon for irreparable rotator cuff tears were included. Among them, 14 patients had intact grafts, and 8 patients were diagnosed with retears on 1-year postoperative magnetic resonance imaging (MRI) scans. Fluoroscopy was performed in all patients preoperatively and at 3-month, 6-month, and 1-year follow-up. Moreover, 3-dimensional bone models from computed tomography, MRI, and fluoroscopic scans during scapular plane abduction of the shoulder joints were analyzed. Results: In the intact graft group, 3-dimensional dynamic shoulder kinematics at 6 months (P = .026) and 1 year (P = .032) postoperatively showed statistically significant decreases in humeral head superior translation compared with preoperatively. The ≥6-mm acromiohumeral distance (AHD) subgroup had a larger decrease in humeral head superior translation from preoperatively than did the <6-mm AHD subgroup (6 months: P = .026; 1 year: P = .032). The retear group had significantly greater humeral head superior translation at 1 year postoperatively than did the ≥6-mm and <6-mm AHD subgroups (post hoc test: P < .001; ≥6-mm AHD vs retear group: P = .001; <6-mm AHD vs retear group: P = .012). Conclusion: SCR with intact grafts resulted in decreased humeral head superior translation after 6 months. Patients with retears showed no improvement in humeral head superior translation. Patients with a preoperative AHD <6 mm had less improvement in humeral head superior translation than did those with a preoperative AHD ≥6 mm. Early surgical treatment before an excessive decrease in preoperative AHD could be helpful for postoperative humeral head translation recovery.
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Affiliation(s)
- Seung-Jun Lee
- Department of Orthopaedics, Busan Central Hospital, Busan, Republic of Korea.,Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, Florida, USA
| | - Young-Kyoung Min
- Department of Orthopedic Surgery, Busan Medical Center, Busan, Republic of Korea
| | - Il-Kwon Chung
- Department of Orthopaedics, Busan Central Hospital, Busan, Republic of Korea
| | - Suk-Woong Kang
- Department of Orthopaedics, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Scott A Banks
- Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, Florida, USA
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37
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Smith TJ, Gowd AK, Kunkel J, Kaplin L, Waterman BR. Superior Capsular Reconstruction Provides Sufficient Biomechanical Outcomes for Massive, Irreparable Rotator Cuff Tears: A Systematic Review. Arthroscopy 2021; 37:402-410. [PMID: 32950647 DOI: 10.1016/j.arthro.2020.09.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/02/2020] [Accepted: 09/06/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To critically review the literature reporting biomechanical outcomes of superior capsular reconstruction (SCR) for the treatment of massive and/or irreparable rotator cuff tears. METHODS A systematic review was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines using the PubMed, MEDLINE, and Cochrane Library databases in August 2020. Cadaveric studies were assessed for glenohumeral translation, subacromial contact pressure, and superior humeral translation comparing SCR with an intact cuff with reference to a torn control state. RESULTS A total of 15 studies (142 shoulders) were included in our data analysis. SCR showed improvements in superior humeral translation, subacromial contact force, and glenohumeral contact force when biomechanically compared with the massive and/or irreparably torn rotator cuff. No statistically significant differences were found between SCR and the intact rotator cuff regarding superior humeral translation (standard mean difference [SMD], 2.09 mm vs 2.50 mm; P = .54) or subacromial contact force (SMD, 2.85 mPa vs 2.83 mPa; P = .99). Significant differences were observed between SCR and the intact cuff for glenohumeral contact force only, in favor of the intact cuff (SMD, 1.73 N vs 5.45 N; P = .03). CONCLUSIONS SCR may largely restore static restraints to superior humeral translation in irreparable rotator cuff tears, although active glenohumeral compression is diminished relative to the intact rotator cuff. CLINICAL RELEVANCE Investigating the biomechanical outcomes of SCR will help surgeons better understand the effectiveness of this treatment option.
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Affiliation(s)
- Tyler J Smith
- Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Anirudh K Gowd
- Division of Sports Medicine, Department of Orthopedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - John Kunkel
- Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Lisa Kaplin
- Division of Sports Medicine, Department of Orthopedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Brian R Waterman
- Division of Sports Medicine, Department of Orthopedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A..
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Liu F, Dong J, Kang Q, Zhou D, Xiong F. Subacromial balloon spacer implantation for patients with massive irreparable rotator cuff tears achieves satisfactory clinical outcomes in the short and middle of follow-up period: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:143-153. [PMID: 31894368 DOI: 10.1007/s00167-019-05834-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/13/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE This meta-analysis was performed systematically to evaluate the efficacy of subacromial balloon spacers for patients with massive, irreparable rotator cuff tears. METHODS Electronic databases, including Medline/PubMed, Embase and Cochrane Library, were systematically searched to identify studies evaluating the efficacy of subacromial spacers for patients with irreparable or massive rotator cuff tears. Meta-analyses were performed to pool the outcome estimates of interest, such as the total constant score (TCS) and its sub-score (pain, activities of daily living [ADL], range of motion [ROM], and strength), Oxford shoulder score (OSS), American Shoulder and Elbow Society scores (ASES) and numeric rating scale (NRS), as well as different outcomes at different time points in the follow-up period. RESULTS Ten studies with a total of 261 patients involving 270 shoulders were deemed viable for inclusion in the meta-analysis. The combined results demonstrated significant improvements in the TCS at the final follow-up (pooled mean difference = 26.4, 95% confidence intervals [CIs] 23.3 to 29.5). A sensitivity analysis and subgroup analysis, which were implemented based on two factors, different follow-up points and sub-scores (pain, ADL, ROM, and strength), revealed a consistent trend. The combined shoulder motion results demonstrated significant improvements in the forward flexion and external rotation (0° abduction) variables rather than in the abduction and external rotation (90° abduction) variables. Additionally, significant improvements in the OSS and ASES and a decrease in the NRS were observed in the middle of the follow-up period. CONCLUSION This meta-analysis indicated that subacromial balloon spacer implantation for patients with massive irreparable rotator cuff tears may achieve satisfactory outcomes between 3 months and 3 years of follow-ups. Although the short- and middle- term effect is significant, the long-term effect needs to be confirmed by large-sample randomized controlled trial. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Jinlei Dong
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Qinglin Kang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Xuhui District, Shanghai, 200233, China
| | - Dongsheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Fei Xiong
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Xuhui District, Shanghai, 200233, China.
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Smith TJ, Gowd AK, Kunkel J, Kaplin L, Hubbard JB, Coates KE, Graves BR, Waterman BR. Clinical Outcomes of Superior Capsular Reconstruction for Massive, Irreparable Rotator Cuff Tears: A Systematic Review Comparing Acellular Dermal Allograft and Autograft Fascia Lata. Arthrosc Sports Med Rehabil 2020; 3:e257-e268. [PMID: 33615273 PMCID: PMC7879184 DOI: 10.1016/j.asmr.2020.09.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose To investigate clinical outcomes after superior capsular reconstruction (SCR) for the treatment of massive and/or irreparable rotator cuff tears treated with either allograft or autograft. Methods Using the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, in April 2020 a systematic review was performed using PubMed, MEDLINE, EMBASE, and Cochrane databases. Clinical studies were assessed for patient-reported outcomes and range of motion, comparing dermal allografts to fascia lata autografts, with a minimum follow-up of 12 months. Results A total of 16 clinical studies involving 598 patients (606 shoulders) were included for data analysis, with a weighted mean follow-up of 36.9 months (range 12 to 60). Visual analogue scale (VAS) pain scores decreased from 4.0 to 6.9 mm preoperatively to 0 to 2.5 mm postoperatively. American Shoulder & Elbow Surgeons score increased from 20.3 to 54.5 preoperatively to 73.7 to 97.0 postoperatively. Forward flexion increased from 27.0° to 142.7° preoperatively to 134.5° to 167.0° postoperatively. External rotation increased from 13.2° to 41.0° preoperatively to 30.0° to 59.0° postoperatively. Acromiohumeral distance increased from 3.4 to 7.1 mm preoperatively to 6.0 to 9.7 mm postoperatively. The total rates of complications, graft failure, and revision surgery were 5.6%, 13.9%, and 6.9%, respectively. Conclusions Irrespective of tissue source, SCR serves as a reasonable joint-preserving option for massive, irreparable rotator cuff tears, with favorable short- to midterm improvements in patient-reported outcomes and range of motion. Level of Evidence IV, systematic review of level III and IV studies.
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Affiliation(s)
- Tyler J. Smith
- Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Anirudh K. Gowd
- Department of Orthopedic Surgery, Division of Sports Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - John Kunkel
- Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, U.S.A
| | - Lisa Kaplin
- Department of Orthopedic Surgery, Division of Sports Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - John B. Hubbard
- Department of Orthopedic Surgery, Division of Sports Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Kevin E. Coates
- Department of Orthopedic Surgery, Division of Sports Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Benjamin R. Graves
- Department of Orthopedic Surgery, Division of Sports Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Brian R. Waterman
- Department of Orthopedic Surgery, Division of Sports Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
- Address correspondence to Brian R. Waterman, MD, Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1070, U.S.A.
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Vogler T, Andreou D, Gosheger G, Kurpiers N, Velmans C, Ameziane Y, Schneider K, Rickert C, Liem D, Schorn D. Long-term outcome of arthroscopic debridement of massive irreparable rotator cuff tears. PLoS One 2020; 15:e0241277. [PMID: 33180802 PMCID: PMC7660551 DOI: 10.1371/journal.pone.0241277] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 10/12/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives To evaluate the clinical and radiographic outcome of low-demand patients with massive rotator cuff tears undergoing arthroscopic debridement in mid- and long-term follow-up, as well as the rate of conversion to reverse shoulder arthroplasty. Methods We performed a retrospective analysis of 19 patients with a mean age at surgery of 68 years (range, 55–80 years) from a previously described consecutive cohort and after a mean follow up of 47 month (FU1) and 145 month (FU2). The functional outcome was evaluated with the VAS score, the American Shoulder and Elbow Surgeons (ASES) score, and the age- and gender-adjusted Constant (aCS) score. The radiographic outcome was classified according to the Hamada classification. Non-parametric analyses were carried out with the Mann-Whitney U for independent samples and the Wilcoxon signed-rank test for related samples. Results Five patients (26%) developed symptomatic cuff tear arthropathy and underwent reverse shoulder arthroplasty after a mean time of 63 months (range, 45–97 months). These patients were excluded from further analyses. The mean VAS score of the remaining 14 patients at FU1 was significantly lower compared to preoperatively (P = .041), while there were no significant differences between the VAS score at FU1 and FU2 (P = 1.0). The ASES score of the affected shoulder at FU1 was significantly higher compared to prior to surgery (P = .028), while there were no significant differences between the scores of the affected shoulder between FU1 and FU2 (P = .878). While the ASES score of the contralateral shoulder at FU1 was significantly higher than the score of the affected shoulder (P = .038), there were no significant differences in the ASES scores of the affected and the healthy shoulder at FU2 (P = .575). The evaluation of the aCS produced similar results. A progression of the Hamada grade was documented in 6 patients. Conclusions Arthroscopic debridement is a safe and valid option for low-demand middle-age or elderly patients with symptomatic massive rotator cuff tears, leading to a significant pain relief and significantly improved functional outcome at mid- and long-term follow up. However, about a quarter of the patients in our cohort had to undergo reverse shoulder arthroplasty due to symptomatic cuff tear arthropathy. Furthermore, some of the remaining patients continued to undergo radiographic progression. This might be due to the natural history of their disease and/or the surgical procedure, and the clinical relevance of this finding should be evaluated in further studies.
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Affiliation(s)
- Tim Vogler
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
- * E-mail:
| | - Dimosthenis Andreou
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Georg Gosheger
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Nico Kurpiers
- Institute of Sports Science, University of Hildesheim, Hildesheim, Germany
| | - Clara Velmans
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Yacine Ameziane
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Kristian Schneider
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Carolin Rickert
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Dennis Liem
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
| | - Dominik Schorn
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany
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Altintas B, Scheidt M, Kremser V, Boykin R, Bhatia S, Sajadi KR, Mair S, Millett PJ. Superior Capsule Reconstruction for Irreparable Massive Rotator Cuff Tears: Does It Make Sense? A Systematic Review of Early Clinical Evidence. Am J Sports Med 2020; 48:3365-3375. [PMID: 32191494 DOI: 10.1177/0363546520904378] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Treatment of irreparable massive rotator cuff tears (MRCTs) in patients without advanced glenohumeral osteoarthritis remains a challenge. Arthroscopic superior capsule reconstruction (SCR) represents a newer method for treatment with increasing popularity and acceptance. PURPOSE To analyze the clinical evidence surrounding SCR and determine the current clinical outcomes postoperatively. STUDY DESIGN Systematic review. METHODS A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Electronic databases of PubMed, MEDLINE, Cochrane, and Google Scholar were used for the literature search. The study quality was evaluated according to the Modified Coleman Methodology Score. Studies in English evaluating SCR outcomes were included. RESULTS Seven studies were reviewed, including 352 patients (358 shoulders) treated with arthroscopic SCR with the mean duration of follow-up ranging from 15 to 48 months (range, 12-88 months). Fourteen patients were lost to follow-up, leaving 338 patients (344 shoulders) with clinical outcome data. Graft types included dermal allografts (n = 3 studies), fascia lata autografts (n = 3), or both (n = 1). Most commonly, a double-row technique was utilized for humeral graft fixation. The most common complication included graft tears in 13% of patients, resulting in 15 SCR revisions and 7 reverse shoulder arthroplasties. Postoperatively, improvements in visual analog scale (2.5 to 5.9), American Shoulder and Elbow Surgeons (20 to 56), Japanese Orthopaedic Association (38.0), Subjective Shoulder Value (37.0 to 41.3), and Constant (11.6 to 47.4) scores were observed. Three studies reported respective satisfaction rates of 72.9%, 85.7% and 90%. Increases in external rotation, internal rotation, and abduction with improved strength in external rotation were observed postoperatively. Improvement of pseudoparalysis was also observed in 3 studies. One study reported return to sports in 100% of patients (2 competitively, 24 recreationally) with no adverse outcomes. CONCLUSION SCR showed good to excellent short-term clinical outcomes with adequate pain relief and functional improvement. The current evidence suggests that the procedure is an alternative for symptomatic patients with irreparable MRCT; however, the included studies were fair to poor in quality, and there were some notable complications. Long-term follow-up will determine the longevity and ultimate role of this new method in the treatment of irreparable MRCT.
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Affiliation(s)
- Burak Altintas
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA.,Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Michael Scheidt
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Victor Kremser
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Robert Boykin
- EmergeOrtho, Blue Ridge Division, Asheville, North Carolina, USA
| | - Sanjeev Bhatia
- Department of Orthopaedic Surgery, Northwestern Medicine, Warrenville, Illinois, USA
| | - Kaveh R Sajadi
- Kentucky Bone & Joint Surgeons, Lexington, Kentucky, USA
| | - Scott Mair
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA
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Zhuo H, Zhu F, Pan L, Li J. The Use of Autologous Iliotibial Band With Gerdy's Tubercle for Irreparable Rotator Cuff Tears. Orthop Surg 2020; 12:1489-1494. [PMID: 33015994 PMCID: PMC7670137 DOI: 10.1111/os.12799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 01/08/2023] Open
Abstract
Objective To determine the radiographic and functional outcomes after autologous iliotibial band with Gerdy's tubercle (ITB‐GT) interposition in patients with irreparable rotator cuff tears (IRCTs). Methods From December 2015 to March 2017, a total of 16 patients who underwent autologous ITB‐GT interposition for IRCTs were identified, including 4 males and 12 females. The mean age was 56.1 ± 10.3 years (range, 44–67 years). Functional assessment consisted of active range of motion (ROM), Visual Analogue scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Constant–Murley score, and patient satisfaction rate. The tendon integrity and acromiohumeral interval (AHI) were assessed by postoperative magnetic resonance imaging (MRI). Results The mean duration of follow‐up was 25.3 ± 3.5 months. At final follow‐up, the patients exhibited significantly improved forward elevation, external rotation, and internal rotation (75.00° ± 13.16° to 159.37° ± 8.51°, t = 26.71, P = 0.001; 17.81° ± 11.54° to 35.31° ± 8.26°, t = 6.57, P = 0.001; 2 to 11, t = 13.10, P = 0.001). Other functional outcomes as measured by VAS score, ASES score, and Constant–Murley score also improved significantly (6.50 ± 1.41 to 1.06 ± 0.93, t = 11.68, P = 0.001; 38.50 ± 8.68 to 81.75 ± 6.80, t = 15.42, P = 0.001; 32.50 ± 8.53 to 77.12 ± 6.72, t = 17.28, P = 0.001). The overall satisfaction rate was 87.5%. The postoperative MRI showed that the tendon integrity was fully intact in 14 patients and partially intact in two patients. The AHI improved significantly from 3.63 ± 1.25 mm preoperatively to 8.37 ± 1.02 mm postoperatively (t = 11.78, P = 0.001). Conclusion Autologous ITB‐GT interposition was a useful treatment option for patients with IRCTs, which resulted in significant improvements in active ROM, subjective functional outcomes, and AHI with excellent tendon integrity at a minimum 2‐year follow‐up.
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Affiliation(s)
- Hongwu Zhuo
- Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Fugui Zhu
- Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Ling Pan
- Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jian Li
- Rehabilitation Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou, China
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Lee KW, Lee GS, Yang DS, Park SH, Chun YS, Choy WS. Clinical Outcome of Arthroscopic Partial Repair of Large to Massive Posterosuperior Rotator Cuff Tears: Medialization of the Attachment Site of the Rotator Cuff Tendon. Clin Orthop Surg 2020; 12:353-363. [PMID: 32904088 PMCID: PMC7449848 DOI: 10.4055/cios19126] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/05/2019] [Indexed: 11/06/2022] Open
Abstract
Backgroud The goal of this study was to evaluate the clinical and radiological outcomes of arthroscopic partial repair with medialization of the attachment site of the rotator cuff tendon and to identify prognostic factors affecting rotator cuff healing in patients with irreparable large to massive posterosuperior rotator cuff tears. Methods Between July 2012 and March 2016, 42 patients with irreparable large to massive posterosuperior rotator cuff tears underwent an arthroscopic partial repair with medialization of the attachment site of the rotator cuff tendon. All patients had a minimum of 2-year follow-up (mean, 35.4 ± 7.3 months). Clinical evaluation was performed using the visual analog scale, the University of California, Los Angeles shoulder rating scale, Constant score, and active range of motion. Radiological evaluation was performed using magnetic resonance imaging and simple radiography. Results Clinical outcomes at the final follow-up improved significantly compared with the preoperative values (all p < 0.001). The failure rate was 23.8% (10/42); however, clinical outcomes significantly improved regardless of cuff healing (all p < 0.001). The mean acromiohumeral distance was 6.5 ± 1.7 mm (range, 3.2-9.7 mm) before surgery and 6.3 ± 1.6 mm (range, 2.8-9.5 mm) at the final follow-up. Preoperative acromiohumeral distance was associated with failure of cuff healing in the univariate analysis (p = 0.043) and multivariate analysis (p = 0.048). A receiver operating characteristic curve was used to determine the predictive cutoff value for the smallest preoperative acromiohumeral distance for successful healing, which was calculated as 5.3 mm. Conclusions Despite healing failure, arthroscopic partial repair with medialization can be a possible treatment option for irreparable large to massive posterosuperior rotator cuff tears because of the improvement in clinical outcome. The shorter preoperative acromiohumeral distance was the single most important factor negatively affecting cuff healing, and the likelihood of success of healing might be improved if a repair is performed when the preoperative acromiohumeral distance is < 5.3 mm.
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Affiliation(s)
- Kwang Won Lee
- Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Gyu Sang Lee
- Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Dae Suk Yang
- Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Seong Ho Park
- Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Young Sub Chun
- Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea
| | - Won Sik Choy
- Department of Orthopedic Surgery, Eulji University School of Medicine, Daejeon, Korea
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Burkhard MD, Dietrich M, Andronic O, Nikolic N, Grueninger P. Arthroscopic repair of posterosuperior rotator cuff tears with bioabsorbable patch augmentation: a magnetic resonance-controlled case series with 1-year follow-up. JSES Int 2020; 4:860-868. [PMID: 33345226 PMCID: PMC7738590 DOI: 10.1016/j.jseint.2020.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Among many advances in the treatment of rotator cuff tears, arthroscopic augmentation techniques with patches of various biological and synthetic graft materials have been introduced to reinforce the repair. However, structural and functional outcomes after patch augmentation vary, and reinforcing the tendon healing remains a challenge. The aim of this study was to evaluate clinical and radiologic outcomes 1 year after arthroscopic posterosuperior (PS) rotator cuff repair with bioabsorbable patch augmentation. Methods From October 2014 to December 2017, all patients with PS rotator cuff tears undergoing arthroscopic repair with patch augmentation using a resorbable, biologically derived poly-4-hydroxybutyrate patch (Biofiber; Wright, Memphis, TN, USA) were enrolled in this study. Only full-thickness PS lesions with ≥1 of the following tear patterns were augmented with a patch and were the subject of this study: large U- and L-shaped tear, transtendinous tear, delamination, and fraying of the bursal layer. Patients were examined preoperatively and at 1 year postoperatively with a standardized examination protocol and magnetic resonance imaging (MRI). Results Sixteen patients were included in this study; 1 patient was lost to follow-up. One patient only underwent clinical follow-up. We detected 1 repair failure (6.7%) with dislocation of the lateral-row anchors on computed tomography scanning at 3 months postoperatively. MRI was performed in 14 patients after 1 year; in all of them, the cuff repair was intact. The Sugaya tendon integrity score was 1.7 ± 0.9. The Constant-Murley score improved from 44 to 89 points (P < .001). Muscular strength improved in the supraspinatus (from 2.6 to 4.8), infraspinatus (from 3.2 to 4.9), and subscapularis (from 4 to 4.9) (all P < .001). Overall, patient satisfaction was high (3.6 ± 0.6). Discussion This small-sized case series is the first to prospectively assess clinical and radiologic outcomes after patch augmentation of PS rotator cuff tears using bioabsorbable poly-4-hydroxybutyrate patches. Good to excellent structural and functional outcomes were observed with a low retear rate (6.7%) and good tendon integrity on 1-year postoperative MRI, and the graft did not cause any complications. The use of bioabsorbable patches could be beneficial when unfavorable PS tear patterns are encountered in which a stable repair of the full tendon thickness at its insertion is otherwise difficult to reach.
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Affiliation(s)
- Marco D Burkhard
- Department of Orthopaedics and Traumatology, Waid City Hospital, Zürich, Switzerland.,Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
| | - Michael Dietrich
- Department of Orthopaedics and Traumatology, Waid City Hospital, Zürich, Switzerland
| | - Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland
| | - Nikola Nikolic
- Department of Radiology, Waid Hospital, Zürich, Switzerland
| | - Patrick Grueninger
- Department of Orthopaedics and Traumatology, Waid City Hospital, Zürich, Switzerland.,Department of Surgery, Spital Limmattal, Schlieren, Switzerland
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Lin J, Sun Y, Chen Q, Liu S, Ding Z, Chen J. Outcome Comparison of Graft Bridging and Superior Capsule Reconstruction for Large to Massive Rotator Cuff Tears: A Systematic Review. Am J Sports Med 2020; 48:2828-2838. [PMID: 31766858 DOI: 10.1177/0363546519889040] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Graft bridging (GB) and superior capsule reconstruction (SCR) were developed to treat large to massive rotator cuff tears (RCTs); however, the outcome differences between GB and SCR remain unclear. PURPOSE To systematically review and compare the outcomes of GB and SCR for large to massive RCT. STUDY DESIGN Systematic review. METHODS A systematic review was performed via a comprehensive search of PubMed, Embase, and the Cochrane Library. Studies of GB or SCR were included according to the inclusion and exclusion criteria. The primary outcome was Constant-Murley score at the final follow-up. Secondary outcomes included the American Shoulder and Elbow Surgeons score, visual analog scale score for pain, active shoulder range of motion, and graft healing rate. Complication rate was the safety outcome measure. Outcomes were summarized into group SCR and group GB, and the results were compared statistically (P < .05). RESULTS A total of 23 studies were included in this review: 238 repairs from the 5 studies in group SCR and 593 repairs from the 18 studies in group GB. For group SCR and group GB, the mean age was 61.6 and 63.3 years, and the mean follow-up was 18.0 and 40.1 months, respectively. Overall, both procedures demonstrated improvement of clinical outcomes. When compared with group SCR, group GB had significantly higher mean differences of the Constant-Murley score (41.9 vs 19.8), American Shoulder and Elbow Surgeons score (39.3 vs 33.8), visual analog scale score for pain (4.4 vs 3.4), and active external rotation at side (15.3 vs 9.3). No statistically significant difference was detected in the mean difference of active forward flexion, internal rotation, abduction, and graft healing rate between the groups. The complication rates were 0.84% (2 of 238) in group SCR and 0.67% (4 of 593) in group GB. CONCLUSION In general, GB showed significantly better clinical and functional outcomes postoperatively than SCR, with a similar complication rate. The available fair-quality evidence suggested that GB might be a better choice for large to massive RCT. More high-quality randomized controlled studies are required to further evaluate the relative benefits of the 2 procedures.
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Affiliation(s)
- Jinrong Lin
- Fudan University Huashan Hospital, Shanghai, China
| | - Yaying Sun
- Fudan University Huashan Hospital, Shanghai, China
| | - Qingyan Chen
- Department of Biology, Boston University, Boston, Massachusetts, USA
| | - Shaohua Liu
- Fudan University Huashan Hospital, Shanghai, China
| | - Zheci Ding
- Fudan University Huashan Hospital, Shanghai, China
| | - Jiwu Chen
- Fudan University Huashan Hospital, Shanghai, China
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46
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Xu C, Yang X. Staged arthroscopic procedure for treating simultaneous shoulder and elbow synovial chondromatosis: A case report and literature review. SAGE Open Med Case Rep 2020; 8:2050313X20951340. [PMID: 32922795 PMCID: PMC7446550 DOI: 10.1177/2050313x20951340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/27/2020] [Indexed: 11/21/2022] Open
Abstract
It is extremely rare for ipsilateral shoulder and elbow synovial chondromatosis to occur simultaneously. We report a very rare case of simultaneous shoulder and elbow synovial chondromatosis in a 53-year-old woman who was treated through staged surgeries. Shoulder arthroscopic synovectomy, debridement, biceps tenodesis, and subacromial decompression were conducted first, followed by elbow arthroscopy 2 months later. Post surgery, there was no recurrence either clinically or radiologically at 2 years follow-up. Despite some loss of the range of motion of the shoulder and muscle strength, the elbow functions recovered fully, and the patient was extremely satisfied with the clinical outcome. We recommend a staged arthroscopic procedure consisting of a thorough synovectomy and joint debridement for this condition.
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Affiliation(s)
- Caiqi Xu
- Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Xingguang Yang
- Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai, China
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Reeves JM, Singh S, Langohr GDG, Athwal GS, Johnson JA. An in-vitro biomechanical assessment of humeral head migration following irreparable rotator cuff tear and subacromial balloon reconstruction. Shoulder Elbow 2020; 12:265-271. [PMID: 32788931 PMCID: PMC7400713 DOI: 10.1177/1758573219865479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/26/2019] [Accepted: 06/05/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND A resorbable subacromial balloon has been developed to address humeral head migration following posterosuperior rotator cuff tears. The purpose of this experimental assessment was to quantify the effect of balloon augmentation on humeral head position. METHODS Eight cadaveric shoulders were subjected to 0°, 30°, 60° and 90° of abduction via a shoulder simulator. The deltoid was activated at 40N, then 80N. The subscapularis and infraspinatus with teres minor were then applied independently and together to create four muscle activation states for each deltoid load. The shoulder was tested intact, torn, then with the balloon. The centre of the humeral head was tracked using active optical markers. RESULTS When the rotator cuff was torn, the humeral head translated superior by 1.4 ± 1 mm overall (P = 0.009). Following balloon augment, the humeral head translated inferiorly by 2 ± 2 mm relative to the intact state (P = 0.042), and significantly more anterior than the intact (3 ± 2 mm; P = 0.005) state. Rotator cuff variation was only significantly different when the balloon was used, with the subscapularis translating the humeral head posteriorly (P = 0.006). DISCUSSION The subacromial balloon inferiorized the humeral head compared to the torn state. Unexpected anterior humeral head translation was attributed to the posterosuperior balloon placement relative to the humeral head.
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Affiliation(s)
- Jacob M Reeves
- Department of Mechanical Engineering, The University of Western Ontario, London, Canada,The Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph’s Hospital, London, Canada
| | - Supriya Singh
- The Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph’s Hospital, London, Canada,Department of Surgery, The University of Western Ontario, London, Canada
| | - G Daniel G Langohr
- Department of Mechanical Engineering, The University of Western Ontario, London, Canada,The Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph’s Hospital, London, Canada
| | - George S Athwal
- The Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph’s Hospital, London, Canada,Department of Surgery, The University of Western Ontario, London, Canada
| | - James A Johnson
- Department of Mechanical Engineering, The University of Western Ontario, London, Canada,The Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph’s Hospital, London, Canada,Department of Surgery, The University of Western Ontario, London, Canada,Department of Biomedical Engineering, The University of Western Ontario, London, Canada,James Johnson, Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph’s Health Care, 268 Grosvenor St, London, ON N6A 4L6, Canada.
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Piekaar RSM, Bouman ICE, van Kampen PM, van Eijk F, Huijsmans PE. The subacromial balloon spacer for massive irreparable rotator cuff tears: approximately 3 years of prospective follow-up. Musculoskelet Surg 2020; 104:207-214. [PMID: 31250379 DOI: 10.1007/s12306-019-00614-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/20/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Irreparable rotator cuff tears (RCT) are still a challenging problem. RCT can result in disability and severe pain. The optimal treatment for this disabling and painful diagnosis remains controversial. The arthroscopic implantation of a biodegradable subacromial balloon spacer is a possible treatment option. In this prospective study, we evaluate the clinical outcome of this balloon spacer after approximately 3 years. METHODS Between March 2014 and December 2015, the biodegradable balloon spacer was implanted into the subacromial space of 46 shoulders of 44 patients with massive irreparable RCT. Pain was evaluated using a numeric rating scale (NRS), and functional outcome was evaluated using the Oxford shoulder score (OSS). Patients were followed prospectively for approximately 3 years. This present study focuses on the comparison between the early and the midterm results up to approximately 3 years. RESULTS All patients were treated by surgical implantation of the subacromial balloon spacer. The comparison between the outcomes of the NRS and the OSS after one and 3 years was made and showed no mutual significant differences, respectively, p = 0.61 and p = 0.08. Significant pain reduction and functional improvement was noticed postoperatively and maintained after approximately 3 years. At last follow-up (mean: 34 months), pain was reduced to a NRS of 3.09 points (95% CI: 2.17-4.01). Functional outcome based on the OSS improved significantly from 21.32 preoperatively to 34.39 (95% CI: 29.17-36.70) at the last follow-up. Correction for estimated confounders did not show significant differences. 82% of the patients were satisfied with the outcome after implantation of the subacromial balloon spacer. No surgical or postoperative medical complications due to implantation of the balloon spacer were reported. CONCLUSIONS Arthroscopic implantation of the biodegradable balloon spacer in the subacromial space is a safe and minimally invasive intervention. It leads to significant reduction in pain and significant improvement of functional daily activities in patients with irreparable RCT during 3 years of follow-up starting postoperative and maintain over time beyond device degradation. A high percentage of patients are satisfied postoperatively. Despite of these positive results after 3 years of follow-up, the specific contribution of the balloon needs further investigation.
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Affiliation(s)
- R S M Piekaar
- The Department of Orthopaedic Surgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
| | - I C E Bouman
- The Department of Orthopaedic Surgery, Haga Hospital The Hague, Sportlaan 600, 2566 MJ, The Hague, The Netherlands
| | - P M van Kampen
- The Department of Orthopaedic Surgery, Bergman Clinics, Laan van Oversteen 20, 2289 CX, Rijswijk, The Netherlands
| | - F van Eijk
- The Department of Orthopaedic Surgery, Bergman Clinics, Laan van Oversteen 20, 2289 CX, Rijswijk, The Netherlands
| | - P E Huijsmans
- The Department of Orthopaedic Surgery, Bergman Clinics, Laan van Oversteen 20, 2289 CX, Rijswijk, The Netherlands
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49
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Johnson SM, Cherry JV, Thomas N, Jafri M, Jariwala A, McLeod GG. Clinical outcomes and ultrasonographic viability of GraftJacket® augmented rotator cuff repair: a prospective follow-up study with mean follow-up of forty-one months. J Clin Orthop Trauma 2020; 11:S372-S377. [PMID: 32523296 PMCID: PMC7275267 DOI: 10.1016/j.jcot.2019.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/27/2019] [Accepted: 09/02/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The management of large rotator cuff tears in patients without evidence of glenohumeral arthritis is challenging and controversial. We wished to investigate the viability of Graft Jacket® augmentation and assess the clinical and radiological outcomes in a prospective study with a select cohort of patients. METHODS All procedures were performed by a single shoulder surgeon over a three-year period. Inclusion criteria were patients with large cuff tears (size 3-5 cm) not amenable to end-to-end repair. Patients with radiographic evidence of glenohumeral arthritis or cuff tear arthropathy were excluded. Open rotator cuff repair followed by bridging with GraftJacket® Regenerative Tissue Matrix was performed. Outcome was assessed with Constant scores (CS), QuickDash (QD) and Oxford Shoulder scores (OSS) at minimum twenty-two months and ultrasound assessment at nine months post-operatively. RESULTS Thirteen patients were identified who fit inclusion criteria (one bilateral). No patients were lost to follow up. At final follow-up thirteen shoulders had achieved function range of movement. Mean CS was 83 (range 70-100), mean Quick DASH was 5.4 (range 0-18.2), and mean OSS was 46 (range 41-48). Shoulder ultrasound revealed an intact Graft Jacket® in these patients.One patient had lower functional movement and worse CS (34), QD (34.1) and OSS (25) and ultrasound assessment identified a re-rupture. DISCUSSION This study indicates that augmentation of large rotator cuff repairs with a GraftJacket® scaffold is a viable option and has good functional results and sustained viability. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
| | - Jennifer V. Cherry
- Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
- Corresponding author.
| | - Naveena Thomas
- Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - Mansoor Jafri
- Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - Arpit Jariwala
- Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
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Kim J, Ryu Y, Kim SH. Surgical Options for Failed Rotator Cuff Repair, except Arthroplasty: Review of Current Methods. Clin Shoulder Elb 2020; 23:48-58. [PMID: 33330234 PMCID: PMC7714325 DOI: 10.5397/cise.2019.00416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 12/30/2019] [Accepted: 01/08/2020] [Indexed: 12/30/2022] Open
Abstract
Although the prevalence of rotator cuff tears is dependent on the size, 11% to 94% of patients experience retear or healing failure after rotator cuff repair. Treatment of patients with failed rotator cuff repair ranges widely, from conservative treatment to arthroplasty. This review article attempts to summarize the most recent and relevant surgical options for failed rotator cuff repair patients, and the outcomes of each treatment, except arthroplasty.
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Affiliation(s)
- Jangwoo Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yunki Ryu
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sae Hoon Kim
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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