1
|
Na Y, Jue H, Xia T, Xue X, Sun L, Chen J, Hua Y. Histologic and biomechanical comparison of fascia lata autograft, acellular dermal xenograft, and synthetic patch for bridging massive rotator cuff tear in a rabbit model. Asia Pac J Sports Med Arthrosc Rehabil Technol 2024; 36:28-39. [PMID: 38584973 PMCID: PMC10998002 DOI: 10.1016/j.asmart.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/17/2024] [Indexed: 04/09/2024] Open
Abstract
Background Bridging repair has emerged as a promising and reliable treatment strategy for the massive rotator cuff tears (MRCTs). However, there remains a lack of evidence on which bridging graft provides the better repair results, and a dearth of animal studies comparing bridging repairs with different grafts. The purpose of this study was to evaluate the histological and biomechanical outcomes of commonly used grafts (autologous fascia lata (FL), acellular dermal matrix graft (ADM), and polyethylene terephthalate (PET) patch). Methods A total of 66 male New Zealand White Rabbits were used to mimic a model of unilateral chronic MRCTs. The rabbits were randomly divided into three groups: (1) FL group, which underwent bridging repair with autologous FL; (2) ADM group, which underwent bridging with ADM; and (3) PET group, which underwent bridging with PET patch. Tissue samples were collected and subjected to histological analysis using Hematoxylin and eosin, Picrosirius red, Safranin O/Fast green staining, and Immunostaining. Collagen diameter and fibril density in the regenerated tendon was analyzed with transmission electron microscopy (TEM). Additionally, biomechanical tests were performed at 6 and 12 weeks after repair. Results The regenerated tendon successfully reattached to the footprint in all experimental groups. At 6 weeks after repair, the FL group had a significantly higher Modified Tendon Histological Evaluation (MTHE) score at the regenerated tendon than the PET group (13.2 ± 1.64 vs 9.6 ± 1.95, respectively; P = 0.038). The picrosirius red staining results showed that the FL group had a significantly higher type I collagen content than the ADM and PET groups at 6 weeks, and this difference was sustained with the PET group at 12 weeks (P < 0.05). Immunofluorescence analysis against CD68 indicated that the number of macrophage infiltrates was significantly lower in the FL group than in the ADM and PET groups (P < 0.05). At 12 weeks after repair, the area of Safranin O metachromasia was significant greater in ADM group than that in the PET group (P = 0.01). The FL group showed a significantly larger collagen diameter in the regenerated tendon than the PET group (P < 0.05), as indicated by TEM results. Furthermore, the FL group resulted in a greater failure load (at 6 weeks; 118.40 ± 16.70 N vs 93.75 ± 9.06 N, respectively; P = 0.019) and elastic modulus (at 6 weeks; 12.28 ± 1.94 MPa vs 9.58 ± 0.79 MPa, respectively; P = 0.024; at 12 weeks; 15.02 ± 2.36 MPa vs 11.63 ± 1.20 MPa, respectively; P = 0.032) than the ADM group. Conclusions This study demonstrated that all three grafts could successfully bridging chronic MRCTs in a rabbit model. However, autologous FL promoted tendon regeneration and maturation, and enhanced the tensile properties of the tendon-to-bone complex when compared with ADM and PET grafts.
Collapse
Affiliation(s)
| | | | | | - Xiaoao Xue
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Luyi Sun
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Chen
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Yinghui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
2
|
Shin KH, Jang IT, Han SB. Outcomes of Superior Capsular Reconstruction Using the Long Head of the Biceps Tendon in Large to Massive Rotator Cuff Tears: A Meta-Analysis and Systematic Review. J Clin Med 2024; 13:1052. [PMID: 38398365 PMCID: PMC10889218 DOI: 10.3390/jcm13041052] [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: 01/04/2024] [Revised: 01/26/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: Addressing large to massive rotator cuff tears (LMRCTs) poses complex challenges. This systematic review investigated outcomes of superior capsular reconstruction (SCR) with the long head of the biceps tendon (LHBT) compared to conventional rotator cuff repair (RCR) for LMRCTs. (2) Methods: A systematic search across the MEDLINE/PubMed, EMBASE, Cochrane Library, and Scopus databases until 1 October 2023 identified studies that directly compared SCR with LHBT with conventional RCR in patients with LMRCTs and included a minimum of a 12-month follow-up period. The assessed outcome measures encompassed retear rates, functional outcomes, range of motion (ROM), and acromiohumeral interval (AHI). Risk of bias assessment was conducted via the Robins-I tool. (3) Results: In six studies with 456 cases (210 SCR using LHBT and 246 using RCR), SCR with LHBT significantly reduced retear rates (OR = 0.21; 95% CI, 0.12-0.36; p < 0.01; I2 = 0%). Furthermore, SCR with LHBT showed significant improvement in range of forward flexion (SMD 0.32, 95% CI: 0.09-0.55, p < 0.01, I2 = 39%) and AHI (SMD 0.61, 95% CI: 0.31-0.92, p < 0.01, I2 = 0%) postoperatively. (4) Conclusion: SCR with LHBT is a safe and effective treatment for LMRCTs, reducing retear rates, maintaining greater postoperative AHI, and improving ROM compared to conventional RCR. Additional high-quality interventional studies are needed to confirm these results.
Collapse
Affiliation(s)
- Kyun-Ho Shin
- Department of Orthopedic Surgery, Yeson Hospital, Bucheon-si 14555, Republic of Korea
| | - Il-Tae Jang
- Nanoori Medical Research Institute, Seoul 06048, Republic of Korea;
| | - Seung-Beom Han
- Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea;
| |
Collapse
|
3
|
Baek CH, Kim BT, Kim JG, Kim SJ. Mid-term Outcome of Superior Capsular Reconstruction Using Fascia Lata Autograft (At Least 6 mm in Thickness) Results in High Retear Rate and No Improvement in Muscle Strength. Arthroscopy 2024:S0749-8063(24)00064-1. [PMID: 38311262 DOI: 10.1016/j.arthro.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE (1) To report and evaluate clinical and radiologic outcomes of superior capsular reconstruction (SCR) using fascia lata autograft in patients with irreparable rotator cuff tears (IRCTs) over a mid-term duration and (2) to assess the overall survival rate of the graft. METHODS We retrospectively reviewed patients who underwent SCR with fascia lata autograft between June 2017 and August 2018. The graft, folded 3 or 4 times, achieved a minimum thickness of 6 mm during the surgical procedure. The inclusion criteria encompassed patients with isolated supraspinatus IRCTs or posterosuperior IRCTs exhibiting poor muscle quality (Goutallier grade ≥3) and without arthritis (Hamada grade ≤ 2). The exclusion criteria included lack of follow-up data or magnetic resonance imaging. Clinical assessments included the visual analog scale score, Constant score, and American Shoulder and Elbow Surgeons (ASES) score; active range of motion; and strength. Radiographic analysis included the acromiohumeral distance, Hamada grade, and graft integrity at final follow-up. A Kaplan-Meier curve was generated to depict SCR graft survivorship. RESULTS In total, 45 patients (mean age, 64.8 ± 5.7 years) were included, and the average follow-up duration was 63.2 ± 5.9 months (range, 50-79 months). There was significant improvement in pain (visual analog scale score of 4.4 ± 1.3 preoperatively vs 1.4 ± 0.4 at final follow-up, P < .001). Yet, 18 patients (40.0%) and 17 patients (37.7%) achieved the minimal clinically important difference in the ASES score and Constant score, respectively. Active forward elevation increased from 119° ± 23° to 137° ± 23° (P < .001), and external rotation at the side improved from 29° ± 11° to 36° ± 12° (P = .002). However, strength did not exhibit improvement in any direction. The acromiohumeral distance decreased from 8.5 ± 1.7 mm to 6.5 ± 1.9 mm (P < .001), and the Hamada grade increased from 1.1 ± 0.3 to 1.8 ± 1.1 (P < .001). Finally, the infection rate was 13.3% (n = 6). CONCLUSIONS Despite a substantial graft retear rate of 62.2%, SCR led to a significant improvement in pain. Nonetheless, 18 patients (40.0%) and 17 patients (37.7%) achieved the minimal clinically important difference in the ASES score and Constant score, respectively. Forward elevation and external rotation at the side showed significant improvement, but no improvement in muscle strength was observed. Finally, significant arthritis progression was observed. LEVEL OF EVIDENCE Level IV, retrospective case series.
Collapse
Affiliation(s)
- Chang Hee Baek
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea.
| | - Bo Taek Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
| | - Jung Gon Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
| | - Seung Jin Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
| |
Collapse
|
4
|
Kimball JS, Woodard D, Gulbrandsen MT, Jobe CM, Phipatanakul WP, Syed HM. Patients With Intact Shoulder Superior Capsular Reconstruction Grafts on Ultrasound Show Significant Improvement in Functional Outcomes at Minimum 2-Year Follow-up. Arthrosc Sports Med Rehabil 2024; 6:100857. [PMID: 38288033 PMCID: PMC10823090 DOI: 10.1016/j.asmr.2023.100857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/04/2023] [Indexed: 01/31/2024] Open
Abstract
Purpose To assess the utility of using dynamic ultrasound for postoperative evaluation after superior capsular reconstruction (SCR) by evaluating graft integrity and its correlation with clinical outcomes at a minimum 2-year follow-up. Methods A retrospective chart review was conducted to identify patients who underwent SCR between July 2015 and July 2020 with a minimum 2-year clinical and ultrasound follow-up. Clinical outcome measures included Simple Shoulder (SS) and American Shoulder and Elbow Surgeon (ASES) scores. Integrity of the SCR graft was evaluated by dynamic ultrasound. Results We evaluated 22 shoulders in 21 patients with a mean follow-up of 44.8 months (range, 24-71 months). The graft was found to be intact by ultrasound evaluation in 82% (18/22). Patients with intact grafts had higher mean SS (11.6 vs 7.8, P = .00079) and ASES (91.2 vs 64.1, P = .0296) scores at latest follow-up compared to those with failed grafts. Those with intact grafts also had significant improvement in SS (3.7 vs 11.6, P < .00001) and ASES (23.2 vs 91.2, P < .00001) scores at latest follow-up compared to their preoperative scores. In contrast, patients with graft failure had no significant improvement in SS (6.3 vs 9.0, P = .123) and ASES (40.4 vs 58.3, P = .05469) scores at latest follow-up compared to their preoperative scores. There was no difference between clinical outcomes at 6 to 12 months vs latest follow-up for both SS (P = .11, P = .5) and ASES (P = .27, P = .21) scores. Conclusions SCR grafts were found by ultrasound to be intact in 82% of cases. Patients with intact grafts on ultrasound had significant improvement in functional outcome scores while those with graft failure did not. Functional outcome scores suggest that maximal recovery from this procedure occurs by 6 to 12 months. Level of Evidence Level IV, therapeutic case series.
Collapse
Affiliation(s)
- Jeff S. Kimball
- Department of Orthopaedic Surgery, Loma Linda University School of Medicine, Loma Linda, California, U.S.A
| | - David Woodard
- Department of Orthopaedic Surgery, Loma Linda University School of Medicine, Loma Linda, California, U.S.A
| | - Matthew T. Gulbrandsen
- Department of Orthopaedic Surgery, Loma Linda University School of Medicine, Loma Linda, California, U.S.A
| | - Christopher M. Jobe
- Department of Orthopaedic Surgery, Loma Linda University School of Medicine, Loma Linda, California, U.S.A
- Veterans Administration Loma Linda, Loma Linda, California, U.S.A
| | - Wesley P. Phipatanakul
- Department of Orthopaedic Surgery, Loma Linda University School of Medicine, Loma Linda, California, U.S.A
| | - Hasan M. Syed
- Department of Orthopaedic Surgery, Loma Linda University School of Medicine, Loma Linda, California, U.S.A
- Veterans Administration Loma Linda, Loma Linda, California, U.S.A
| |
Collapse
|
5
|
Kim JG, Lim C, Kim BT, Baek CH. Superior Capsular Reconstruction Versus Middle Trapezius Tendon Transfer for Isolated Irreparable Supraspinatus Tendon Tears: Static Versus Dynamic Reconstruction. Am J Sports Med 2024; 52:431-440. [PMID: 38179610 DOI: 10.1177/03635465231213340] [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] [Indexed: 01/06/2024]
Abstract
BACKGROUND Both superior capsular reconstruction (SCR) and middle trapezius tendon (MTT) transfer can be performed in nonarthritic young and active patients with isolated irreparable supraspinatus tendon tears (IISTTs). However, to our knowledge, no comparative clinical studies have been conducted on these procedures. PURPOSE To evaluate and compare the clinical and radiological outcomes of SCR and arthroscopic-assisted MTT transfer in patients with IISTTs. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 60 patients with IISTTs were categorized into 2 groups according to the surgical procedure-Group S underwent SCR (n = 34); Group M underwent MTT transfer (n = 26). The clinical outcomes included the visual analog scale score for pain, active shoulder range of motion, American Shoulder and Elbow Surgeons score, and University of California, Los Angeles, shoulder score. Radiological outcomes included the assessment of the acromiohumeral distance, progression of cuff tear arthropathy (Hamada grade), subacromial bone erosion, and graft failure. RESULTS The mean follow-up time was 39.3 ± 5.2 months (range, 26-59 months) and 37.6 ± 9.8 months (range, 27-54 months) in Group S and Group M, respectively. Significant improvements in clinical outcomes were observed in both groups, while the active forward flexion (148.2°± 24.1° vs 165.9°± 8.7°; P = .003) and abduction (131°± 37.3° vs 152.5°± 17.9°; P = .035) were significantly higher in Group M at the final follow-up. No significant differences were found in the postoperative Constant, American Shoulder and Elbow Surgeons, and University of California, Los Angeles, shoulder scores between the 2 groups. Radiologically, although no difference was found in the Hamada grade at the final follow-up between the 2 groups (P = .143), the rates of acromial wear (58.8% vs 15.4%; P < .001) and graft retear (47.1% vs 7.7%; P < .001) were significantly higher in Group S than in Group M. CONCLUSION Both SCR and MTT transfer improved the overall clinical outcomes of IISTTs postoperatively, whereas MTT transfer was superior to SCR in terms of active forward flexion and abduction range of motion. Although higher rates of graft failure and subacromial bone erosion were observed in Group S, no difference was found in the clinical scores between the 2 groups at the short-term follow-up. However, further well-structured, prolonged comparative trials should be conducted in the future.
Collapse
Affiliation(s)
- Jung Gon Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
| | - Chaemoon Lim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
| | - Bo Taek Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
| | - Chang Hee Baek
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Jeollanam-do, Republic of Korea
| |
Collapse
|
6
|
Chung SW, Kim DH, Lee HJ, Hong WK, Chung SH, Yoon JP. Superior capsular reconstruction for irreparable rotator cuff tear: a review of current methods. Clin Shoulder Elb 2023; 26:438-444. [PMID: 37994007 DOI: 10.5397/cise.2023.00514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/30/2023] [Indexed: 11/24/2023] Open
Abstract
Irreparable massive rotator cuff tears can significantly impact daily life; and these types of tears can be difficult to repair completely, especially in younger patients who are more active and have higher functional requirements. Since its introduction by Mihata and the colleagues, superior capsular reconstruction (SCR) has gained popularity in the treatment of irreparable massive rotator cuff tears and has shown promising short-term results. A variety of studies have focused on the clinical and biomechanical outcomes of this procedure. This article reviews the biomechanics, indications for the surgical procedure, graft options, surgical technique, and rehabilitation from SCR.
Collapse
Affiliation(s)
- Seok Won Chung
- Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul, Korea
| | - Dong-Hyun Kim
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Hyun Joo Lee
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Won Ki Hong
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Seung Ho Chung
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| | - Jong Pil Yoon
- Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
| |
Collapse
|
7
|
Hasegawa A, Mihata T, Yamamoto N, Takahashi N, Takayama K, Uchida A, Neo M. Postoperative graft integrity affects clinical outcomes after superior capsule reconstruction using fascia lata autograft in posterior-superior rotator cuff tears: a multicenter study. J Shoulder Elbow Surg 2023; 32:1476-1485. [PMID: 36681104 DOI: 10.1016/j.jse.2022.12.010] [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: 09/07/2022] [Revised: 11/24/2022] [Accepted: 12/11/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Previous studies have postulated that graft thickness and graft healing may be important factors for optimizing clinical outcomes of superior capsule reconstruction (SCR) for patients with irreparable rotator cuff tears (RCTs). However, the relationship between postoperative graft integrity and clinical outcomes after SCR remains unclear. We aimed to assess the relationship between postoperative graft integrity, including graft thickness and size of graft tear, and clinical outcomes after SCR in patients with irreparable RCTs. METHODS This retrospective multicenter study included 188 patients (86 women, 102 men; mean age, 69.2 years; range, 49-87 years) with irreparable RCTs who underwent arthroscopic SCR using fascia lata autografts. Using magnetic resonance imaging, the graft integrity was evaluated postoperatively at or after 1 year and was classified, according to Hasegawa's classification, into 4 categories: type I-II, intact graft of sufficient thickness; type III, thinned graft without discontinuity; type IV, presence of a minor discontinuity; and type V, presence of a major discontinuity. We compared (1) baseline characteristics, (2) visual analog scale (VAS) for pain, (3) American Shoulder and Elbow Surgeons (ASES) score, (4) active shoulder range of motion, and (5) acromiohumeral distance (AHD) among 4 groups based on postoperative graft integrity. RESULTS Magnetic resonance imaging scans revealed 152 shoulders (80.9%) with type I-II graft, 13 (6.9%) with type III graft, 13 (6.9%) with type IV graft, and 10 (5.3%) with type V graft. VAS and ASES scores significantly improved after SCR in all graft types (P < .0001 to P = .02). However, shoulders with type V grafts had significantly inferior postoperative VAS and ASES scores compared to those with type I-II grafts (P = .001 and P < .0001, respectively). Shoulders without graft tears (types I-II and III) showed significant improvements in shoulder elevation and internal rotation after SCR (P < .0001 to P = .02). In contrast, shoulders with large graft tears (type V) showed no significant improvement in shoulder range of motion. Postoperative acromiohumeral distance significantly increased only in shoulders with type I-II grafts (P < .0001). CONCLUSION Postoperative graft thickness and size of graft tear affected clinical and radiographic outcomes after SCR using a fascia lata autograft. Patients with large graft tears had significantly inferior postoperative clinical scores compared to those with intact grafts of sufficient thickness, although arthroscopic SCR provided pain relief even in patients with graft tears. Shoulders with intact grafts of sufficient thickness restored glenohumeral stability and showed better clinical outcomes than those with graft thinning or tears.
Collapse
Affiliation(s)
- Akihiko Hasegawa
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
| | - Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan; Department of Orthopedic Surgery, First Towakai Hospital, Takatsuki, Japan
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Norimasa Takahashi
- Shoulder and Elbow Service, Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Japan
| | - Kazumasa Takayama
- Department of Orthopaedics, Kurashiki Central Hospital, Okayama, Japan
| | - Akihiro Uchida
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| |
Collapse
|
8
|
Joo MS, Lee SH, Kim DK, Cho YH, Kim JW. Outcomes After Superior Capsular Reconstruction With an Achilles Tendon-Bone Allograft Using the Modified Keyhole Technique: A 2-Year Follow-up of a Novel Technique for Irreparable Rotator Cuff Tears. Orthop J Sports Med 2023; 11:23259671231182327. [PMID: 37435426 PMCID: PMC10331213 DOI: 10.1177/23259671231182327] [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: 02/15/2023] [Accepted: 03/20/2023] [Indexed: 07/13/2023] Open
Abstract
Background Despite improved outcomes, failure or nonhealing of graft materials has been reported after superior capsular reconstruction (SCR) for massive irreparable rotator cuff tears. Purpose To evaluate the short-term clinical and radiological outcomes of a novel technique for SCR using an Achilles tendon-bone allograft. Study Design Case series; Level of evidence, 4. Methods We performed a retrospective review of patients who underwent SCR using an Achilles tendon-bone allograft with the modified keyhole technique and who had a minimum follow-up of 2 years. The visual analog scale score for pain, American Shoulder and Elbow Surgeons score, and Constant score were evaluated as subjective outcomes, while range of motion of the shoulder joint and isokinetic strength were evaluated as objective outcomes. The acromiohumeral interval (AHI), bone-to-bone healing of the allograft and humeral head on computed tomography, and graft integrity on magnetic resonance imaging were evaluated as radiological outcomes. Results This study included 32 patients with a mean age of 56.8 ± 4.2 years and a mean follow-up of 28.4 ± 6.2 months. A significant improvement from preoperatively to the last follow-up was seen in the mean visual analog scale score for pain (from 6.7 to 1.8), American Shoulder and Elbow Surgeons score (from 42.7 to 83.8), Constant score (from 47.2 to 78.5), and AHI (from 4.8 to 8.2 mm) (P < .001 for all) as well as range of motion in forward elevation and internal rotation (P < .001 for both). Medial-to-lateral graft integrity was good in all patients. Nonunion at the fitting zone of the keyhole on the greater tuberosity was diagnosed in 1 case (3.1%), and failure of incorporation between the allograft and remnant tendon at the site of posterior margin convergence was observed in 4 cases (12.5%). Conclusion The outcomes after SCR using an Achilles tendon-bone allograft and the keyhole technique improved, with an increased AHI and excellent integrity in the medial and lateral directions compared with preoperatively. This technique is a reasonable option for the surgical treatment of irreparable rotator cuff tears.
Collapse
Affiliation(s)
- Min-Su Joo
- Department of Orthopedics, Wonkwang University Hospital, Iksan, Republic of Korea
| | - Sung-Hyun Lee
- Department of Orthopedics, Wonkwang University Hospital, Iksan, Republic of Korea
| | - Do-Kyun Kim
- Department of Orthopedics, Wonkwang University Hospital, Iksan, Republic of Korea
| | - Yang-Hun Cho
- Department of Orthopedics, Wonkwang University Hospital, Iksan, Republic of Korea
| | - Jeong-Woo Kim
- Department of Orthopedics, Wonkwang University Hospital, Iksan, Republic of Korea
| |
Collapse
|
9
|
Lee JB, Kholinne E, Ben H, So SP, Alsaqri H, Lee HJ, Koh KH, Jeon IH. Clinical and Radiological Outcomes of Arthroscopic Superior Capsular Reconstruction Versus Primary Rotator Cuff Repair in Massive Rotator Cuff Tears: A Propensity Score-Matched Study. Am J Sports Med 2023; 51:1971-1978. [PMID: 37260275 DOI: 10.1177/03635465231171928] [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] [Indexed: 06/02/2023]
Abstract
BACKGROUND Arthroscopic superior capsular reconstruction (aSCR) has emerged as a treatment option for managing massive rotator cuff tears (MRCTs) given the unpredictable results after an arthroscopic rotator cuff repair (aRCR). Yet, few comparative studies of aSCR and aRCR have been conducted. PURPOSE To compare the clinical and radiological outcomes between aRCR and aSCR in patients with MRCT. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 163 cases of MRCT from 2010 to 2020 with follow-up ≥2 years were retrospectively reviewed. Among them, 102 had aRCR and 61 had aSCR using fascia lata autograft. Propensity score matching was used to select controls matched for age, sex, diabetes mellitus, osteoporosis, preoperative American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation score, Constant score, pain visual analog scale (pVAS) score, range of motion (ROM), tear size, global fatty degeneration index, and acromiohumeral distance (AHD). Last, 33 cases in each group were selected after propensity score matching. Radiological assessment was conducted using serial postoperative magnetic resonance imaging. Pre- and postoperative findings-including American Shoulder and Elbow Surgeons, pVAS, Single Assessment Numeric Evaluation, and Constant scores and ROM-were assessed to compare clinical outcomes. For radiological outcomes, global fatty degeneration index, AHD, and healing rate were evaluated. Healing failure was defined as Sugaya classification IV or V in the aRCR group, as compared with a full-thickness tear of the graft in the aSCR group, which corresponded to Sugaya classification IV or V. RESULTS Postoperative clinical outcomes were significantly improved at the final follow-up in both groups. In the aSCR group, postoperative forward flexion, pVAS, and AHD were significantly improved as compared with the aRCR group (mean, 161° vs 148° [P = .02]; 1.03 vs 1.64 [P = .047]; 7.00 vs 5.23 mm [P < .001], respectively). The healing rate was 20 of 33 (60.6%) for aRCR and 29 of 33 (87.9%) for aSCR (P = .022). CONCLUSION aSCR and aRCR are effective and reliable treatment options for MRCT. However, when compared with aRCR, aSCR showed improved clinical outcomes, including pVAS score, postoperative ROM, and favorable radiological findings, including AHD and a higher healing rate.
Collapse
Affiliation(s)
- Jun-Bum Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Erica Kholinne
- Department of Orthopedic Surgery, St Carolus Hospital, Faculty of Medicine, Trisakti University, Jakarta, Indonesia
| | - Hui Ben
- Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Pil So
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hood Alsaqri
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Orthopaedic Surgery, Rustaq Hospital, Rustaq, Sultanate of Oman
| | - Hyun June Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
10
|
Kim DS, Han JY, Park YJ, Kwak JW, Lee BS. Comparative analysis of superior capsule reconstruction between long head of biceps tendon autograft and human dermis allograft. J Shoulder Elbow Surg 2023; 32:820-831. [PMID: 36174817 DOI: 10.1016/j.jse.2022.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 07/18/2022] [Accepted: 08/11/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although many superior capsule reconstruction (SCR) techniques are currently practiced in clinical settings, guidelines for choosing the appropriate graft material are lacking. Therefore, at most times, the surgeon's personal preference becomes the deciding factor. This study compared 2 fairly recent SCR techniques-SCR with biceps tendon (BT) autograft and SCR with human dermis (HD) allograft-by evaluating clinical and radiologic outcomes to aid the surgeon's decision in choosing the appropriate graft. METHODS Thirty-one patients underwent SCR using BT autograft (SCR BT), and 22 underwent SCR using HD allograft (SCR HD). SCR BT was selected for patients with a partial BT tear <20%, no severe inflammation signs, and favorable anchor conditions. SCR HD was performed in patients with a BT tear >20%, a superior labrum anterior-posterior (SLAP) lesion, severe inflammation, or subluxation. Range of motion (ROM), strength and shoulder function scoring, plain radiography, and magnetic resonance imaging were evaluated before and after surgery at regular intervals. RESULTS In the SCR BT group, forward flexion ROM increased from 122° ± 43° to 149° ± 18° at 2 years postoperatively, whereas in the SCR HD group, forward flexion ROM improved from 129° ± 28° to 149° ± 18°. In the SCR BT group, internal rotation (IR) ROM increased from 5 ± 3 to 6 ± 2 at 2 years postoperatively, whereas in the SCR HD group, IR ROM improved from 5 ± 3 to 6 ± 1. Although ROM, strength, visual analog scale score, American Shoulder and Elbow Surgeons score, and Constant score all improved 2 years after surgery, no statistically significant differences were found. Six months after surgery, graft thickness was 3.58 ± 0.384 mm in the SCR BT group and 2.49 ± 0.326 mm in the SCR HD group (P < .001). At 2 years postoperatively, graft thickness was 3.54 ± 0.399 mm in the SCR BT group and 2.49 ± 0.306 mm in the SCR HD group (P < .001). The SCR HD group showed a negative correlation of -0.475 between graft thickness and IR ROM (P = .026). In the SCR BT group, a negative correlation of -0.466 was found between graft thickness and IR ROM (P = .008). A positive correlation of 0.363 was found between IR ROM and the acromiohumeral distance when the results were compared before and 2 years after surgery (P = .045). CONCLUSION Both SCR using BT autograft and SCR using HD allograft tissue showed favorable results, and no significant difference was noted between the 2 techniques. Given that the 2 techniques show equally favorable results, the surgeon's personal preference in choosing the SCR technique appears to be acceptable. Understanding the costs and patient's characteristics may aid the surgeon in deciding on the graft material.
Collapse
Affiliation(s)
- Doo Sup Kim
- Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Jin Young Han
- Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Wonju, Republic of Korea.
| | - Yeon Jae Park
- Department of Medical Statistics, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Ji Woong Kwak
- Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Bum Seok Lee
- Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| |
Collapse
|
11
|
Ben H, Kholinne E, Zeng CH, So SP, Lee JB, Sun Y, Koh KH, Jeon IH. Early Postoperative MRI Evaluation of a Fascia Lata Autograft With and Without Polypropylene Mesh Augmentation After Superior Capsular Reconstruction. Am J Sports Med 2023; 51:912-918. [PMID: 36786289 DOI: 10.1177/03635465231151927] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND Recently, a polypropylene mesh has been introduced and reported to improve clinical outcomes after superior capsular reconstruction (SCR) using a fascia lata autograft (FLA). However, mesh-related events such as a foreign body response may trigger inflammation, which might affect graft healing and remodeling. PURPOSE/HYPOTHESIS The aim was to investigate whether the healing and remodeling of an FLA were affected by the use of a mesh by comparing the signal intensity of an FLA-alone group vs an FLA + Mesh group on postoperative magnetic resonance imaging (MRI). The hypothesis was that the use of a mesh would decrease the MRI signal intensity of FLA during the early postoperative phase. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who had undergone SCR using an FLA with or without a mesh between March 2013 and August 2021 were retrospectively analyzed. Follow-up MRI was performed at 3 months. A total of 78 patients (24 in the FLA group and 54 in the FLA + Mesh group) with intact grafts were included. Graft remodeling was evaluated by analyzing the signal-to-noise quotient (SNQ) at the humeral, mid-substance, and glenoid sites. Theoretically, lower SNQ ratios indicate higher strength and better healing of the graft. RESULTS The mean SNQ was 30.603 (range, 11.790-72.710) in the FLA group and 18.367 (range, 4.464-69.500) in the FLA + Mesh group (P < .001). Furthermore, significant differences were found between the 2 groups at the humeral and mid-substance sites (37.863 [range, 5.092-81.187] vs 15.512 [range, 1.814-80.869], P < .001; and 29.168 [range, 6.103-73.900] vs 16.878 [range, 2.454-92.416], P = .003; respectively). However, there was no difference between the 2 groups at the glenoid site (25.346 [range, 7.565-86.353] vs 20.354 [range, 3.732-88.468], P = .057). CONCLUSION At the 3-month follow-up, the FLA + Mesh group showed a lower MRI signal intensity than the FLA group. The healing and remodeling of an FLA may be enhanced when a mesh is used.
Collapse
Affiliation(s)
- Hui Ben
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Erica Kholinne
- Faculty of Medicine, Universitas Trisakti, Department of Orthopedic Surgery, St Carolus Hospital, Jakarta, Indonesia
| | - Chu Hui Zeng
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Pil So
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jun-Bum Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yucheng Sun
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Kyoung-Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
12
|
Early postoperative recovery comparisons of superior capsule reconstruction to tendon transfers. J Shoulder Elbow Surg 2023; 32:276-285. [PMID: 36115613 DOI: 10.1016/j.jse.2022.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/11/2022] [Accepted: 07/29/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND The management of massive posterosuperior rotator cuff tears is controversial, with no gold standard. Two recently developed techniques that have shown promising initial results include arthroscopic superior capsular reconstruction (SCR) and tendon transfers (latissimus or lower trapezius). However, there remains a scarcity of studies examining each procedure's early postoperative clinical outcomes individually or in comparison to each other. The purpose of this study is to compare the early postoperative recovery outcomes of tendon transfers (TTs) to SCR. METHODS Using the surgical outcomes system global database (Arthrex Inc.), we assessed the postoperative recovery outcomes for all patients who had outcomes recorded at least 6 months after SCR or TT. The time points analyzed included preoperative and postoperative (2 weeks, 6 weeks, 3 months, 6 months, 1 year, 2 years). The outcomes analyzed included pain visual analog scale (VAS) score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, VR-12 physical, and Single Assessment Numeric Evaluation (SANE). RESULTS Overall, 163 patients underwent SCR and 24 arthroscopically assisted TT. The mean age for SCR and TT was 60 and 56 years, respectively. Postoperative recovery curves demonstrate that both procedures produced improved outcomes at each postoperative time point compared to preoperative. The pain and functional outcomes measures, including VAS, ASES, SANE, and VR-12 physical, were comparable for TT and SCRs, with similar recovery curves between the 2 techniques. Ultimately at 2 years postoperatively, there were no significant differences between the 2 techniques. CONCLUSIONS Analysis of the early outcomes associated with arthroscopic treatment of massive posterosuperior rotator cuff tears demonstrated that the arthroscopically assisted tendon transfers and arthroscopic superior capsular reconstruction had similar pain and functional outcomes throughout the 2-year postoperative recovery period. Overall, the process of recovery appears equivalent between the 2 techniques. Future studies are needed to assess the outcomes of each technique and specific indications in an attempt to delineate an algorithm for the treatment of irreparable rotator cuff tears.
Collapse
|
13
|
Hasegawa A, Mihata T, Fukunishi K, Itami Y, Uchida A, Neo M. Structural and clinical outcomes after superior capsule reconstruction using an at least 6-mm-thick fascia lata autograft including the intermuscular septum. J Shoulder Elbow Surg 2023; 32:e48-e59. [PMID: 35998778 DOI: 10.1016/j.jse.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/18/2022] [Accepted: 07/07/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Superior capsule reconstruction (SCR) is a viable treatment option for irreparable rotator cuff tears. However, graft tear rate is highly variable in the previous studies, and the impact of graft tears on clinical outcomes after arthroscopic SCR remains controversial. We aimed to investigate the graft tear rate, timing of graft tear, and the impact of graft tears on clinical outcomes after arthroscopic SCR using an at least 6-mm-thick fascia lata autograft including the intermuscular septum. METHODS This retrospective multi-institutional study included 154 patients (79 women and 75 men; mean age, 69.9 yr; age range, 49-87 yr) with irreparable rotator cuff tears who underwent arthroscopic SCR using an at least 6-mm-thick fascia lata autograft including the intermuscular septum and completed a minimum 2-year follow-up. Postoperative graft integrity was evaluated by magnetic resonance imaging examinations performed at 3, 6, 12, and 24 mo after surgery. The presence of a full-thickness defect within the graft was diagnosed as a graft tear. In contrast, a graft without a full-thickness defect was diagnosed as a healed graft. We compared the following data between patients with and without graft tears: (1) baseline characteristics, (2) visual analog scale pain score, (3) Japanese Orthopaedic Association score, (4) American Shoulder and Elbow Surgeons shoulder score, and (5) active range of motion. RESULTS The overall graft tear rate was 11.7% (18 of 154 patients). Of 18 graft tears, 14 (77.8%) occurred within 6 mo after SCR. Two additional graft tears were diagnosed at 12 mo postoperatively and another 2 at 24 mo after SCR. The visual analog scale, American Shoulder and Elbow Surgeons, and Japanese Orthopaedic Association scores improved significantly after SCR in both patients with and without graft tears (all P < .0001). However, patients with graft tears showed significantly inferior postoperative visual analog scale, American Shoulder and Elbow Surgeons, and Japanese Orthopaedic Association scores (1.9, 75.2, and 77.4, respectively) than those without graft tears (0.5, 93.1, and 92.3, respectively; all P < .01). CONCLUSIONS The overall graft tear rate after arthroscopic SCR using an at least 6-mm-thick fascia lata autograft including the intermuscular septum was low (11.7%), relatively to that reported in previous studies. The majority of graft tears (77.8%) occurred within 6 mo after SCR. Graft healing was associated with more favorable clinical outcomes after SCR.
Collapse
Affiliation(s)
- Akihiko Hasegawa
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan.
| | - Teruhisa Mihata
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan; Department of Orthopedic Surgery, First Towakai Hospital, Takatsuki, Japan
| | - Kunimoto Fukunishi
- Department of Orthopedic Surgery, Rakusai Shimizu Hospital, Kyoto, Japan
| | - Yasuo Itami
- Department of Orthopedic Surgery, Takatsuki Red Cross Hospital, Takatsuki, Japan
| | - Akihiro Uchida
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| |
Collapse
|
14
|
Superior capsular reconstruction using hybrid graft for irreparable massive rotator cuff tear. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07321-2. [PMID: 36709237 DOI: 10.1007/s00167-023-07321-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 01/13/2023] [Indexed: 01/30/2023]
Abstract
PURPOSE To evaluate the clinical and radiological outcomes of arthroscopic superior capsular reconstruction (SCR) using hybrid grafts composed of tensor fascia lata autografts and human dermal allografts. METHODS This study included 30 patients with chronic irreparable posterosuperior rotator cuff tears (RCTs) who underwent arthroscopic SCR using a hybrid graft composed of tensor fascia lata autograft and human dermal allograft. Clinical outcomes were evaluated using the pain visual analogue scale score, shoulder range of motion, American Shoulder and Elbow Surgeons score, constant score, University of California-Los Angeles score, and simple shoulder test score preoperatively and at least 2 years after surgery. Radiographic analysis included the Hamada classification grade, acromiohumeral distance (AHD), and graft integrity at 2 years after surgery. RESULTS All patients exhibited significant clinical improvement in all functional outcome measurements, except external rotation (all P < 0.05). The number of patients who exhibited pseudoparalysis decreased from 7 (23.3%) to 2 (6.7%) postoperatively. Complications were not observed. Radiologically, the mean postoperative AHD increased significantly from 6.9 ± 1.6 cm to 8.8 ± 2.1 cm at 2 years postoperatively (P < 0.001). Twenty five out of the 30 (83.3%) patients showed successful graft healing, and all healing failures occurred on the humeral side. The differences between the healed-graft and failed-graft groups were significantly lower graft thickness (P = 0.001) and smaller AHD (P < 0.001) in the failed-graft group. Every functional outcome scores were not statistically different between healed-graft and failed-graft groups. CONCLUSIONS An arthroscopic SCR technique using a hybrid graft consisting of a tensor fascia lata autograft and human dermal allograft showed satisfactory clinical outcomes in patients with irreparable RCTs. LEVEL OF EVIDENCE IV.
Collapse
|
15
|
Campbell RE, Lee D, Day LM, Dixit A, Freedman KB, Tjoumakaris FP. Management of Massive Rotator Cuff Tears Without Arthropathy. Orthopedics 2023; 46:e1-e12. [PMID: 35876782 DOI: 10.3928/01477447-20220719-02] [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] [Indexed: 02/03/2023]
Abstract
Arthroplasty is not an optimal treatment for massive rotator cuff tears in patients who are active and without glenohumeral arthritis. Several surgical techniques have been developed for these patients, including arthroscopic rotator cuff repair with single-/double-row repair (with or without interval slides, margin convergence, graft augmentation), graft bridging, superior capsular reconstruction, tuberoplasty, and tendon transfers. Complete, tension-free, anatomic repair is ideal; however, tendon atrophy and retraction associated with massive tears often complicate repairs. All surgical treatments significantly increase patient-reported functional outcomes 1 year after intervention, with many treatments demonstrating improved mid-term and long-term outcomes. [Orthopedics. 2023;46(1):e1-e12.].
Collapse
|
16
|
Sun K, Li Y. Study of arthroscopic superior capsule reconstruction in the treatment of irreparable rotator cuff tears. Front Surg 2023; 9:895571. [PMID: 36684146 PMCID: PMC9852769 DOI: 10.3389/fsurg.2022.895571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 11/22/2022] [Indexed: 01/09/2023] Open
Abstract
Background The objective of this study was to investigate the clinical outcome and radiographic findings after arthroscopic superior capsule reconstruction (ASCR) with a new augmented autograft technique for irreparable rotator cuff tears. Methods Between 2018 and 2020, 11 patients whose shoulders had irreparable rotator cuff tears underwent ASCR using a fascia lata weaving mesh. Physical examination, radiography, and magnetic resonance imaging (MRI) were performed before surgery and the average follow-up was 20 months (18-24 months) after surgery. Clinical outcome scores were recorded. Results Average clinical outcome scores improved significantly at the final follow-up, with 94.7 points scored on the American Shoulder and Elbow Surgeons scale (range, 85-100 points) and 34.5 points on the University of California, Los Angeles scale (33-35 points) (P < 0.05). Mean active elevation increased significantly from 30.1° to 150° (P < 0.05) and external rotation increased from 30° to 59.2° (P < 0.05). The acromiohumeral distance (AHD) increased from 3.9 ± 0.6 mm preoperatively to 10.1 ± 0.7 mm postoperatively (P < 0.05). No patient had graft tear or tendon retear during follow-up. Conclusions ASCR with a new augmented autograft can restore the function of the shoulder joint with irreparable rotator cuff tears. Our results suggest that this reconstruction technique can help obtain good clinical and radiographic outcomes, which can provide a reliable method for the treatment of irreparable rotator cuff tears. Level of Evidence Level IV, therapeutic case series.
Collapse
|
17
|
Ting RS, Rosenthal R, Al-Housni HS, Lam PH, Murrell GA. Factors influencing clinical outcomes in superior capsular reconstruction: A scoping review. J Clin Orthop Trauma 2023; 36:102081. [PMID: 36479505 PMCID: PMC9720335 DOI: 10.1016/j.jcot.2022.102081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/18/2022] [Accepted: 11/23/2022] [Indexed: 12/02/2022] Open
Abstract
Background It is undetermined how effective superior capsule/capsular reconstruction (SCR) is, and which factors influence clinical outcomes. Questions/purposes (1) To identify which factors influence outcomes in SCR, (2) to evaluate the effect of graft integrity on clinical outcomes, and (3) to compare SCR to other procedures for irreparable rotator cuff tears. Methods PubMed and EMBASE databases were searched for clinical SCR studies. Data on specific factors that influenced outcomes, that compared outcomes between intact/torn graft groups, or compared SCR to alternative treatments for irreparable tears were extracted by two investigators. Random-effects meta-analysis was performed to compare outcomes between intact vs torn SCR grafts. Results 394 articles were identified. 100 full-text articles were screened. 13 studies were included for scoping review. Eight studies were meta-analyzed. Better clinical scores were found in younger patients, with intact/repairable subscapularis, without acetabulization/arthritis, who played sports. In patients with irreparable tears without arthritis, SCR produced similar clinical scores at 2 years as shoulder arthroplasty and partial infraspinatus repair, and greater improvements in ASES and Constant scores than latissimus dorsi tendon transfer. Intact grafts produced better VAS (mean difference [MD] = 0.97, 95% confidence interval [-1.45-0.50], P < 0.0001, I 2 = 67%, n [patients] = 261), ASES (MD = 8.29, [2.89-13.70], P = 0.003, I 2 = 74%, n = 281), external rotation (MD = 4.49, [0.36-8.61], P = 0.03, I 2 = 0%, n = 240), and acromiohumeral distance (MD = 2.45, [0.96-3.94], P = 0.001, I 2 = 92%, n = 260) than torn grafts. Conclusions Patients who underwent SCR for irreparable rotator cuff tears were more likely to have better clinical outcomes if they were younger, had intact/repairable subscapularis, without acetabulization/arthritis, played sports and had intact grafts.
Collapse
Affiliation(s)
- Ryan S. Ting
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Ron Rosenthal
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Hilal S.A. Al-Housni
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - Patrick H. Lam
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| | - George A.C. Murrell
- Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
18
|
Does arthroscopic superior capsule reconstruction using porcine dermal xenograft represent a viable option in case of massive irreparable posterosuperior rotator cuff tear? Arch Orthop Trauma Surg 2023; 143:439-445. [PMID: 35084550 DOI: 10.1007/s00402-022-04335-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 01/03/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of the present study was to evaluate clinical and structural outcomes of patients with a massive irreparable rotator cuff tear treated with arthroscopic superior capsule reconstruction using an acellular porcine dermal xenograft. We hypothesized that this procedure would lead to improvement in clinical and functional results and that structural failure would not influence the final clinical results. MATERIALS AND METHODS A retrospective analysis on arthroscopic superior capsule reconstruction performed from October 2016 to January 2019 was conducted. The procedure was performed in patients with a massive irreparable posterosuperior rotator cuff tear without a severe glenohumeral arthropathy (Hamada I and II) and complaining a painful pseudoparalysis. Clinical evaluation and MRI study were performed before surgery and after at least 14 months. RESULTS A comprehensive group of 21 patients with 11 females and 10 males and a mean age of 57 ± 8.5 years underwent arthroscopic superior capsule reconstruction. The graft had a thickness of 1.5 mm in the first 9 cases (43%) since it was used in a single layer. The graft was thereafter doubled for technique evolution in the following 12 cases (57%) achieving a graft thickness of 3 mm. Active ROM significantly improved with a mean increase of active forward flexion from 72.8° ± 7.5° to 120.6° ± 4.5°, active abduction from 68.3° ± 10.2° to 140.2° ± 8.8° and external rotation from 38.2° ± 11.2° to 56.7° ± 6.8° at the last follow-up. The mean Constant score significantly improved from 40.4 ± 6.7 to 73.3 ± 8.2. A graft tear revealed in 52% (11/21) of overall patients was significantly more frequent in single layer graft when compared to double layer (77% vs 33%, p < 0.05). Location and type of graft tear significantly influenced final outcomes. Patients with a healed (graft continuity with bone at medial and lateral insertion) or medial graft tear showed statistically significant better outcomes when compared with patients in which the graft was completely reabsorbed or torn on humeral side (p < 0.05). CONCLUSION Arthroscopic superior capsule reconstruction using an acellular porcine dermal xenograft may be a viable alternative to treat massive posterosuperior rotator cuff tear in patients with a painful pseudoparalysis without anterosuperior escape. Structural failure may strongly influence final outcomes with significant role played by tear location.
Collapse
|
19
|
Davies A, Singh P, Reilly P, Sabharwal S, Malhas A. Superior capsule reconstruction, partial cuff repair, graft interposition, arthroscopic debridement or balloon spacers for large and massive irreparable rotator cuff tears: a systematic review and meta-analysis. J Orthop Surg Res 2022; 17:552. [PMID: 36536436 PMCID: PMC9764484 DOI: 10.1186/s13018-022-03411-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Multiple non-arthroplasty surgical techniques are described for the management of large and massive irreparable rotator cuff tears. There is currently no consensus on the best management strategy. Our aim was to compare clinical outcomes following arthroscopic debridement, arthroscopic partial cuff repair, superior capsule reconstruction, balloon spacers or graft interposition for the management of large and massive irreparable rotator cuff tears. METHODS A comprehensive search was performed of the following databases: Medline, Embase, CINAHL and Cochrane Database of Systematic Reviews. Data were extracted from relevant studies published since January 2000 according to the pre-specified inclusion criteria. The primary outcome was the post-operative improvement in shoulder scores. Meta-analysis of the primary outcome was performed. Secondary outcomes included retear rates and complications. RESULTS Eighty-two studies were included reporting the outcomes of 2790 shoulders. Fifty-one studies were included in the meta-analysis of the primary outcome. The definition of an irreparable tear varied. All procedures resulted in improved shoulder scores at early follow-up. Shoulder scores declined after 2 years following balloon spacers, arthroscopic debridement and partial cuff repair. High retear rates were seen with partial cuff repairs (45%), graft interposition (21%) and superior capsule reconstruction (21%). CONCLUSIONS Large initial improvements in shoulder scores were demonstrated for all techniques despite high retear rates for reconstructive procedures. Shoulder scores may decline at mid- to long-term follow-up.
Collapse
Affiliation(s)
- Andrew Davies
- grid.7445.20000 0001 2113 8111Cutrale Perioperative and Aging Group, Department of Bioengineering, Imperial College London, 86 Wood Lane, London, W120BZ UK
| | - Prashant Singh
- grid.417895.60000 0001 0693 2181Department of Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Peter Reilly
- grid.417895.60000 0001 0693 2181Department of Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Sanjeeve Sabharwal
- grid.417895.60000 0001 0693 2181Department of Orthopaedics, Imperial College Healthcare NHS Trust, London, UK
| | - Amar Malhas
- grid.419297.00000 0000 8487 8355Department of Orthopaedics, Royal Berkshire NHS Foundation Trust, Reading, UK
| |
Collapse
|
20
|
Graft Healing Is More Important Than Graft Technique: Superior Capsular Reconstruction Versus Bridging Grafts-A Prospective Randomized Controlled Trial. Arthroscopy 2022; 38:3109-3117. [PMID: 35835435 DOI: 10.1016/j.arthro.2022.06.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 06/21/2022] [Accepted: 06/25/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare superior capsular reconstruction (SCR) versus bridging graft (BG) for massive irreparable rotator cuff tears (RCTs). METHODS A prospective double-blind randomized study was conducted to compare SCR versus BG for massive irreparable RCTs. Fifty patients (mean age: 60.2 ± 6.0 years) with chronic tears (mean duration of symptoms: 5 ± 5.2 years) were intraoperatively randomized following partial repair to SCR or BG using human dermal allograft. All patients underwent standardized rehabilitation and were followed at 3, 6, 12, and 24 months clinically and radiographically. Magnetic resonance imaging were obtained at 12 months to determine graft integrity. RESULTS At 2 years, 46 patients were available for follow-up. Mean American Shoulder and Elbow Surgeons (ASES), Western Ontario Rotator Cuff (WORC), and Quick Disabilities of the Arm, Shoulder and Hand scores were 74.8 ± 23.9, 66.0 ± 28.3, and 24.7 ± 26.1 for the SCR group, and 77.9 ± 19.9, 69.5 ± 24.5, and 25.0 ± 19.1 for the BG group, respectively, with no significant difference between groups. Magnetic resonance imaging demonstrated 18 of 24 (75%) in the SCR group and 14 of 22 (64%) in the BG group were intact at 12 months (P = .53). Patients with intact grafts compared with those with retorn grafts, whether SCR or BG, had greater ASES and WORC scores at 24 months (ASES 81.0 ± 18.7 vs 65.7 ± 24.4, P = .021 and WORC 72.3 ± 24.6 vs 53.7 ± 26.7, P = .04) and greater acromiohumeral intervals on radiographs at all follow-up time points. CONCLUSIONS When performing arthroscopic reconstruction using human dermal allograft for an irreparable RCT, whether the proximal edge of the graft is attached on the glenoid bone or to the torn tendon does not significantly change short-term clinical and radiographic outcomes. LEVEL OF EVIDENCE I, therapeutic.
Collapse
|
21
|
Lee A, Farooqi AS, Novikov D, Li X, Kelly JD, Parisien RL. Clinical and Functional Outcomes by Graft Type in Superior Capsular Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med 2022; 50:3998-4007. [PMID: 34633206 DOI: 10.1177/03635465211040440] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In recent years, superior capsular reconstruction (SCR) has emerged as a promising treatment for massive rotator cuff tears and has been performed with an array of graft options, most commonly dermal allograft and tensor fascia lata (TFL) autograft. PURPOSE To compare the clinical outcomes, functional outcomes, and complication rates after SCR performed with dermal allograft, TFL autograft, long head of the biceps tendon (LHBT) autograft, and porcine xenograft. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS PubMed, Cochrane Library, and Embase were systematically reviewed for studies that enrolled ≥10 patients who underwent SCR and presented clinical outcome data at a minimum follow-up of 12 months. When available, pre- and postoperative patient-reported outcome scores and clinical examination data were extracted. Outcome data were then compared by graft type. A meta-analysis was also conducted of graft tear and reoperation rates after SCR with dermal allograft and TFL autograft. RESULTS Human dermal allograft and TFL autograft were each utilized in 7 studies, LHBT autograft in 2 studies, and porcine xenograft in 1 study. Dermal allograft, TFL autograft, and LHBT autograft demonstrated comparable median (range) postoperative American Shoulder and Elbow Surgeons scores of 85.3 (77.5-89), 88.6 (73.7-94.3), and 82.7 (80-85.4), respectively. The median postoperative pain scores per visual analog scale for dermal allograft, TFL autograft, and LHBT autograft were 0.8, 2.5, and 1.4. Median postoperative forward elevation was 159.0°, 147.0°, 163.8°, and 151.4° for dermal allograft, TFL autograft, LHBT autograft, and porcine xenograft. Meta-analysis demonstrated a comparable pooled graft tear rate between TFL autograft (9%; 95% CI, 4%-16%) and dermal allograft (7%; 95% CI, 2%-13%). Similarly, the pooled reoperation rate was similar for TFL autograft (3%; 95% CI, 0%-7%) and dermal allograft (6%; 95% CI, 2%-12%). Among the 3 studies with pre- and postoperative information on pseudoparalysis, 73 of 76 (96%) patients with an intact/repairable subscapularis had a reversal of their pseudoparalysis after SCR. CONCLUSION Dermal allograft, TFL autograft, and LHBT autograft are all suitable options for SCR and demonstrate significant improvements in American Shoulder and Elbow Surgeons score, pain score per visual analog scale, and forward elevation. Moreover, dermal allograft and TFL autograft have comparable rates of graft tear and reoperation.
Collapse
Affiliation(s)
- Alexander Lee
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ali S Farooqi
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Novikov
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Xinning Li
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - John D Kelly
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
22
|
Yeom JW, Kim DM, Lee JB, Ben H, Alahmadi BM, Park JH, Koh KH, Jeon IH. Patient Acceptable Symptom State, Minimal Clinically Important Difference, and Substantial Clinical Benefit After Arthroscopic Superior Capsular Reconstruction. Am J Sports Med 2022; 50:3308-3317. [PMID: 36041050 DOI: 10.1177/03635465221118582] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient Acceptable Symptom State (PASS), minimal clinically important difference (MCID), and substantial clinical benefit (SCB) have rarely been assessed after arthroscopic superior capsular reconstruction (ASCR) with fascia lata autograft. PURPOSE (1) To investigate PASS, MCID, and SCB values for pain visual analog scale (pVAS), American Shoulder and Elbow Surgeons (ASES) score, Constant score, and Single Assessment Numeric Evaluation (SANE) after ASCR with fascia lata autograft, (2) to investigate factors for achieving PASS, MCID, and SCB. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS We retrospectively collected data from patients who underwent ASCR between June 2013 and October 2020. A total of 88 patients were included, and anchor questions for deriving PASS, MCID, and SCB values were applied at a minimum 1-year follow-up postoperatively. PASS, MCID, and SCB were derived using sensitivity- and specificity-based approaches. Univariable and multivariable logistic regression analyses were performed to determine factors for achieving PASS, MCID, and SCB. RESULTS Based on receiver operating characteristic curves, all 4 scores had acceptable area under the curve values (>0.7) for PASS, MCID, and SCB values. The PASS, MCID, and SCB values were 1.5, 2.5, and 4.5 for pVAS; 81.0, 19.0, and 27.5 for the ASES score; 60.5, -0.5, and 5.5 for the Constant score; and 75.0, 27.5, and 32.5 for SANE, respectively. Poor preoperative scores were related to significantly higher odds ratios (ORs) for achieving MCID and SCB. Wide acromiohumeral distance and dominant side were related to higher ORs for achieving PASS for the ASES score, and subscapularis tear was related to lower ORs for achieving PASS for pVAS and SCB for the Constant score. CONCLUSION Reliable PASS, MCID, and SCB values were achieved for at least 1 year after ASCR surgery. Poor preoperative score, wide acromiohumeral distance, and dominant side all demonstrated higher ORs for at least one value, but a subscapularis tear demonstrated lower ORs for achieving PASS for pVAS and SCB for the Constant score.
Collapse
Affiliation(s)
- Ji Woong Yeom
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Department of Orthopaedic Surgery, Gangbook Yonsei Hospital, Seoul, Republic of Korea
| | - Dong Min Kim
- Department of Orthopaedic Surgery, Sarang Plus Hospital, Seoul, Republic of Korea
| | - Jun-Bum Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hui Ben
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Basim Masoud Alahmadi
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Hee Park
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyoung Hwan Koh
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
23
|
Zhang K, Xia Q, Lai S, Li J, Fu W. A Scoping Review of Postoperative Rehabilitation Protocols After Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears. Orthop J Sports Med 2022; 10:23259671221120052. [PMID: 36105657 PMCID: PMC9465587 DOI: 10.1177/23259671221120052] [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: 04/22/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background Superior capsular reconstruction (SCR) is an option for patients with massive or irreparable rotator cuff tears. Purpose To describe the literature on rehabilitation protocols after SCR of rotator cuff tears, with emphasis on the timing of the introduction of motion. Study Design Scoping review; Level of evidence, 4. Methods We conducted a scoping review of articles published on PubMed, Ovid, Embase, and the Cochrane Library from inception to October 2020. The methodological index for non-randomized studies (MINORS) was used to assess the individual studies. For each article, we summarized the study characteristics, patient demographics, and rehabilitation protocols after SCR: duration of immobilization, initiation of passive range of motion (ROM), active-assisted ROM, active ROM, strengthening, and return to activities. In a subgroup narrative analysis, rehabilitation protocols were stratified by graft type: autograft versus nonautograft (xenograft, allograft, and synthetic). Results A total of 21 studies met the search criteria. Six studies had level 3 evidence and 15 had level 4 evidence; 16 studies were considered high quality according to the MINORS score. After SCR, an abduction immobilizer was recommended for a duration of 3 to 6 weeks. Of the 21 studies, 7 (33%) started passive ROM during the first week, and 5 reported strict immobilization without motion for up to 6 weeks. All 8 studies that reported return-to-sports timing recommended delaying return until at least 6 months postoperatively. Passive ROM was recommended earlier for patients with nonautograft versus autograft (χ2 = 225; P < .001). There was a high level of heterogeneity in the rehabilitation protocols after SCR. Conclusion The majority of published protocols were descriptive. At present, there is little agreement on the published rehabilitation guidelines after SCR, precluding specific clinical best practice suggestions. Although there was a tendency of recommending early motion in nonautograft cases, the optimal protocols based on graft healing and functional outcomes require further verification based on the clinical outcomes from high-quality studies.
Collapse
Affiliation(s)
- Kaibo Zhang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Qinghong Xia
- Operating Room of Anesthesia Surgery Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Sike Lai
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Weili Fu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
24
|
Hughes JD, Davis B, Whicker E, Sprowls GR, Barrera L, Baradaran A, Sabzevari S, Burnham JM, Shah AA, Lin A. Nonarthroplasty options for massive, irreparable rotator cuff tears have improvement in range of motion and patient-reported outcomes at short-term follow-up: a systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 31:1883-1902. [PMID: 35972518 DOI: 10.1007/s00167-022-07099-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare various nonarthroplasty treatment options for massive, irreparable rotator cuff tears, including allograft bridging/augmentation, debridement, partial repair, superior capsule reconstruction (SCR), subacromial balloon spacer, and tendon transfer. METHODS A comprehensive search was conducted through the PubMed, MEDLINE, and EMBASE databases for all articles pertaining to nonarthroplasty treatment options for irreparable rotator cuff tears. Inclusion criteria included manuscripts published between 2009 and 2020 with at least 1 year follow-up and Level I-IV evidence. Articles were separated into six groups: debridement, arthroscopic and open repair, allograft bridging/augmentation, SCR, subacromial balloon spacer, and tendon transfer. Data points included range of motion (external rotation, abduction, forward flexion, and internal rotation), visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Constant score, rate of revision surgery, and rate of conversion to arthroplasty. RESULTS A total of 83 studies and 3363 patients were included. All treatment options had statistically significant improvements in postoperative range of motion and patient-reported outcomes. Debridement had statistically significantly greater postoperative abduction and forward flexion range of motion, as well as better VAS pain scores, compared to the other treatment options. The SCR subgroup had the greatest improvement in ASES scores postoperatively. The overall revision rate was 7.2% among all surgical options, with the allograft bridging/augmentation group having the lowest rate of revision at 0-8.3%. The overall rate of conversion to arthroplasty was 7.2%, with debridement having the greatest rate of conversion at 15.4%. CONCLUSION All six nonarthroplasty treatment options for irreparable rotator cuff tears resulted in statistically significant improvements in range of motion and patient-reported outcomes at 1 year follow-up or more, with low rates of revision and conversion to arthroplasty. Debridement had statistically significantly greater postoperative abduction and forward flexion range of motion, as well as better VAS pain scores, compared to the other treatment options. However, these conclusions should be interpreted with caution due to the heterogeneous nature of the data, lack of prospective randomized control trials, and short-term follow-up. The findings of this study highlight the complexity of irreparable, massive rotator cuff tears, and the need for an individualized approach when treating these patients. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Jonathan D Hughes
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA.
| | - Brian Davis
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Emily Whicker
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA
| | - Gregory R Sprowls
- Department of Orthopaedic Surgery, Baylor Scott and White Medical Center-Temple, Temple, TX, USA
| | - Lindsay Barrera
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Ashkan Baradaran
- Department of Orthopaedic Surgery, Mashhad University of Medical Sciences, Mashhad, Khorasan Razavi, Iran
| | - Soheil Sabzevari
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA.,Department of Orthopaedic Surgery, Mashhad University of Medical Sciences, Mashhad, Khorasan Razavi, Iran
| | - Jeremy M Burnham
- Department of Orthopaedic Surgery, Ochsner Health System Baton Rouge, Baton Rouge, LA, USA
| | - Anup A Shah
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Orthopaedic Surgery, Kelsey-Seybold Clinic, Houston, TX, USA
| | - Albert Lin
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA
| |
Collapse
|
25
|
Vaudreuil NJ, Dooney T, Lee TQ, Limpisvasti O. Shoulder Surgeon Techniques and Preferences in Treatment of Massive Rotator Cuff Tears: Current Practices for Rotator Cuff Repair and Superior Capsule Reconstruction. JSES Int 2022; 6:978-983. [DOI: 10.1016/j.jseint.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
26
|
Wang Y, Ding W, Xu J, Ruan D, Heng BC, Ding Q, Shen L, Ding S, Shen W. Arthroscopic Superior Capsular Reconstruction for Massive Irreparable Rotator Cuff Tears Results in Significant Improvements in Patient Reported Outcomes and Range of Motion: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e1523-e1537. [PMID: 36033196 PMCID: PMC9402467 DOI: 10.1016/j.asmr.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose The purposes of this study were to evaluate the clinical outcomes (with the minimum mean follow-up period of 2 years) of arthroscopic superior capsular reconstruction (ASCR) using different grafts for massive irreparable rotator cuff tears (MIRCTs) and to explore whether margin convergence in ASCR affects range of motion (ROM) outcomes. Methods This systematic review was registered in PROSPERO and was then conducted following PRISMA guidelines by searching the databases: MEDLINE, EMBASE, Web of Science, and Cochrane Library database before April 2021. These literature searches investigating the clinical outcomes of ASCR were included. The methodological quality of included studies was assessed using the MINORS criteria. The data, including margin convergence, patient-reported outcome scores, range of motion, and complications, were extracted and analyzed. The minimal clinically important differences (MCID) criteria was used to define clinical significance. Results 15 studies met the inclusion criteria. All studies reported statistically significant improvements in visual analog scale scores (range: 2.07 to 7.1) and American Shoulder and Elbow Surgeons scores (range: 18.1 to 58). Significant improvements of Constant scores were noted in 4 of 5 reporting studies (mean improvement ranged from 14.64 to 50.79). Active forward flexion/elevation (11 studies), active abduction (4 studies), and active external rotation (8 studies) displayed improvements in all reporting studies, with mean changes ranging from 12 to 73.68, 19 to 89.21, and 1 to 24.74, respectively. The mean change of postoperative acromiohumeral distance ranged from −0.86 mm to 3.2 mm in 9 studies. The postoperative complication rate of ASCR ranged from 4.5% to 47.6%. The anterior margin convergence in SCR was associated with a relatively poor improvement in active external rotation. Conclusions ASCR contributes to significant improvements in patient-reported clinical outcomes and ROM at follow-up after a mean of more than two years, emerging as a viable option for patients with MIRCTs. The anterior margin convergence should be prudently chosen, especially in ASCR using fascia lata autograft, on account of the probable restriction on postoperative active external rotation. Level of Evidence Level IV, systematic review of Level III and IV studies.
Collapse
Affiliation(s)
- Yongjian Wang
- Department of Orthopedics, First People’s Hospital of Wenling, Affiliated Wenling Hospital of Wenzhou Medical University, Wenling, hejiang, PR China
| | - Wei Ding
- Department of Orthopedic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, PR China
| | - Jungang Xu
- Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Dengfeng Ruan
- Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Boon Chin Heng
- Peking University School of Stomatology, Beijing, PR China
| | - Qianhai Ding
- Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lingfang Shen
- Air Force Health Care Center for Special Services, Hangzhou, PR China
| | - Shaohua Ding
- Department of Orthopedic Surgery, Ningbo Medical Center Lihuili Hospital, Ningbo, PR China
- Shaohua Ding, M.D., Department of Orthopedic Surgery, Ningbo Medical Center Lihuili Hospital, 57 Xingning Road, Ningbo, 315000, PR China.
| | - Weiliang Shen
- Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China; Orthopaedics Research Institute of Zhejiang University, Zhejiang, PR China; China Orthopaedic Regenerative Medicine (CORMed), Hangzhou, PR China; Dr. Li Dak Sum and Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, Zhejiang, PR China; Department of Sports Medicine, School of Medicine, Zhejiang University, Zhejiang, PR China; Department of Orthopedics, Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, Zhejiang University Huzhou Hospital, Huzhou, Zhejiang, PR China
- Address correspondence to Weiliang Shen, M.D., Department of Orthopaedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie Fang Road, Hangzhou 310009, China.
| |
Collapse
|
27
|
Woodmass JM, Wagner ER, Welp KM, Chang MJ, Morissette MP, Higgins LD, Warner JJ. Partial Rotator Cuff Repair Provides Improved Patient-Reported Outcome Measures Following Superior Capsule Reconstruction (SCR). Arthrosc Sports Med Rehabil 2022; 4:e1261-e1268. [PMID: 36033178 PMCID: PMC9402424 DOI: 10.1016/j.asmr.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/07/2022] [Indexed: 12/01/2022] Open
Abstract
Purpose To evaluate the role of concomitant partial rotator cuff repair (RCR) (i.e., infraspinatus) on patient-reported clinical outcomes following superior capsule reconstruction (SCR). Methods Postoperative recovery outcomes of SCR alone were compared with SCR with concomitant infraspinatus rotator cuff repair (SCR+RCR) at 3, 6, 12, and 24 months. Patients were included if they had an SCR surgery with or without a concomitant infraspinatus repair. Patients were excluded if they did not have a minimum of 6 months’ follow-up or if a preoperative baseline questionnaire was not performed. Outcome measures included pain visual analog scale, American Shoulder and Elbow Surgeons (ASES) Shoulder Function, ASES Shoulder Index, and Single Assessment Numeric Evaluation (SANE) score. Results Overall, 180 patients were evaluated, including 163 patients who underwent SCR alone and 17 patients who underwent concomitant infraspinatus repair (SCR+RCR). There was no difference in demographic data including age, sex, and body mass index. The postoperative recovery curves demonstrated SCR alone and SCR+RCR both provide significantly improved pain and functional scores at 2 years postoperatively (P < .001). When we compared the 2 groups, SCR+RCR provided significantly improved ASES Index (87.6 vs 78.2, P = .048) and ASES Function (25.5 vs 21.7, P = .02). There was no statistically significant difference in SANE scores (75.5 vs 64.2, P = .07) at 24 months’ follow-up. Conclusions SCR provides modest improvements in pain and function at 2 years postoperatively in patients with irreparable rotator cuff tears. Patients who underwent SCR and concomitant infraspinatus repair demonstrated significantly improved ASES Index and ASES Function scores and statistically nonsignificant improvement in SANE scores at 24 months postoperatively when compared with SCR alone. Level of Evidence III, retrospective cohort study.
Collapse
Affiliation(s)
- Jarret M. Woodmass
- Pan Am Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
- Address correspondence to Jarret Woodmass, M.D., F.R.C.S.C., Pan Am Clinic, University of Manitoba, 75 Poseidon Bay, Winnipeg, Manitoba, Canada R3M 3E4.
| | - Eric R. Wagner
- Department of Orthopedic Surgery, Emory University, Atlanta, Georgia, U.S.A
| | - Kathryn M. Welp
- Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Michelle J. Chang
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri, U.S.A
| | | | | | - Jon J.P. Warner
- Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| |
Collapse
|
28
|
Outcomes of arthroscopic-assisted middle trapezius tendon transfer for isolated irreparable supraspinatus tendon tears: minimum 2-year follow-up. Arch Orthop Trauma Surg 2022; 143:2547-2556. [PMID: 35840715 DOI: 10.1007/s00402-022-04542-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/01/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Middle trapezius tendon (MTT) transfer has been proposed as a feasible option for managing isolated irreparable supraspinatus tears (IISTTs). However, no clinical study has been attempted. This study aimed to evaluate clinical and radiologic outcomes of arthroscopic-assisted MTT transfer in patients with IISTTs. METHODS This retrospective study included patients who underwent arthroscopic-assisted MTT transfer using fascia lata autograft for IISTTs. Clinical outcomes, including pain visual analog scale (VAS), Constant, American Shoulder and Elbow Society (ASES), University of California Los Angeles (UCLA) shoulder scores and active range of motion (aROM), were assessed. Radiographic analyses included the acromiohumeral distance (AHD), Hamada grade, and transferred tendon integrity at the final follow-up. RESULTS Twenty-two patients (mean age: 63.3 ± 6.8 [51‒74] years; mean follow-up period: 28.9 ± 4.9 [24‒44] months) met the study criteria. The mean VAS, Constant, ASES, and UCLA scores improved postoperatively at the final follow-up (p < 0.001). The mean aROMs for forward flexion and abduction were significantly increased postoperatively. No significant changes of AHD (p = 0.105) and Hamada grade (p = 0.815) were observed postoperatively. One patient had a re-tear of the transferred tendon at the footprint site at the final follow-up. CONCLUSION In this minimum 2-year follow-up study of the novel aMTT transfer using fascia lata autograft, we found significant improvement in pain relief, clinical scores, and active forward flexion and abduction. Additionally, no significant progression of cuff tear arthropathy was observed at the final follow-up. Therefore, aMTT transfer could be a promising treatment option for patients with IISTTs. However, further multicenter and long-term trials are needed to verify its effectiveness. LEVEL OF EVIDENCE Retrospective case series, level IV.
Collapse
|
29
|
Gbejuade H, Patel MS, Singh H, Modi A. Reconstruction of irreparable rotator cuff tears with an acellular dermal matrix in elderly patients without joint arthritis. Shoulder Elbow 2022; 14:83-89. [PMID: 35845625 PMCID: PMC9284257 DOI: 10.1177/1758573220965535] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 09/22/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Reverse shoulder arthroplasty is the mainstay of treatment for symptomatic irreparable rotator cuff tears in elderly patients without arthritis. However, this treatment incurs significant costs and is a major surgical undertaking. This study explores an alternative that involves the reconstruction of irreparable rotator cuff tears using an acellular dermal matrix in elderly patients without established joint arthritis. METHODS We prospectively evaluated the reconstruction of massive irreparable rotator cuff tears in 21 patients aged 68 years and over without radiographic glenohumeral joint osteoarthritis in whom conservative management had failed. A human dermal acellular matrix graft was used as a bridging graft for reconstruction. Pain scores, Oxford Shoulder Scores and ranges of movement were all assessed preoperatively and postoperatively. The mean follow-up period was 5.8 years (range 2.6 to 8.9 years). RESULTS Statistically significant (p < 0.05) improvements were observed in Oxford Shoulder Scores (mean preoperative score, 21; mean postoperative score, 46), pain scores (mean preoperative score, 6; mean postoperative score, 0) and ranges of movement. Patients also reported a high satisfaction rate with the procedure. DISCUSSION Human tissue matrix allografts could serve as a suitable option for the treatment of elderly patients with massive irreparable rotator cuff tears without arthritis.
Collapse
Affiliation(s)
- Herbert Gbejuade
- Herbert Gbejuade, Department of Orthopaedic Surgery,
University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester
LE5 4PW, UK.
| | | | | | | |
Collapse
|
30
|
Villatte G, Erivan R, Nourissat G, Marcheix PS, Pereira B, Aubret S, Boisgard S, Descamps S. Allograft and autograft provide similar retear rates for the management of large and massive rotator cuff tears: a review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:2039-2059. [PMID: 34586436 DOI: 10.1007/s00167-021-06745-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/08/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Currently, autografts and allografts are largely used to treat large or massive rotator cuff tear (RCT), without any evidence in favour of one graft or the other. The purpose of this study was to determine the rate of retear of autograft and allograft in the treatment of large or massive posterosuperior RCT. METHOD The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review and meta-analysis of the results in the literature as well as the presentation of results. A search of the literature was performed in the electronic databases MEDLINE, Scopus, Embase, and the Cochrane Library. The quality of the included studies was evaluated according to the MINORS (Methodological Index for Nonrandomized Studies) score. Inclusion criteria were studies in English evaluating clinical and radiological results of surgical treatment with autograft or allograft for large or massive RCT since 2008. The main criterion was the retear rate of the graft assessed on MRI or US scan at 1-year minimum follow-up. Partial tear were classified as "tear". RESULTS The overall retear rate was 23.6% (15.5-32.7) at a mean follow-up of 18.4 ± 7.8 (12-36) months. There was no significant difference between the two kinds of graft, with a retear rate of 27.0% (15.4-40.2) and 20.9% (9.9-34.2) with autograft and allograft respectively (n.s.). Similar improvements of functional scores (+ 28.8 to 38.4 points for the Constant score, + 33.6 to 38.4 points for the ASES, and - 4.0 to - 4.1 points for pain-VAS) were reported in the two groups after at 27.2 ± 11.1 (12-48) months. The rate of complications except retear was 1.8% (0.2, 3.7) with autograft and 0.5% (0.8, 1.8) with allograft (n.s.). CONCLUSION The use of autograft and allograft for the treatment of large or massive RCT leads to similar retear rate and clinical outcomes at short to medium terms. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Guillaume Villatte
- Université Clermont Auvergne, CNRS, SIGMA Clermont, ICCF, 63000, Clermont-Ferrand, France.
- Service d'orthopédie-Traumatologie. CHU Montpied Clermont-Ferrand, 63000, Clermont-Ferrand, France.
| | - Roger Erivan
- Université Clermont Auvergne, CNRS, SIGMA Clermont, ICCF, 63000, Clermont-Ferrand, France
- Service d'orthopédie-Traumatologie. CHU Montpied Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Geoffroy Nourissat
- Clinique Maussins-Nollet, Ramsay Générale de Santé, 78000, Paris, France
| | - Pierre-Sylvain Marcheix
- Service de Chirurgie Orthopédique et Traumatologique, CHU de Limoges, 2, avenue Martin-Luther-King, 87042, Limoges cedex, France
| | - Bruno Pereira
- DRCI, CHU de Clermont Ferrand, BP 69, 63003 Cedex 01, Clermont Ferrand, France
| | - Sylvain Aubret
- Université Clermont Auvergne, CNRS, SIGMA Clermont, ICCF, 63000, Clermont-Ferrand, France
| | - Stéphane Boisgard
- Université Clermont Auvergne, CNRS, SIGMA Clermont, ICCF, 63000, Clermont-Ferrand, France
- Service d'orthopédie-Traumatologie. CHU Montpied Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Stéphane Descamps
- Université Clermont Auvergne, CNRS, SIGMA Clermont, ICCF, 63000, Clermont-Ferrand, France
- Service d'orthopédie-Traumatologie. CHU Montpied Clermont-Ferrand, 63000, Clermont-Ferrand, France
| |
Collapse
|
31
|
Tear pattern after superior capsular reconstruction using an acellular dermal matrix allograft. J Shoulder Elbow Surg 2022; 31:e279-e288. [PMID: 35026395 DOI: 10.1016/j.jse.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 11/26/2021] [Accepted: 12/04/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The healing rate and tear pattern of grafts in superior capsular reconstruction (SCR) using acellular dermal matrix (ADM) allograft are poorly understood, and clinical results based on the graft status remain controversial. METHODS Fifty-one consecutive patients undergoing arthroscopic SCR with ADM between October 2017 and February 2020 were enrolled. Range of motion, strength, and the visual analog scale pain (PVAS) score, American Shoulder and Elbow Surgeons (ASES) score, and Constant score were evaluated preoperatively and at the last follow-up. Postoperative magnetic resonance imaging was performed in all patients and was obtained at least 6 months (mean, 8.9 ± 3.6 months) after surgery. The graft tear status was analyzed on magnetic resonance imaging, and the numbers of patients who achieved the minimal clinically important difference and patient acceptable symptomatic state were analyzed to determine the differences in outcome according to graft tear status. RESULTS The range of motion and clinical results improved at a minimum of 1 year (mean, 18 ± 5.4 months), whereas strength in forward flexion and external rotation did not (P = .676 and P = .995, respectively). The graft was intact in 36 of 51 patients (70.6%), 9 patients (17.6%) showed an incomplete graft tear with maintained continuity (partial graft rupture at 1 anchor on either the glenoid or humeral side), and 6 patients (11.8%) showed complete graft rupture (5 on the glenoid side and 1 on the humeral side). In cases with a tear (either incomplete or complete), the odds of achieving the minimal clinically important difference for the PVAS score (P = .047) and ASES score (P = .020) was significantly lower than that of the intact graft. However, when the continuity of the graft was maintained, even in cases with a partial tear, patients who reached the patient acceptable symptomatic state showed significantly higher odds for the PVAS score and trends for the ASES score. CONCLUSION After SCR using ADM, the graft status could be classified as intact, an incomplete graft tear (where the continuity between the glenoid and humerus was maintained), or an complete tear. When the graft continuity was maintained, even in incomplete graft tears, patients were generally satisfied with postoperative pain and function at 1 year following SCR.
Collapse
|
32
|
Baek CH, Lim C, Kim JG. Superior Capsular Reconstruction Versus Lower Trapezius Transfer for Posterosuperior Irreparable Rotator Cuff Tears With High-Grade Fatty Infiltration in the Infraspinatus. Am J Sports Med 2022; 50:1938-1947. [PMID: 35536232 DOI: 10.1177/03635465221092137] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Superior capsular reconstruction (SCR) and lower trapezius transfer (LTT) have recently been utilized to treat irreparable rotator cuff tears (IRCTs). There is still no clear guideline on which treatment method is a better fit for posterosuperior IRCTs with high-grade 4 fatty infiltration in the infraspinatus. PURPOSE To compare the clinical and radiological outcomes between arthroscopic-assisted SCR (aSCR) and arthroscopic-assisted LTT (aLTT) in patients with posterosuperior IRCTs with high-grade (Goutallier grade 4) fatty infiltration in the infraspinatus muscle. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS This retrospective study included patients who underwent aSCR or aLTT for posterosuperior IRCTs with high-grade 4 fatty infiltration in the infraspinatus and had a minimum follow-up of 2 years between 2017 and 2019. A total of 58 patients were divided into 2 groups according to the surgical procedure: aSCR group (n = 22) and aLTT group (n = 36). Clinical outcomes comprised the visual analog scale score for pain, active shoulder range of motion (ROM), the American Shoulder and Elbow Surgeons (ASES) score, and patient satisfaction. Radiological outcomes comprised the acromiohumeral distance (AHD). The progression of arthritis was evaluated via the Hamada grade. Graft integrity was assessed on postoperative magnetic resonance imaging scans. RESULTS Significant improvements in clinical outcomes were observed in both groups. However, active shoulder ROM (forward elevation: 165.7°± 22.3° vs 145.5°± 32.3°, respectively [P = .015]; external rotation: 51.7°± 10.9° vs 41.1°± 7.0°, respectively [P < .001]), the postoperative ASES score (84.8 ± 7.6 vs 76.8 ± 20.3, respectively; P = .045), and patient satisfaction (8.9 ± 1.2 vs 6.4 ± 2.1, respectively; P = .041) were significantly higher with aLTT than with aSCR. There was no significant difference between the groups in AHD at 2 years postoperatively. However, the rate of progression of arthritis was significantly higher with aSCR (22.7%) than with aLTT (2.8%) (P = .027). Moreover, the graft retear rate was significantly higher with aSCR (63.6%) than with aLTT (8.3%) at 2 years postoperatively (P < .001). CONCLUSION Although aSCR and aLTT both provided improvements in overall clinical outcomes for posterosuperior IRCTs with high-grade 4 fatty infiltration in the infraspinatus, aLTT was superior in terms of functional improvement, patient satisfaction, progression of arthritis, and graft integrity. Therefore, we prefer aLTT for posterosuperior IRCTs under the condition of high-grade 4 fatty infiltration in the infraspinatus.
Collapse
Affiliation(s)
- Chang Hee Baek
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu, Republic of Korea
| | - Chaemoon Lim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu, Republic of Korea
| | - Jung Gon Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu, Republic of Korea
| |
Collapse
|
33
|
Shoulder Superior Capsular Reconstruction Hybrid Graft Thickness Greater Than Preoperative Acromiohumeral Distance Increases Graft Retear Rate and Subacromial Erosion. Arthroscopy 2022; 38:1784-1792. [PMID: 34942316 DOI: 10.1016/j.arthro.2021.11.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 11/15/2021] [Accepted: 11/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the impact of graft thickness on clinical outcomes and graft retear after superior capsular reconstruction (SCR) using a hybrid graft combining both fascia lata autograft and dermal allograft in patients with massive rotator cuff tear (MRCT). METHODS Between January 2017 and February 2019, this study enrolled 58 patients with MRCT who underwent SCR using a hybrid graft combining both fascia lata autograft and dermal allograft. We evaluated clinical outcomes and compared differences between the graft intact and the graft retear group. Moreover, subgroup analysis was performed for patients having a preoperative acromiohumeral distance (AHD) less than or equal to the used graft thickness (group 1) and the results were compared with those for preoperative AHD greater than the used graft thickness (group 2). RESULTS Fifty-five patients who underwent MRCT with a mean age of 65.1 ± 5.7 years old were followed up during a mean period of 30.5 ± 6.5 (range, 24-37) months. There were significant differences in clinical outcome measures preoperatively and postoperatively (P < .05). There were no significant differences in clinical outcomes between the graft intact and graft retear groups (P > .05). The subgroup analysis revealed that the retear (68.6% vs 30.4%, P = .004) and subacromial erosion rates (91.4% vs 60.9%, P = .005) were significantly greater in for patients having a preoperative AHD less than or equal to the used graft thickness (group 1). CONCLUSIONS SCR using a hybrid graft combining both fascia lata autograft and dermal allograft is promising with improved clinical scores (P < .05) irrespective of the graft integrity. The use of a graft with a thickness greater than a patient's preoperative AHD could increase graft retear and subacromial erosion rates after SCR. However, there was no significant difference in clinical outcomes according to the relationship between used graft thickness and preoperative AHD. LEVEL OF EVIDENCE Level IV, therapeutic case series.
Collapse
|
34
|
Evuarherhe A, Condron NB, Gilat R, Knapik DM, Patel S, Wagner KR, Garrigues GE, Romeo A, Verma N, Cole BJ. Defining Clinically Significant Outcomes Following Superior Capsular Reconstruction With Acellular Dermal Allograft. Arthroscopy 2022; 38:1444-1453.e1. [PMID: 34863902 DOI: 10.1016/j.arthro.2021.11.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/12/2021] [Accepted: 11/20/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To define clinically significant outcomes (CSO) thresholds for minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient-acceptable symptomatic state (PASS) in patients undergoing superior capsular reconstruction (SCR) with an acellular dermal allograft. We also evaluated patient-specific variables predictive of achieving CSO thresholds. METHODS The American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Single Assessment Numeric Evaluation (SANE), and subjective Constant-Murley (Constant) scores were collected preoperatively and at the most recent follow up for patients undergoing SCR from 2010 to 2019. A distribution-based approach was used to calculate MCID, and an anchor-based approach was used to calculate SCB and PASS. Logistic regression was used to determine factors associated with CSO achievement. RESULTS Fifty-eight patients were identified (n = 39 males; n = 19 females) with a mean age of 53.4 ± 14.1 years at surgery and an average follow-up of 23 months. The MCID, SCB, and PASS were 11.2, 18.02, and 68.82 for ASES, 14.5, 23.13, and 69.9 for SANE, and 3.6, 10, and 18 for Constant, respectively. Subscapularis tear, female sex, and workers compensation (WC) status reduced odds of achieving MCID. Reduced odds of achieving Constant SCB were associated with older age, female sex, and WC status, while concomitant distal clavicle excision during SCR and lower preoperative ASES increased odds of achieving ASES SCB. Reduced odds for achieving ASES PASS were associated with female sex and WC status, while reduced odds for achieving SANE PASS were associated with subscapularis tearing preoperatively. CONCLUSION On the basis of calculated values for MCID, SCB, and PASS, subscapularis tearing, WC status, age, and sex are associated with failure to achieve clinically significant outcomes following SCR. Concomitant distal clavicle excision during SCR and lower preoperative ASES was predictive for achievement of MCID and SCB. By defining the thresholds and variables predictive of achieving CSOs following SCR, surgeons may better counsel patients prior to SCR. LEVEL OF EVIDENCE Level IV, case series.
Collapse
Affiliation(s)
- Aghogho Evuarherhe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago Illinois, U.S.A
| | - Nolan B Condron
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago Illinois, U.S.A
| | - Ron Gilat
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago Illinois, U.S.A
| | - Derrick M Knapik
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago Illinois, U.S.A
| | - Sumit Patel
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago Illinois, U.S.A
| | - Kyle R Wagner
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago Illinois, U.S.A
| | - Grant E Garrigues
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago Illinois, U.S.A
| | - Anthony Romeo
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago Illinois, U.S.A
| | - Nikhil Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago Illinois, U.S.A
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago Illinois, U.S.A..
| |
Collapse
|
35
|
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.
Collapse
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
| |
Collapse
|
36
|
Awad MA, Sparavalo S, Ma J, King JP, Wong I. Interposition Graft Bridging Reconstruction of Irreparable Rotator Cuff Tears Using Acellular Dermal Matrix: Medium-Term Results. Arthroscopy 2022; 38:692-698. [PMID: 34384854 DOI: 10.1016/j.arthro.2021.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 07/28/2021] [Accepted: 08/01/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE In this study, we aimed to evaluate the medium-term clinical outcomes for patients who underwent bridging reconstruction. METHODS A retrospective chart review was conducted for all patients who underwent bridging reconstruction between 2010 and 2018. Patients who were missing either pre- or postoperative outcome scores were excluded. All included patients completed self-reported questionnaires (Western Ontario Rotator Cuff [WORC] and Disabilities of the Arm, Shoulder and Hand [DASH]) pre- and postoperatively at 6 months, 1 year, and annually thereafter. All scores were reported out of 100. RESULTS Ninety-one patients initially met our inclusion criteria, and 33 were excluded owing to lack of either pre- or postoperative outcome scores. Nine patients were lost to follow-up; therefore, 49 patients were finally evaluated, including 30 males (61.2%) and 19 females (38.8%) with an age of 59.6 ± 10.4 years (mean ± standard deviation) and mean follow-up of 5.3 years (range 2 to 9). Both WORC and DASH scores significantly improved from pre- to postoperatively (WORC: 69.6 ± 12.2 to 27.9 ± 23.7, P < .001; DASH: 51.5 ± 17.5 to 24.5 ± 23.0, P = .001). For WORC and DASH, 92% and 74% of patients, respectively, met the minimal clinical importance difference. CONCLUSION Our results showed that patients' clinical outcome scores significantly improved with an average of 5-year follow-up, which demonstrates that bridging reconstruction is a safe procedure with promising midterm clinical outcomes. LEVEL OF EVIDENCE IV, retrospective case series.
Collapse
Affiliation(s)
- Moayd Abdullah Awad
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sara Sparavalo
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jie Ma
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John-Paul King
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ivan Wong
- Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
| |
Collapse
|
37
|
Ângelo ACLPG, de Campos Azevedo CI. Donor-Site Morbidity After Autologous Fascia Lata Harvest for Arthroscopic Superior Capsular Reconstruction: A Midterm Follow-up Evaluation. Orthop J Sports Med 2022; 10:23259671211073133. [PMID: 35141340 PMCID: PMC8819761 DOI: 10.1177/23259671211073133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Autologous fascia lata (AFL) graft use in arthroscopic superior capsular reconstruction (ASCR) is effective for the treatment of irreparable rotator cuff tears (RCTs). Although donor-site morbidity (DSM) is a recurrent argument against AFL graft use, scientific evidence for this argument is lacking. Purpose: To report the midterm clinical follow-up evaluation of DSM in ASCR using minimally invasively harvested AFL grafts and compare thigh function and patient satisfaction with those of an unharvested control group. Study Design: Cohort study; Level of evidence, 3. Methods: Of 66 consecutive patients who underwent ASCR using a minimally invasively harvested AFL graft, 39 patients with a minimum follow-up of 24 months were retrospectively evaluated (ASCR group) and compared with 39 randomly selected patients who underwent arthroscopic RCT repair by the same surgeons (control group). The functional outcomes of both thighs were evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Patient satisfaction was evaluated using the Patient Scar Assessment Questionnaire (PSAQ) and a subjective questionnaire. Pain was quantified using a visual analog scale (VAS). Results: The ASCR group had a mean age of 65 years (range, 51-77 years) and a mean follow-up of 47 months (range, 24-66 months). The WOMAC score in the harvested thigh differed by 0.8% from that in the contralateral thigh ( P = .002). The mean PSAQ score differed by 6 points from the minimum PSAQ score ( P < .001). Overall, 95% of the patients indicated that they would undergo the same surgery again and that the shoulder outcome compensated for the thigh symptoms. There was no significant association between the presence of residual thigh symptoms and the willingness to undergo the same surgery again ( P = .354). The mean VAS score in the harvested thigh was 0.6 (range, 0-5). There was no significant difference in the average WOMAC score or VAS score between groups ( P = .684 and P = .148, respectively). Conclusion: Despite the proportion of residual symptoms, the associated functional effects were small and not clinically significant, and the vast majority of patients were accepting of the harvest symptoms given the improvement in shoulder function.
Collapse
Affiliation(s)
| | - Clara Isabel de Campos Azevedo
- Hospital dos SAMS de Lisboa, Lisbon, Portugal
- Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
- Hospital CUF Tejo, Lisbon, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal
- ICVS/3B’s–Instituto de Investigação em Ciências da Vida e Saúde/Biomaterials, Biodegradables and Biomimetics PT Government Associate Laboratory, Braga/Guimarães, Portugal
| |
Collapse
|
38
|
Soderlund M, Boren M, O’Reilly A, San Juan A, Mahylis JM. Arthroscopic debridement for management of massive, irreparable rotator cuff tears: a systematic review of outcomes. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:1-7. [PMID: 37588294 PMCID: PMC10426654 DOI: 10.1016/j.xrrt.2021.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Background Surgical management of massive irreparable rotator cuff tears remains controversial. Arthroscopic debridement (AD) has shown promising results especially in the population older than 65 years; however, there is no consensus on the benefits of various AD procedures. The aim of this systematic review was to evaluate the functional midterm to long-term outcomes in patients treated with AD in combination with subacromial decompression, biceps tenotomy, tuberoplasty, or bursectomy, without repair of the rotator cuff tear. Methods A comprehensive search was performed in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane databases for studies reporting clinical outcomes of AD of massive rotator cuff tears. Quality was determined using the Methodological Index for Nonrandomized Studies (MINORS) criteria by two independent reviewers. Pooled frequency-weighted means and standard deviations were calculated for patient-reported outcomes. Results Sixteen articles containing 643 patients and 662 shoulders met the eligibility criteria. The mean age at the time of surgery was 65.9 ± 4.4 years with a mean follow-up period of 46.5 ± 27.3 months. There was notable clinically significant improvement across all patient-reported outcome scores postoperatively: Constant 70.4 ± 8.9 (P value = .06), University of California, Los Angeles ultrasonography 26.7 ± 5.2 (P value = .001), American Shoulder and Elbow Surgeons score 71.7 ± 2.1 (P value = .12), Disabilities of the Arm, Shoulder, and Hand score 35.3, and visual analog score 1.7 ± 0.9. Forty-nine patients (7%) required reoperation, which most commonly was a reverse total shoulder arthroplasty for the development of rotator cuff arthropathy. Conclusion Arthroscopic debridement with a combination of subacromial decompression, tuberoplasty, subacromial bursectomy, and biceps tenotomy, for treatment of massive irreparable rotator cuff tears, produces good functional outcomes and improvement in pain at mid to long term follow up for the low-demand population greater than 65 years of age looking for pain relief over substantial increase in function.
Collapse
Affiliation(s)
- Matthew Soderlund
- Department of Orthopaedic Surgery, Midwestern University/Franciscan Health-Olympia Fields, Olympia Fields, IL, USA
| | - Morgan Boren
- Department of Orthopaedic Surgery, Midwestern University/Franciscan Health-Olympia Fields, Olympia Fields, IL, USA
| | - Andrew O’Reilly
- Department of Orthopaedic Surgery, Midwestern University/Franciscan Health-Olympia Fields, Olympia Fields, IL, USA
| | - Angielyn San Juan
- Department of Orthopedic Surgery, Northshore University Health System, Evanston, IL, USA
| | - Jared M. Mahylis
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, MI, USA
| |
Collapse
|
39
|
Superior Capsular Reconstruction: A Salvage Option for Massive Irreparable Rotator Cuff Tears with Pseudoparalysis or Subscapularis Insufficiency. Arthroscopy 2022; 38:253-261. [PMID: 34052375 DOI: 10.1016/j.arthro.2021.05.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/05/2021] [Accepted: 05/12/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE We sought to examine superior capsular reconstruction (SCR) outcomes after minimum 2-year follow-up and determine risk factors that were predictive of outcomes. METHODS Forty consecutive patients (mean age 57.3 years, 87.5% male) who underwent SCR for massive irreparable rotator cuff tears (RCT) met the inclusion criteria. Minimum 2-year follow-up was obtained for 32 patients (80% follow-up). Patient demographics and preoperative clinical findings were collected. Postoperative data, including complications, patient satisfaction, strength and range-of-motion (ROM), and patient-reported outcomes were collected. RESULTS The Hamada score was ≤2 in 88% with average acromiohumeral interval distance of 6.8 mm. Preoperatively, 6 patients had external rotation lag (19%) and 6 had pseudoparalysis (19%). Intraoperative assessment of the subscapularis demonstrated true insufficiency in 38%. There was significant improvement in forward elevation (FE) (31° increase; P = .007) and strength in all planes (all P < .05). Patient-reported outcomes significantly improved (American Shoulder and Elbow Surgeon [ASES] 34-point increase; visual analog scale [VAS] 2.9-point decrease; single alpha-numeric evaluation [SANE] 48-point increase; all P < .05). Twenty-six patients (81%) were completely or somewhat satisfied with surgery. At time of final follow-up, 3/32 patients (9%) failed SCR and converted to reverse total shoulder arthroplasty. There were 4 (13%) reported complications (2 patients had postoperative falls; 1 patient had persistent severe pain; 1 had persistent stiffness). One patient was deceased. Patients with pseudoparalysis (n = 6) had significant improvement in post-operative FE (28 vs 154°; P < .0001) and SANE score (P = .016) with 66% patient satisfaction. However, outcome scores overall remained lower than SCR without pseudoparalysis. Regarding subscapularis insufficiency (n = 12), significant improvement was seen in postoperative FE (108 vs 158°; P = .019) and patient-reported outcome scores (P < .005). In patients converted from SCR to reverse total shoulder arthroplasty (n = 3), there were no distinguishing characteristics present. CONCLUSION Superior capsular reconstruction is an effective salvage operation for massive irreparable RCT. Patients with pseudoparalysis or subscapularis insufficiency demonstrate significant postoperative improvement in FE and patient-reported outcomes. LEVEL OF EVIDENCE IV, retrospective cohort.
Collapse
|
40
|
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: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 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.
Collapse
|
41
|
Ahmad RG. Shoulder impingement: various risk factors for supraspinatus tendon tear: A case group study. Medicine (Baltimore) 2022; 101:e28575. [PMID: 35060519 PMCID: PMC8772690 DOI: 10.1097/md.0000000000028575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 12/22/2021] [Indexed: 01/05/2023] Open
Abstract
A total of 680 cases of monolateral shoulder pain and functional impairment were included, and Chi-Squared tests was incorporated to test for possible associations.No relation between impingement syndrome and potential risk factors was found, such as presence of down slopping (P = .083), presence of ossification acromiale (P = .102), presence of calcific tendinitis (P = .144), types of acromion (I [P = .600], II [P = .536], III [P = .633] and IV [P = .832]) and grade of acromioclavicular degenerative changes (mild [P = .077], moderate [P = .111], and severe [P = .700]). However, a significant relationship was uncovered between impingement syndrome and risk factors such as gender (X2 = 7.004, df = 1, P = .08) (where females were more prone), history of shoulder dislocation (X2 = 19.440, df = 1, P = .001), presence of supraspinatus tendon tear or tendinopathy (X2 = 69.344, df = 1, P = .001) and supraspinatus complete tear (X2 = 13.593, df = 1, P = .001). A significant relationship was found between the type of supraspinatus pathology and factors such as gender (female more prone) (X2 = 34.719, df = 3, P = .01), presence of down slopping (X2 = 57.765, df = 3, P = .01), history of shoulder dislocation (X2 = 148.880, df = 3, P = .001), type III of the acromion (X2 = 12.979, df = 3, P = .005), presence of acromioclavicular generative changes mild (X2 = 76.408, df = 3, P = .001) and moderate (X2 = 29.697, df = 3, P = .001), and acromiohumeral distance of ≤3 mm (X2 = 18.915, df = 3, P = .001), 3.1 to 6 mm (X2 = 13.212, df = 3, P = .004), and 9.1-12 mm (X2 = 15.066, df = 3, P = .002). Overall, the Magnetic Resonance Imaging results yielded high sensitivity for detecting full-thickness supraspinatus tears.Considering the findings, this study may help radiologists understand the salient risk factors and identify which factors are mainly responsible for supraspinatus tendon tears and the respective grade of tear (articular partial, bursal partial, complete, or tendinopathy).
Collapse
|
42
|
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]
|
43
|
Mirzayan R, Acevedo DC, Sidell MA, Otarodi KA, Hall MP, Suh BD, Singh A. Classification system of graft tears following superior capsule reconstruction. Clin Imaging 2021; 83:11-15. [PMID: 34923361 DOI: 10.1016/j.clinimag.2021.11.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Superior capsule reconstruction (SCR) is a treatment option for irreparable massive rotator cuff tears (MRCT). The purpose of this study is to describe a classification system for graft integrity and tear location. METHODS Patients who underwent SCR at a single institution were included. Pre-operative age, gender, prior surgery, Hamada grade, and Goutallier stage were recorded. An MRI was performed postoperatively to assess graft integrity and tear location. RESULTS 53 patients met inclusion criteria. Mean age was 60.1 ± 7.9 years. A post-operative MRI was performed in 42 (80%) patients at a mean of 14 ± 7 months (range, 6-40 months). MRIs demonstrated an intact graft in 16 (38%) shoulders. Of the 26 graft tears, 14 (54%) were from the glenoid, 5 (19%) mid-substance, 6 (23%) from the tuberosity, and 1 (3.8%) had complete graft absence. CONCLUSION Graft tears are common following SCR. We describe four different graft tear locations and submit a classification system that can be used in future studies to better compare outcomes based on graft integrity and tear location. Clinical correlation with graft integrity and graft tear location needs to be further investigated.
Collapse
Affiliation(s)
- Raffy Mirzayan
- Kaiser Permanente Southern California, Department of Orthopaedics, Baldwin Park, CA, United States of America.
| | - Daniel C Acevedo
- Kaiser Permanente Southern California, Department of Orthopaedics, Panorama City, CA, United States of America
| | - Margo A Sidell
- Kaiser Permanente Southern California, Department of Research and Evaluation, Pasadena, CA, United States of America
| | - Karimdad A Otarodi
- Kaiser Permanente Southern California, Department of Orthopaedics, San Diego, CA, United States of America
| | - Michael P Hall
- Kaiser Permanente Southern California, Department of Orthopaedics, South Bay, CA, United States of America
| | - Brian D Suh
- Kaiser Permanente Southern California, Department of Orthopaedics, San Diego, CA, United States of America
| | - Anshuman Singh
- Kaiser Permanente Southern California, Department of Orthopaedics, San Diego, CA, United States of America
| |
Collapse
|
44
|
Werthel JD, Vigan M, Schoch B, Lädermann A, Nourissat G, Conso C. Superior capsular reconstruction - A systematic review and meta-analysis. Orthop Traumatol Surg Res 2021; 107:103072. [PMID: 34560311 DOI: 10.1016/j.otsr.2021.103072] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/13/2021] [Accepted: 08/05/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Since Mihata's 2012 proposal to arthroscopically reconstruct the superior capsule of patients with massive irreparable cuff tears, many studies have reported the clinical results of this technique using different types of grafts (fascia lata autograft, dermal allograft, porcine dermal xenograft or long head of biceps autograft). PURPOSE The objective of this meta-analysis was to report the clinical and radiological results of these superior capsule reconstructions. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) recommendations were used to conduct this systematic review. A bibliographic search was performed of the electronic databases MEDLINE, Scopus, Embase and the Cochrane Library. The quality of the studies was assessed according to the MINORS criterion (Methodological Index for Nonrandomized Studies). The inclusion criteria were studies in English evaluating superior capsular reconstruction. RESULTS No level I or II studies met the inclusion criteria. Eighteen studies were selected from the 97 identified, including 637 shoulders (64% male) with a mean age of 62 years [95% CI: 60.3-63.5]. At the mean follow-up of 24.3 months (12-60), the range of motion was significantly increased from 82.6° [60.0-105.2] to 141.9° [109.9-173.8] in abduction, from 113.1° [98.3-127.9] to 153.3° [147.4-159.2] in elevation, from 35.5° [30.9-40.2] 43.4° [35.4-51.3] in external rotation and from 7.2 [5.4-9] to 9.9 [8.9-10.9] in internal rotation. Functional scores were significantly improved from 5.4 [4.8-5.9] to 1.3 [0.9-1.7] points for VAS, from 42.5 [15.7-69.3] to 59.3 [30.1-88.6] points for Constant, from 39.0% [38.1-39.8] to 79.8% [76.4-83.3] for the SSV, and from 48.2 [45.2-51.1] to 81.2 [77.2-85.1] points for the ASES. The healing rate was 76.1% [64.4-84.9]. The complication rate was 5.6% [1.8-16.3] and the reverse shoulder arthroplasty revision rate was 7.1% [3.8-12.8]. CONCLUSION Superior capsule reconstructions allow satisfactory clinical and radiological results to be obtained at 2 years of follow-up. Due to the small number of high quality comparative studies available, its true place in the therapeutic arsenal cannot be fully confirmed. However, it seems that the best indication for this technique is isolated irreparable rupture of the supraspinatus, in cases of medical treatment failure. LEVEL OF EVIDENCE III; meta-analysis of heterogeneous studies.
Collapse
Affiliation(s)
- Jean-David Werthel
- Hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
| | - Marie Vigan
- Hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | | | -
- 15, rue Ampère, 92500 Rueil Malmaison, France
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Faculty of Medicine, La Tour Hospital, University of Geneva, Geneva University Hospitals, Geneva, Switzerland
| | | | - Christel Conso
- Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| |
Collapse
|
45
|
Ciccotti M, Horan MP, Nolte PC, Elrick BP, Millett PJ. Outcomes After Arthroscopic Rotator Cuff Repair Using Margin Convergence Versus Superior Capsular Reconstruction: Should Candidates for Margin Convergence Be Treated With Superior Capsular Reconstruction? Orthop J Sports Med 2021; 9:23259671211050624. [PMID: 34778478 PMCID: PMC8573497 DOI: 10.1177/23259671211050624] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 06/29/2021] [Indexed: 11/17/2022] Open
Abstract
Background Both margin convergence rotator cuff repair (MC-RCR) and superior capsular reconstruction (SCR) result in improved clinical outcomes in the treatment of massive rotator cuff tears (RCTs). The question remains whether it is better to perform MC-RCR using native, albeit occasionally deficient, tissues or to perform primary SCR. Purpose/Hypothesis To compare the clinical results of MC-RCR versus SCR for the treatment of massive RCTs. It was hypothesized that SCR would yield better outcomes. Study Design Cohort study; Level of evidence, 3. Methods Included were patients who underwent arthroscopic MC-RCR or SCR for massive RCTs performed by a single surgeon between 2014 and 2019. MC-RCR was performed if it was technically possible to close the defect; otherwise, SCR was performed. Outcomes were assessed at 6 months and then annually using American Shoulder and Elbow Surgeons; Single Assessment Numerical Evaluation; shortened version of Disabilities of the Arm, Shoulder and Hand; 12-Item Short Form Health Survey Physical Component Summary; and patient satisfaction scores. The minimal clinically important difference (MCID), substantial clinical benefit (SCB), and Patient Acceptable Symptom State (PASS) were compared between groups. Revision surgeries and complications were reported. Results Included were 46 patients in the MC-RCR group (mean age, 59 ± 8 years) and 46 patients in the SCR group (mean age, 57 ± 7 years); 29 patients in each group were available at 2-year follow-up. Preoperative outcome scores were not significantly different between groups. Within groups, all outcome scores improved from pre- to postoperatively (P < .05), with no significant differences in postoperative scores or patient satisfaction between groups. No significant between-group differences were noted in the percentage of patients who reached the MCID, SCB, and PASS (MCID, 92.3% vs 84.6%; SCB, 80.8% vs 80.8%; and PASS, 66.7% vs 66.7%). SCR had a significantly lower survivorship rate compared with MC-RCR (84.7% vs 100%) (P = .026). Conclusion Both MC-RCR and SCR provided similar improvement in outcomes; however, SCR resulted in a significantly lower survivorship rate at 2 years postoperatively. If an RCT is technically repairable, we recommend that it be repaired primarily, even if MC techniques are needed to close the defect. SCR remains a good option for massive RCTs that are not technically repairable.
Collapse
Affiliation(s)
- Michael Ciccotti
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | | | - Philip-C Nolte
- Steadman Philippon Research Institute, Vail, Colorado, USA.,Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany
| | | | | |
Collapse
|
46
|
Beraldo RA, Gracitelli MEC, Malavolta EA, Assunção JH, Silva FBDAE, Neto AAF. Tratamento das rupturas irreparáveis do manguito rotador: Reconstrução capsular superior com aloenxerto de fáscia lata. Rev Bras Ortop 2021; 57:876-883. [PMID: 36226220 PMCID: PMC9550356 DOI: 10.1055/s-0041-1732389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/11/2021] [Indexed: 11/13/2022] Open
Abstract
Objective
The objective of the present study was to evaluate the efficacy and safety of superior capsular reconstruction (SCR) using fascia lata allograft.
Methods
A prospective case series of 15 patients with irreparable supraspinatus tear who underwent SCR using fascia lata allograft. The American Shoulder and Elbow Surgeons (ASES) scale at 12 months after surgery was the primary outcome. The University of California Los Angeles (UCLA), Constant-Murley, and Single Assessment Numeric Evaluation (SANE) scales, in addition to the range of motion, were secondary outcomes. Radiological parameters were also evaluated by simple radiographs and magnetic resonance imaging (MRI).
Results
Fifteen patients completed 12 months of postoperative follow-up. The ASES score increased from 34.0 to 73.0 (
p
= 0.005). The UCLA, Constant-Murley, and SANE scales also showed statistically significant differences (
p
= 0.001;
p
= 0.005; and
p
= 0.046). In the evaluation of range of motion, there was improvement in elevation and in external rotation (95 to 140°,
p
= 0.003; 30 to 60°,
p
= 0.007). Six patients (40%) had complete graft healing. The clinical outcomes were significantly higher in the patients who presented graft healing.
Conclusions
Superior capsular reconstruction using a fascia lata allograft is a safe and effective procedure in short follow-up. Level of Evidence IV; Therapeutic Study; Case Series.
Collapse
Affiliation(s)
- Rodrigo Alves Beraldo
- Ortopedista e Traumatologista, Especialista em Ombro e Cotovelo, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Mauro Emilio Conforto Gracitelli
- Ortopedista e Traumatologista, Especialista em Ombro e Cotovelo, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Eduardo Angeli Malavolta
- Ortopedista e Traumatologista, Especialista em Ombro e Cotovelo, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Jorge Henrique Assunção
- Ortopedista e Traumatologista, Especialista em Ombro e Cotovelo, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Fernando Brandão de Andrade e Silva
- Ortopedista e Traumatologista, Especialista em Ombro e Cotovelo, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Arnaldo Amado Ferreira Neto
- Ortopedista e Traumatologista, Especialista em Ombro e Cotovelo, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| |
Collapse
|
47
|
Itami Y, Park MC, Lin CC, Patel NA, McGarry MH, Park CJ, Neo M, Lee TQ. Biomechanical analysis of progressive rotator cuff tendon tears on superior stability of the shoulder. J Shoulder Elbow Surg 2021; 30:2611-2619. [PMID: 33895297 DOI: 10.1016/j.jse.2021.04.012] [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: 10/18/2020] [Revised: 03/28/2021] [Accepted: 04/04/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The biomechanical relationship between irreparable rotator cuff tear size and glenohumeral joint stability in the setting of superiorly directed forces has not been characterized. The purpose of this study was to quantify kinematic alterations of the glenohumeral joint in response to superiorly directed forces in a progressive posterosuperior rotator cuff tear model. METHODS Nine fresh-frozen cadaveric shoulders (mean age; 58 years) were tested with a custom shoulder testing system. Three conditions were tested: intact, stage II (supraspinatus) tear, stage III (supraspinatus + anterior half of infraspinatus) tear. At each condition, range of motion and humeral head positions were measured with a "balanced" loading condition, and with a superiorly directed force ("unbalanced loading condition"). At each of the 0°, 20°, and 40° of glenohumeral abduction positions, all measurements were made at 0°, 30°, 60°, and 90° of external rotation (ER). Two-way repeated measures analysis of variance with Tukey post hoc tests were performed for statistical analyses. RESULTS With the balanced load, no significant change in superior humeral head position was observed in stage II tears. Stage III tears significantly changed the humeral head position superiorly at 30° and 60° ER at each abduction angle compared with the intact condition (P ≤ .028). With superiorly directed load, stage II and stage III tears both showed statistically significant increases in superior translation at all degrees of ER for all degrees of abduction (P ≤ .035), except stage II tears at 0° ER and 40° abduction (P = .185) compared with the intact condition. Stage II tears showed posterior translations with 30° and 60° ER, both at 20° and 40° of abduction. Stage III tears also showed posterior translations with 90° ER for all abduction angles (P ≤ .039). CONCLUSION With superiorly directed loads, complete supraspinatus tendon tears created superior translations at all abduction angles, and posterior instability in the middle ranges of rotation for 20° and 40° of abduction. Larger tears involving the anterior half of the infraspinatus tendon caused significant superior and posterior translations within the middle ranges of ER for all abduction angles. In addition to superior instability, posterior translation should be considered when selecting or developing surgical techniques for large posterosuperior rotator cuff tears.
Collapse
Affiliation(s)
- Yasuo Itami
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA; Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Maxwell C Park
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Woodland Hills, CA, USA.
| | - Charles C Lin
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Nilay A Patel
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA; Department of Orthopaedic Surgery University of California, Irvine, Orange, CA, USA
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | | | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| |
Collapse
|
48
|
Takayama K, Yamada S, Kobori Y. Clinical outcomes and temporal changes in the range of motion following superior capsular reconstruction for irreparable rotator cuff tears: comparison based on the Hamada classification, presence or absence of shoulder pseudoparalysis, and status of the subscapularis tendon. J Shoulder Elbow Surg 2021; 30:e659-e675. [PMID: 33930558 DOI: 10.1016/j.jse.2021.04.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/02/2021] [Accepted: 04/04/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Superior capsular reconstruction (SCR) has recently gained popularity as a surgical solution for patients with massive rotator cuff tears or shoulder pseudoparalysis (PPS). Good clinical outcomes have been reported after SCR; however, the factors that influence its clinical outcomes remain unclear. Therefore, in this study, we aimed to clarify the factors influencing postoperative outcomes after SCR using tensor fascia lata graft, for which we evaluated the Hamada grade, patients with or without PPS, and the status of the subscapularis tendon (SSC). METHODS In total, 54 consecutive patients with irreparable rotator cuff tears or PPS who underwent SCR between June 2014 and October 2018 were included. The enrolled patients were grouped and compared as follows: (1) Hamada grade 2 (11 patients) and Hamada grade 3 (43 patients) and (2) non-PPS (22 patients), moderate PPS (16 patients), and severe PPS (16 patients). For subanalysis, the 32 PPS patients were divided into 3 groups: intact SSC (11 patients), repairable SSC (16 patients), and irreparable SSC (5 patients). To assess shoulder function, the American Shoulder and Elbow Surgeons (ASES) score was evaluated before surgery and at 24 months postoperatively; shoulder range of motion was evaluated at 2, 3, 4, 5, 6, 8, 10, 12, and 24 months postoperatively. RESULTS No significant differences in postoperative ASES scores and shoulder range of motion were observed between the Hamada grade 2 and grade 3 groups or between the non-PPS, moderate PPS, and severe PPS groups. However, significant differences in postoperative shoulder elevation and ASES scores were observed between the intact SSC and irreparable SSC groups (P = .006) and between the repairable SSC and irreparable SSC groups (P = .003). CONCLUSIONS This study demonstrated that the status of the SSC, rather than the Hamada grade or the presence or absence of PPS, influences the clinical outcomes after SCR. Therefore, reparability or intactness of the SSC is an important factor in considering the surgical indication for SCR.
Collapse
Affiliation(s)
- Kazumasa Takayama
- Department of Orthopedics, Kurashiki Central Hospital, Kurashiki, Japan.
| | - Shunsuke Yamada
- Department of Orthopedics, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yuu Kobori
- Department of Orthopedics, Kurashiki Central Hospital, Kurashiki, Japan
| |
Collapse
|
49
|
Zhao J, Luo M, Pan J, Liang G, Feng W, Zeng L, Yang W, Liu J. Risk factors affecting rotator cuff retear after arthroscopic repair: a meta-analysis and systematic review. J Shoulder Elbow Surg 2021; 30:2660-2670. [PMID: 34089878 DOI: 10.1016/j.jse.2021.05.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Retear after arthroscopic rotator cuff repair (ARCR) consistently challenges medical staff and patients, and the incidence of retear after surgery is 10%-94%. The purpose of this study was to identify the risk factors that cause retear after ARCR and provide theoretical guidance for clinical intervention to reduce the occurrence of postoperative rotator cuff retear. METHODS The protocol for this meta-analysis was registered with PROSPERO (CRD42021225088). PubMed, Web of Science, and Embase were searched for observational studies on risk factors for rotator cuff retear after arthroscopic repair. Meta-analytical methods were used to determine the odds ratio or weighted mean difference of potential risk factors related to postoperative rotator cuff retear. Stata 15.1 was used to quantitatively evaluate the publication bias of the statistical results. RESULTS Fourteen studies from 6 countries with a total of 5693 patients were included. The meta-analysis revealed that the risk factors for retear after rotator cuff repair were age, body mass index, diabetes, subscapularis and infraspinatus fatty infiltration, symptom duration, bone mineral density, tear length, tear width, tear size area, amount of retraction, critical shoulder angle, acromiohumeral interval, distance from the musculotendinous junction to the glenoid, operative duration, biceps procedure, and postoperative University of California Los Angeles shoulder score. CONCLUSION These findings can help clinical medical staff identify patients who are prone to retear early after arthroscopic repair and develop targeted prevention and treatment strategies for modifiable risk factors, which are of great significance for reducing the occurrence of rotator cuff retear after ARCR.
Collapse
Affiliation(s)
- Jinlong Zhao
- The Second School of Clinical Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China; Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China
| | - Minghui Luo
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China; The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Jianke Pan
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China; The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Guihong Liang
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China; The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Wenxuan Feng
- The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Lingfeng Zeng
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China; The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Weiyi Yang
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China; The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China
| | - Jun Liu
- Research Team on Bone and Joint Degeneration and Injury, Guangdong Academy of Traditional Chinese Medicine, Guangzhou, China; The Second Affiliated Hospital, Guangzhou University of Chinese Medicine (Guangdong Province Hospital of Traditional Chinese Medicine), Guangzhou, China.
| |
Collapse
|
50
|
Li H, Zhou B, Tang K. Advancement in Arthroscopic Superior Capsular Reconstruction for Irreparable Massive Rotator Cuff Tear. Orthop Surg 2021; 13:1951-1959. [PMID: 34585538 PMCID: PMC8528972 DOI: 10.1111/os.12976] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/28/2020] [Accepted: 02/01/2021] [Indexed: 11/28/2022] Open
Abstract
Irreparable massive rotator cuff tear (IMRCT) was one of the causes of shoulder dysfunction, despite technical improvement, the failure rate of IMRCT was still demonstrated to be high. Traditional treatments like non-surgical treatments, partial rotator cuff repair, and tendon transfers could only achieve a slight improvement. A potential cause for high failure rate was the fact that traditional treatments cannot restore the superior stability of glenohumeral joint, and thus restricted the movement of shoulder joint severely. Superior capsular reconstruction (SCR) using a variety of grafts (autograft, allograft, xenograft, or synthetic grafts) provided a promising option for IMRCT. In surgery, graft was fixed medially to superior glenoid and laterally to the footprint of humeral greater tuberosity. SCR could increase the stability of the superior glenohumeral joint, decrease the subacromial pressure and acromiohumeral distance. This review summarized the relevant literature regarding the alternative grafts, surgery indications, operative techniques and clinical outcomes of SCR. we compared the different grafts, key surgical steps, the advantages and disadvantages of different surgical methods to provide clinicians with new surgical insights into the treatments of IMRCT. In conclusion, IMRCT without severe glenohumeral arthritis was the best suitable indication for SCR. The clinical outcomes were positive in the short-term and middle-term following-up. More studies were necessary to determine long-term results of this surgical procedure.
Collapse
Affiliation(s)
- Huaisheng Li
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Binghua Zhou
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| | - Kanglai Tang
- Department of Orthopedic Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China
| |
Collapse
|