1
|
Baek CH, Kim BT, Kim JG, Kim SJ. Increased latissimus dorsi and teres major muscle volume after anterior transfer for irreparable anterior superior rotator cuff tear: correlation with improved internal rotation strength. Arch Orthop Trauma Surg 2024; 144:1491-1502. [PMID: 38316700 DOI: 10.1007/s00402-023-05192-3] [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: 08/27/2023] [Accepted: 12/19/2023] [Indexed: 02/07/2024]
Abstract
INTRODUCTION While the well-established correlation between increased muscle volume and enhanced muscle strength is widely recognized, there have been no studies assessing volumetric muscle changes in transfer surgery in the shoulder. This study aimed to evaluate changes in transferred muscle volume and their clinical implications in anterior latissimus dorsi and teres major (aLDTM) tendon transfer in patients with anterior superior irreparable rotator cuff tears (ASIRCTs). MATERIALS AND METHODS The study retrospectively examined 40 patients who underwent aLDTM tendon transfers for ASIRCTs between August 2018 and January 2022. Using ImageJ software, the LDTM muscle was segmented in T2-weighted oblique axial images, and total muscle volume (tLDTMV) of both immediate and postoperative 1-year were calculated. Pearson correlation analysis was used to determine the correlation between ΔtLDTMV and ΔASES scores, Δactive-ROM, and Δstrength. RESULTS The current study revealed an 11.4% increase in tLDTMV at 1-year postoperative. Patients were grouped based on postoperative ASES score: Group 1 (Optimal, n = 17) and Group 2 (Suboptimal, n = 23). Although tLDTMVimmediate postoperative values were similar between groups (P = 0.954), tLDTMV1-year postoperative value was significantly higher in Group 1 compared to Group 2 (P = 0.021). In correlation analysis, ΔtLDTMV showed significant correlations with ΔASES score (r = 0.525, P < 0.001), ΔaROM of forward elevation (FE) (r = 0.476, P = 0.002), ΔaROM of internal rotation (IR) at back (r = 0.398, P = 0.011), Δstrength of FE (r = 0.328, P = 0.039), Δ strength of IR at 90° abduction (r = 0.331, P = 0.037), and IR at side (r = 0.346, P = 0.029). CONCLUSIONS Significant increase in tLDTMV was observed at 1-year postoperative for ASIRCT patients. Notably, greater ΔtLDTMV exhibited a correlation with better ASES scores, increased aROM and strength in both FE and IR. Nevertheless, further research is required by employing more robust standardized measurement tools and a larger sample size.
Collapse
Affiliation(s)
- Chang Hee Baek
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-Ro , Yeosu-Si, Jeollanam-Do, 59709, Republic of Korea.
| | - Bo Taek Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-Ro , Yeosu-Si, Jeollanam-Do, 59709, Republic of Korea
| | - Jung Gon Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-Ro , Yeosu-Si, Jeollanam-Do, 59709, Republic of Korea
| | - Seung Jin Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-Ro , Yeosu-Si, Jeollanam-Do, 59709, Republic of Korea
| |
Collapse
|
2
|
Baek CH, Kim BT, Kim JG, Kim SJ. Joint-preserving treatment for global irreparable rotator cuff tears: combined anterior Latissimus dorsi and Teres major tendon transfer. Arch Orthop Trauma Surg 2024; 144:1473-1483. [PMID: 38285220 DOI: 10.1007/s00402-023-05196-z] [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: 11/18/2023] [Accepted: 12/19/2023] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Treating global irreparable rotator cuff tears (GIRCTs) that involve both antero-and postero-superior cuff tendon tears could be a challenging problem. There has been limited joint-preserving treatment options in high-demand patients with minimal glenohumeral arthritis. The study aims to assess the clinical outcome of combined anterior latissimus dorsi and teres major tendon (aLDTM) transfer for patients with both GIRCTs and minimal glenohumeral arthritis. MATERIALS AND METHODS This retrospective study included patients who underwent combined aLDTM transfer for GIRCTs between 2018 May and 2020 October. Clinical outcomes include pain VAS, Constant, American Shoulder and Elbow Society (ASES), University of California Los Angeles (UCLA), activities of daily living requiring active internal rotation (ADLIR) score, active range of motion (aROM), strength, rates of pseudoparalysis or pseudoparesis reversal and return to work. Radiographic assessment included the acromiohumeral distance (AHD), Hamada grade, and transferred tendon integrity at final follow-up. RESULTS 23 patients (mean age: 64.7 ± 5.9 years [55-74]) were included and the mean follow-up period was 28.2 ± 4.3 [24‒36] months. Postoperatively, VAS, Constant, ASES, UCLA, and ADLIR scores significantly improved at final follow-up (P < .001). Postoperative aROM was significantly improved in forward elevation (FE) to 129° ± 29°, abduction (ABD) to 105° ± t3°, and internal rotation (IR) at back to 5.9 ± 2.5. Strength of both FE and IR were also significantly improved (P < .001). Patients with preoperative pseudoparalysis (2 of 4 patients) and pseudoparesis (6 of 6 patients) experienced a reversal. No significant change in AHD and hamada grade was confirmed at final follow-up. 3 patients experienced partial tear of the transferred tendon. CONCLUSIONS In this study, we found significant improvement in clinical outcomes with no significant progression of arthritis by final follow-up. The aLDTM transfer could be an alternative choice of joint-preserving treatment option for young and active patients with GIRCTs and minimal glenohumeral arthritis. However, large and long-term studies should be conducted to establish its adequacy. STUDY DESIGN Case series. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Chang Hee Baek
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-ro, Yeosu-si, Jeollanam-do, 59709, Republic of Korea.
| | - Bo Taek Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-ro, Yeosu-si, Jeollanam-do, 59709, Republic of Korea
| | - Jung Gon Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-ro, Yeosu-si, Jeollanam-do, 59709, Republic of Korea
| | - Seung Jin Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, 50, Yeoseo 1-ro, Yeosu-si, Jeollanam-do, 59709, Republic of Korea
| |
Collapse
|
3
|
Takayama K, Ito H. Clinical outcomes and temporal changes in the range of motion following reverse total shoulder arthroplasty. J Orthop Sci 2023; 28:1258-1265. [PMID: 36243593 DOI: 10.1016/j.jos.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 07/09/2022] [Accepted: 09/25/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Reverse total shoulder arthroplasty is a definitive solution for the treatment of massive rotator cuff tear and shoulder pseudoparalysis since it can improve shoulder function, especially in elderly individuals. For many elderly individuals, the concern is when they can return to their daily lives after surgery. This study aimed to clarify the characteristics of temporal postoperative values following reverse total shoulder arthroplasty and investigate the factors that affect clinical outcomes. METHODS This study included 52 patients (mean 79.2 years, range 70-87 years) who underwent primary reverse total shoulder arthroplasty for shoulder pseudoparalysis at a single institution by a single surgeon using the same implant between October 2014 and June 2019. We divided 52 patient into the following groups (1) female (n = 34)vs. male (n = 18) patients; (2) with (n = 19) vs. without (n = 33) arthritic changes in glenohumeral joints (Hamada grade 2, 3 vs. 4, 5); (3) with (n = 23) vs. without (n = 29) subscapularis tendon repair; and investigated the temporal changes in the range of motion (flexion, abduction, external rotation, and internal rotation) and American Shoulder and Elbow Surgeons scores. RESULTS Significant differences were observed in postoperative shoulder flexion (P = .046) and abduction (P = .049) between the female and male groups. The male patients were able to obtain quick functional recovery. However, no significant differences were observed in postoperative American Shoulder and Elbow Surgeons scores, and the shoulder range of motion between patients with Hamada grade 2, 3 and 4, 5, and between the subscapularis repair and no repair groups. CONCLUSION The factor that affected the final and temporal values of range of motion after reverse total shoulder arthroplasty was sex, rather than the arthritic changes in glenohumeral joint and the treatment of the subscapularis tendon.
Collapse
Affiliation(s)
- Kazumasa Takayama
- Department of Orthopaedics, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 7108602, Japan.
| | - Hiromu Ito
- Department of Orthopaedics, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 7108602, Japan
| |
Collapse
|
4
|
Rhee YG, Kyeong TH, Rhee SM, Kantanavar R. Anterior capsular reconstruction in irreparable subscapularis tear: human dermal allograft. J Shoulder Elbow Surg 2023; 32:2256-2263. [PMID: 37263481 DOI: 10.1016/j.jse.2023.04.029] [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: 01/22/2023] [Revised: 04/16/2023] [Accepted: 04/19/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND The irreparable subscapularis (SSc) tears pose an extremely difficult situation to manage, especially in the younger population. The anterior capsular reconstruction (ACR) with human dermal allograft (HDA) is an alternative to tendon transfer with sound biomechanical advantages and clinical outcomes. The purpose of this study was to evaluate the early clinical and radiologic outcomes of open ACR with HDA in patients with irreparable SSc tears. METHODS Eighteen patients who had an open ACR with HDA for irreparable SSc tears between August 2020 and January 2022 were enrolled. There were 11 male and 7 female patients with a mean age of 63.7 years and a mean follow-up of 17 months (range, 12-28 months). The dominant side was affected in 10 patients. One of the 18 patients had reconstruction with single-layer HDA, 14 had double-layer HDA, and 3 had SSc augmentation over double-layer HDA. Clinical and radiologic outcomes were assessed and compared pre- and postoperatively. RESULTS There was significant improvement in visual analog scale score from 6.6 ± 1.6 to 1.6 ± 1.5 (P < .001) and in the total University of California-Los Angeles shoulder score from 12.4 ± 4.3 to 29.0 ± 4.5 (P < .001). Forward flexion, abduction, and internal rotation (IR) increased by 28.6°, 32.5°, and 11.8°, respectively (P < .001). External rotation decreased by 6.4° (P = .020). There was notable improvement in IR strength (percentage of that of the opposite, normal side) from 66.0% ± 19.4% to 84.4% ± 22.3% (P = .008). The mean postoperative coracohumeral distance improved from 3.0 to 6.0 mm (P < .001), the anterior translation of the humeral head reduced from 1.5 to 0.5 mm (P = .210), and the acromiohumeral interval from 8.1 to 8.8 mm (P = .070). The patients' satisfaction at final follow-up was rated 4.1 of 5.0 (P < .001). Sixteen of 18 patients (88.9%) had the HDA healed at the glenoid and humeral side, and 2 (11.1%) had retear at the final follow-up. Among the 17 who had double-layer HDA, none showed any healing between the layers. CONCLUSION This study showed that early significant and comprehensive improvement inclusive of pain relief, improvement in range of motion, IR strength, and reduction of anterosuperior translation was achievable by open ACR with HDA for irreparable SSc tear.
Collapse
Affiliation(s)
- Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Myongji Hospital, Goyang-si, Kyunggi Gyeonggi-do, Republic of Korea
| | - Tae Hyun Kyeong
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Myongji Hospital, Goyang-si, Kyunggi Gyeonggi-do, Republic of Korea
| | - Sung Min Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, KyungHee University Hospital, Seoul, Republic of Korea
| | - Radhakrishna Kantanavar
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Myongji Hospital, Goyang-si, Kyunggi Gyeonggi-do, Republic of Korea.
| |
Collapse
|
5
|
Pak T, Hwang S, Ardebol J, Ghayyad K, Menendez ME, Gobezie R, Denard PJ. Arthroscopic Repair of Massive Rotator Cuff Tears Leads to Functional Improvement in Most Patients at 4-Year Follow-up. Arthrosc Sports Med Rehabil 2023; 5:100750. [PMID: 37645387 PMCID: PMC10461212 DOI: 10.1016/j.asmr.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 05/16/2023] [Indexed: 08/31/2023] Open
Abstract
Purpose To assess functional outcomes and healing 4 years after arthroscopic repair of massive rotator cuff tears (MRCTs). Methods We conducted a retrospective study of patients who underwent arthroscopic rotator cuff repair of an MRCT-defined as a complete 2-tendon tear or a tear greater than 5 cm in any dimension-performed by 2 surgeons at different institutions between January 2015 and December 2018. At a minimum of 4 years postoperatively, patient-reported outcomes collected included the visual analog scale pain score, American Shoulder and Elbow Surgeons (ASES) score, Veterans RAND 12 (VR-12) score, and Subjective Shoulder Value (SSV) score. Repair technique and concomitant procedures were also gathered. Tendon healing was evaluated via ultrasound at final follow-up. Results Functional outcomes were available for 101 patients at a mean of 63.6 ± 8.8 months (range, 48-82 months) postoperatively. Mean ASES scores improved from 40.1 to 78 (P < .001); VR-12 scores, from 37.1 to 47.7 (P < .001); and SSV scores, from 36.7 to 84.6 (P < .001). Forward flexion improved from 126° to 144° (P = .001), external rotation remained unchanged (from 47° to 44°, P = .268), and internal rotation improved by 2 spinal levels (from L4 to L2, P = .0001). Eighty-eight percent of patients (89 of 101) were satisfied with the procedure, and only 5% underwent reverse shoulder arthroplasty within the study period. Among the 39 patients who underwent postoperative ultrasound to assess healing, 56% showed complete tendon healing. There was no difference in healing or outcomes according to tear pattern. Additionally, tendon healing did not affect outcomes. Conclusions Arthroscopic repair of MRCTs leads to functional improvements and patient satisfaction in most cases at 4-year follow-up. The rates of patients achieving the minimal clinically important difference were 77.5%, 87.6%, 59.7%, and 80.6% for the ASES score, SSV score, VR-12 score, and visual analog scale pain score, respectively. Complete tendon healing is difficult to achieve but does not appear to limit functional improvements. Level of Evidence Level IV, therapeutic case series.
Collapse
Affiliation(s)
- Theresa Pak
- Oregon Shoulder Institute, Medford, Oregon, U.S.A
| | - Simon Hwang
- Oregon Shoulder Institute, Medford, Oregon, U.S.A
| | | | | | | | | | | |
Collapse
|
6
|
Thangarajah T, Tsuchiya S, Lukenchuk J, Lo IK. Arthroscopic superior capsular reconstruction with dermal allograft for primary and recurrent rotator cuff tears. JSES Int 2023; 7:574-580. [PMID: 37426916 PMCID: PMC10328778 DOI: 10.1016/j.jseint.2023.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Background The aim of this study was to compare the clinical outcomes and retear rate of arthroscopic superior capsular reconstruction (SCR) with dermal allograft following structural failure of a previous rotator cuff repair, with a cohort of primary SCRs. Methods This was a retrospective comparative study with a study group comprising 22 patients who were followed up at a minimum of 24 (mean, 41; range, 27-65) months after SCR with dermal allograft performed for structural failure of a previous rotator cuff repair. The control group included 13 patients who previously underwent a primary SCR using dermal allograft and were followed up for 24 months. Clinical outcome measures comprised range of motion, the American Shoulder and Elbow Surgeons score, and the Western Ontario Rotator Cuff (WORC) Index. Radiological outcomes included the acromiohumeral interval and graft integrity on magnetic resonance imaging at one year. Logistic regression was used to determine whether SCR being undertaken as either a primary or revision procedure influenced functional outcomes or retear rate. Results The mean age at the time of surgery was 58 (range, 39-74) years for the study group and 60 (range, 48-70) years for the control group. Forward flexion improved from a mean of 117° (range, 7°-180°) preoperatively to 140° (range, 45°-170°) postoperatively (P = .11), and external rotation increased from a mean of 31° (range, 0°-70°) preoperatively to 36° (range, 0°-60°) postoperatively (P = .23). The American Shoulder and Elbow Surgeons score improved (P = 0) from a mean of 38 (range, 12-68) to 73 (range, 17-95), and the WORC Index improved (P = 0) from a mean of 29 (range, 7-58) to 59 (range, 30-97). Following SCR, there was no significant change in the acromiohumeral interval. The graft was intact in 42% of cases on magnetic resonance imaging and none of the retears underwent further surgery. Compared to revision SCR, primary SCR resulted in a significant improvement in forward flexion (P = .001), external rotation (P = 0), and WORC Index (P = .019). Logistic regression demonstrated that SCR performed as a revision procedure was associated with a higher retear rate (P = .006) and worse forward flexion (P = .009) and external rotation (P = .008). Conclusion SCR using human dermal allograft following structural failure of a previous rotator cuff repair can lead to an improvement in clinical outcomes but the results are inferior to primary procedures.
Collapse
Affiliation(s)
- Tanujan Thangarajah
- Corresponding author: Tanujan Thangarajah, MB ChB (hons), MSc, PhD, FRCS (Tr&Orth), MAcadMEd, Department of Trauma and Orthopaedic Surgery, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4 Canada.
| | | | | | | |
Collapse
|
7
|
Biomechanical comparison of combined latissimus dorsi and teres major tendon transfer vs. latissimus dorsi tendon transfer in shoulders with irreparable anterosuperior rotator cuff tears. J Shoulder Elbow Surg 2023; 32:703-712. [PMID: 36529382 DOI: 10.1016/j.jse.2022.11.007] [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: 06/27/2022] [Revised: 10/26/2022] [Accepted: 11/10/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Irreparable anterosuperior rotator cuff tears (IASRCTs) can result in a gradual loss of active elevation and internal rotation, superior and anterior translation of the humeral head, and cuff tear arthropathy. Joint-preserving treatment options for IASRCTs in young and high-demand elderly patients remain a subject of ongoing debate. The aim of the study was to evaluate the biomechanical efficacy of the combined latissimus dorsi and teres major tendon (LDTM) transfer and compare it to an isolated latissimus dorsi (LD) transfer in a cadaveric IASRCT model. METHODS Eight cadaveric shoulders (mean age, 68.3 ± 5.2 years; range 58-71) were tested with a custom shoulder testing system. All specimens were tested at 0°, 30°, and 60° of glenohumeral abduction in the scapular plane under 4 conditions: (1) intact, (2) IASRCT, (3) combined LDTM transfer, and (4) isolated LD transfer. The superior and anteroinferior translation and subacromial contact pressure were measured. The effects of 3 different LD and LDTM muscle loading conditions were investigated to determine the effectiveness of the muscle transfer conditions. A linear mixed effect model was used for statistical analysis, followed by a Tukey post hoc test. RESULTS IASRCTs significantly increased superior translation, anteroinferior translation, and subacromial peak contact pressure. Combined LDTM transfer significantly decreased superior and anteroinferior translation compared with IASRCTs in all positions and muscle loadings. Isolated LD transfer did not significantly decrease superior (P > .115) and anteroinferior translation (P > .151) compared to IASRCT at any abduction and muscle loads except superior translation at 60° abduction and 90° of external rotation (ER) (P < .036). LDTM transfer also significantly decreased peak contact pressure from the IASRCT condition at every abduction angle (P < .046). However, isolated LD transfer significantly decreased subacromial peak contact pressure only at 30° abduction and 0° and 30° of ER with triple loading (P < .048), as well as at 60° abduction and 90° of ER (P < .003). CONCLUSIONS Combined LDTM transfer decreased superior translation, anteroinferior translation, and subacromial contact pressure compared with the IASRCT condition. Isolated LD transfer did not improve glenohumeral translation and subacromial contact pressure. Combined LDTM transfer may be a more reliable treatment option than isolated LD transfer in patients with an IASRCT.
Collapse
|
8
|
Ulstrup A, Reinhold M, Falster O. Superior capsular reconstruction with a porcine xenograft. JSES Int 2023. [DOI: 10.1016/j.jseint.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
|
9
|
Bozoğlan M, Danışman M, Demir T, Karaca H, Esenyel CZ. The clinical results of lower trapezius tendon transfer with the peroneus longus allograft augmentation combined with interpositional repair with fascia lata in massive irreparable rotator cuff tears. Saudi Med J 2023; 44:164-170. [PMID: 36773966 PMCID: PMC9987693 DOI: 10.15537/smj.2023.44.2.20220721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/14/2022] [Indexed: 02/13/2023] Open
Abstract
OBJECTIVES To investigate the clinical results of lower trapezius (LT) tendon transfer and interpositional repair that were performed simultaneously in patients with massive irreparable rotator cuff tears. METHODS Between 2018 and 2020 years, 16 patients with massive irreparable rotator cuff tears that were treated with LT tendon transfer and interpositional repair at the same time were included in this study. The mean follow-up period was 29±3 months (24-39 months) and the mean age of patients was 62±9 years (42-73 years). The acromio-humeral distance, active range of motions, Visual Analog Scale (VAS) scores, University of California-Los Angeles (UCLA) scores and Constant-Murley scores were made preoperatively and at the final follow-up. RESULTS At the final follow-up, forward flexion was increased from 109˚±24.7 to 144˚±22.21 (p=0.005), abduction from 60˚±16.33 to 135˚±16.33 (p=0.005) and external rotation from 12˚±16.87 to 35˚±14.34 (p=0.005). Total UCLA scores were 5.9±2.13 to 22.7±5.29 (p=0.005), Constant-Murley scores were 24±9.43 to 50.2±14.28 (p=0.008), VAS scores were 6.1±1.1 to 2.4±1.35 (p=0.007), mean acromio-humeral distances were 4.64±0.85 mm (3.42-6.23 mm) to 6.58 mm (5.25-8.21 mm) (p=0.005) preoperatively and at the final follow-up. Except one patient who had a frozen shoulder any significant complication was detected. CONCLUSION Adding interpositional repair to the LT tendon transfer in patients with posterior superior irreparable rotator cuff tear seems to have satisfactory short to mid-term clinical outcomes without an increase in complications.
Collapse
Affiliation(s)
- Muhammet Bozoğlan
- From the Orthopaedics and Traumatology Department (Bozoğlan), Izmir Health Sciences University Tepecik Training and Research Hospital, Izmir; and from the Orthopaedics and Traumatology Department (Danışman, Demir, Karaca, Esenyel), Prof. Dr. Ilhan Ozdemir Education and Research Hospital, Giresun, Turkey.
- Address correspondence and reprint request to: Dr. Muhammet Bozoğlan, Orthopaedics and Traumatology Department, Izmir Health Sciences University Tepecik Training and Research Hospital, Izmir, Turkey. E-mail: ORCID ID: https://orcid.org/0000-0002-1368-833X
| | - Murat Danışman
- From the Orthopaedics and Traumatology Department (Bozoğlan), Izmir Health Sciences University Tepecik Training and Research Hospital, Izmir; and from the Orthopaedics and Traumatology Department (Danışman, Demir, Karaca, Esenyel), Prof. Dr. Ilhan Ozdemir Education and Research Hospital, Giresun, Turkey.
| | - Tuğcan Demir
- From the Orthopaedics and Traumatology Department (Bozoğlan), Izmir Health Sciences University Tepecik Training and Research Hospital, Izmir; and from the Orthopaedics and Traumatology Department (Danışman, Demir, Karaca, Esenyel), Prof. Dr. Ilhan Ozdemir Education and Research Hospital, Giresun, Turkey.
| | - Halil Karaca
- From the Orthopaedics and Traumatology Department (Bozoğlan), Izmir Health Sciences University Tepecik Training and Research Hospital, Izmir; and from the Orthopaedics and Traumatology Department (Danışman, Demir, Karaca, Esenyel), Prof. Dr. Ilhan Ozdemir Education and Research Hospital, Giresun, Turkey.
| | - Cem Zeki Esenyel
- From the Orthopaedics and Traumatology Department (Bozoğlan), Izmir Health Sciences University Tepecik Training and Research Hospital, Izmir; and from the Orthopaedics and Traumatology Department (Danışman, Demir, Karaca, Esenyel), Prof. Dr. Ilhan Ozdemir Education and Research Hospital, Giresun, Turkey.
| |
Collapse
|
10
|
Pogorzelski J, Rupp MC, Scheiderer B, Lacheta L, Schliemann B, Schanda J, Heuberer P, Schneider M, Hackl M, Lorbach O. Management of Irreparable Posterosuperior Rotator Cuff Tears-A Current Concepts Review and Proposed Treatment Algorithm by the AGA Shoulder Committee. J Pers Med 2023; 13:jpm13020191. [PMID: 36836425 PMCID: PMC9964754 DOI: 10.3390/jpm13020191] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
Posterosuperior rotator cuff tears range among the most common causes of shoulder complaints. While non-operative treatment is typically reserved for the elderly patient with low functional demands, surgical treatment is considered the gold standard for active patients. More precisely, an anatomic rotator cuff repair (RCR) is considered the most desirable treatment option and should be generally attempted during surgery. If an anatomic RCR is impossible, the adequate choice of treatment for irreparable rotator cuff tears remains a matter of debate among shoulder surgeons. Following a critical review of the contemporary literature, the authors suggest the following evidence- and experience-based treatment recommendation. In the non-functional, osteoarthritic shoulder, treatment strategies in the management of irreparable posterosuperior RCT include debridement-based procedures and reverse total shoulder arthroplasty as the treatment of choice. Joint-preserving procedures aimed at restoring glenohumeral biomechanics and function should be reserved for the non-osteoarthritic shoulder. Prior to these procedures, however, patients should be counseled about deteriorating results over time. Recent innovations such as the superior capsule reconstruction and the implantation of a subacromial spacer show promising short-term results, yet future studies with long-term follow-up are required to derive stronger recommendations.
Collapse
Affiliation(s)
- Jonas Pogorzelski
- Department of Orthopedic Sports Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany
- Private Practice OC Erlangen-Ebermannstadt, Nägelsbach Str. 25b, 91052 Erlangen, Germany
- Correspondence:
| | - Marco-Christopher Rupp
- Department of Orthopedic Sports Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany
| | - Bastian Scheiderer
- Department of Orthopedic Sports Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany
| | - Lucca Lacheta
- Department of Orthopedic Sports Medicine, Technical University of Munich, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 Munich, Germany
| | - Benedikt Schliemann
- Herz Jesu Hospital Münster-Hiltrup, Westfalen Str. 109, 48165 Münster, Germany
| | - Jakob Schanda
- Private Practice Dr. Schanda, Rochusgasse 17/13, 1030 Vienna, Austria
| | - Philipp Heuberer
- Private Practice OrthoCare, Kurbad Str. 14, 1100 Vienna, Austria
| | - Marco Schneider
- University of Witten/Herdecke, Alfred-Herrhausen-Straße 45, 58455 Witten, Germany
| | - Michael Hackl
- Department of Trauma-, Hand- and Elbow Surgery, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | | | - Olaf Lorbach
- Schoen-Clinic Lorsch, Department of Shoulder Surgery and Sports Traumatology, Wilhelm-Leuschner-Straße 10, 64653 Lorsch, Germany
| |
Collapse
|
11
|
Tendon Transfers, Balloon Spacers, and Bursal Acromial Reconstruction for Massive Rotator Cuff Tears. Clin Sports Med 2023; 42:125-140. [DOI: 10.1016/j.csm.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
12
|
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
|
13
|
Baek CH, Kim JG, Baek GR. Outcomes of combined anterior latissimus dorsi and teres major tendon transfer for irreparable anterosuperior rotator cuff tears. J Shoulder Elbow Surg 2022; 31:2298-2307. [PMID: 35550431 DOI: 10.1016/j.jse.2022.03.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/22/2022] [Accepted: 03/27/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Irreparable anterosuperior rotator cuff tears (IASRCTs) can result in loss of active elevation, loss of internal rotation, and pseudoparalysis. Joint-preserving treatment options for IASRCTs in young and high-demand elderly patients are limited. The purpose of this study was to evaluate the clinical and radiologic outcomes of combined anterior latissimus dorsi and teres major (aLDTM) tendon transfer in patients with IASRCTs without reconstruction of the superior rotator cuff and capsular portion. METHODS This retrospective study was conducted between 2015 and 2018. We included patients who underwent combined aLDTM tendon transfer for IASRCTs. Clinical outcomes included visual analog scale for pain, Constant score, American Shoulder and Elbow Surgeons score, University of California Los Angeles shoulder scores, activities of daily living requiring active internal rotation score, active range of motion, subscapularis-specific physical examination, and rate of return to work. Radiographic analyses included the assessment of acromiohumeral distance, Hamada grade for cuff tear arthropathy, rate of anterior glenohumeral subluxation reduction, and transferred tendon integrity at 2 years postoperatively. RESULTS The mean follow-up period was 38.1 ± 13.7 (range: 24-63) months. Of the patients, 30 (mean age: 64.1 years) met the study criteria. Postoperatively, mean Constant, American Shoulder and Elbow Surgeons, University of California Los Angeles, and activities of daily living requiring active internal rotation scores improved from 47.4 to 69.9 (P < .001), 44.9 to 79.2 (P < .001), 20.0 to 28.7 (P < .001), and 13.2 to 26.9 (P < .001), respectively. The mean active range of motion was significantly increased postoperatively for both forward elevation (P < .001) and internal rotation at the back (P < .001). Of the patients, 24 (83%) returned to their previous work. No significant progression of cuff tear arthropathy was observed at final follow-up (Hamada grade: preoperative 1.3 ± 0.5 to postoperative 1.5 ± 0.7; p=0.155). Fifteen of 30 patients (50%) restored the anterior glenohumeral subluxation that was apparent preoperatively. One patient presented with transient axillary nerve palsy after surgery. Two patients presented with partial nonretracted tears of the transferred tendon. CONCLUSION This minimum 2-year follow-up study demonstrated that combined aLDTM tendon transfer without reconstruction of the superior rotator cuff and capsular portion was a viable treatment option with favorable clinical and radiologic outcomes for patients with IASRCTs.
Collapse
Affiliation(s)
- Chang Hee Baek
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu-si, Jeollanam-do, Republic of Korea.
| | - Jung Gon Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu-si, Jeollanam-do, Republic of Korea
| | - Gyu Rim Baek
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| |
Collapse
|
14
|
Premsiri A, Mahasupachai N, Chanlalit C. Arthroscopic-assisted lower trapezius transfer with peroneus longus graft for massive irreparable rotator cuff tear and glenohumeral joint instability: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:539-545. [PMID: 37588471 PMCID: PMC10426571 DOI: 10.1016/j.xrrt.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Arnakorn Premsiri
- Department of Orthopedics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Nattakorn Mahasupachai
- Department of Orthopedics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Cholawish Chanlalit
- Department of Orthopedics, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| |
Collapse
|
15
|
Baek CH, Lee DH, Kim JG. Latissimus dorsi transfer vs. lower trapezius transfer for posterosuperior irreparable rotator cuff tears. J Shoulder Elbow Surg 2022; 31:1810-1822. [PMID: 35339706 DOI: 10.1016/j.jse.2022.02.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Latissimus dorsi transfer (LDT) and lower trapezius transfer (LTT) are effective treatment options for posterosuperior irreparable rotator cuff tears (IRCTs) in relatively young patients and elderly high-demand patients without arthritic changes. However, the optimal treatment option for patients with posterosuperior IRCT remains a subject of ongoing debate. This study aimed to compare clinical and radiologic short-term outcomes between arthroscopic-assisted LDT (aLDT) and arthroscopic-assisted LTT (aLTT) in patients with posterosuperior IRCT. METHODS This retrospective crossover study included patients who underwent aLDT or aLTT for posterosuperior IRCT and who had a minimum clinical follow-up time of 2 years after undergoing surgical procedures between January 2012 and June 2019. A total of 90 patients with posterosuperior IRCT were divided into 2 groups according to the surgical procedure: group D underwent aLDT (n = 48) and group T underwent aLTT (n = 42). Clinical outcomes comprised the visual analog scale score for pain, active shoulder range of motion (ROM), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, and activities of daily living that require active external rotation (ADLER) score. Radiologic outcomes included acromiohumeral distance (AHD). The progression of arthritis was evaluated using Hamada grade. Graft integrity was assessed using postoperative magnetic resonance imaging. RESULTS Significant improvements in clinical outcomes were observed in both groups. Active shoulder external rotation (P < .001), postoperative ASES score (P < .001), and ADLER score (P < .001) were significantly higher in group T than in group D. AHD at 2-year follow-up was significantly higher in group T than in group D (P < .001). The rate of progression of arthritis was significantly higher in group D (31.3%) than in group T (7.1%) (P = .031). CONCLUSIONS Although both LDT and LTT improved the overall clinical outcomes of patients with posterosuperior IRCT, LTT was superior to LDT in terms of shoulder ROM, functional improvement, and progression of arthritis. Our findings indicate that LTT may be the preferred treatment option for posterosuperior IRCT in relatively active and young patients.
Collapse
Affiliation(s)
- Chang Hee Baek
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu-si, Republic of Korea.
| | - Dong Hyeon Lee
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu-si, Republic of Korea
| | - Jung Gon Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu-si, Republic of Korea
| |
Collapse
|
16
|
López-Zamora I, Campos-Varela I, Luzardo-González A, Justes-Solé A. [Early physiotherapy in lower trapezius transfer for massive and irreparable rotator cuff injuries. A case report]. Rehabilitacion (Madr) 2022; 57:100748. [PMID: 35803750 DOI: 10.1016/j.rh.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 10/17/2022]
Abstract
Massive and irreparable lesions of the rotator cuff are frequent between people over 60 years old. Recently, inferior trapezium transference with Achilles tendon allograft has demonstrated very good results to restore shoulder's function. For this kind of surgery, it is recommended an absolute immobilization in shoulder abduction at 90° and maximal external rotation between 6-8 weeks. A 57-year-old woman underwent surgery with a lower trapezius transfer to repair the rotator cuff due to a massive and irreparable tear. She started aquatic physiotherapy 15 days after surgery and conventional physiotherapy treatment at 25 days, with a follow-up of 12 months. Good functional results of the operated shoulder were obtained, which were maintained in the postoperative follow-up. In this case early physiotherapy did not result in any risk of suture dehiscence, loosen or distressing of the allograft.
Collapse
Affiliation(s)
- I López-Zamora
- Unidad de Fisioterapia, Servicio de Medicina Física y Rehabilitación, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
| | - I Campos-Varela
- Unidad de Fisioterapia, Servicio de Medicina Física y Rehabilitación, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - A Luzardo-González
- Unidad de Fisioterapia, Servicio de Medicina Física y Rehabilitación, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - A Justes-Solé
- Unidad de Fisioterapia, Servicio de Medicina Física y Rehabilitación, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| |
Collapse
|
17
|
Luo Z, Lin J, Sun Y, Zhu K, Wang C, Chen J. Outcome Comparison of Latissimus Dorsi Transfer and Pectoralis Major Transfer for Irreparable Subscapularis Tendon Tear: A Systematic Review. Am J Sports Med 2022; 50:2032-2041. [PMID: 34138660 DOI: 10.1177/03635465211018216] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Latissimus dorsi transfer (LDT) and pectoralis major transfer (PMT) were developed to treat an irreparable subscapularis tendon tear (ISScT); however, the difference in their outcomes remains unclear. PURPOSE To systematically review and compare the outcomes of LDT and PMT for ISScT. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review was performed through a comprehensive search of Embase, PubMed, and the Cochrane Library. Studies of LDT or PMT were included according to the inclusion and exclusion criteria. The primary outcome was the Constant-Murley score (CMS) at the final follow-up. Secondary outcomes included the subjective shoulder value (SSV), visual analog scale (VAS) score for pain, active shoulder range of motion, and the belly-press and lift-off tests. Postoperative failure and complication rates were the safety outcome measures. Outcomes were summarized into the LDT and PMT groups, and results were compared statistically (P < .05). RESULTS Twelve studies were included in this review: 184 shoulders from 9 studies for the PMT group and 85 shoulders from 3 studies for the LDT group. For the PMT and LDT groups, the mean ages were 58.9 and 55.1 years, respectively, and the mean follow-up was 66.9 and 17.4 months, respectively. Overall, the LDT and PMT groups improved in the primary outcome (CMS) and secondary outcomes (SSV, VAS, ROM, and belly-press and lift-off tests), with low rates of failure and complication. When compared with the PMT group, the LDT group showed more significant improvements in CMS (35.2 vs 24.7; P < .001), active forward flexion (44.3° vs 14.7°; P < .001), abduction (35.0° vs 17.6°; P < .002), and positive belly-press test rate (45% vs 27%; P < .001). No statistically significant difference was seen between the groups in postoperative failure rate, complication rate, mean improvement of active internal rotation, VAS, or SSV. CONCLUSION In general, LDT showed significantly better clinical outcomes postoperatively than did PMT. The available fair-quality evidence suggested that LDT might be a better choice for ISScT. Further evaluations on the relative benefits of the 2 surgical approaches are required, with more high-quality randomized controlled studies.
Collapse
Affiliation(s)
- Zhiwen Luo
- Department of Sports Medicine, Fudan University Huashan Hospital Huashan Hospital, Shanghai, China
| | - Jinrong Lin
- Department of Sports Medicine, Fudan University Huashan Hospital Huashan Hospital, Shanghai, China
| | - Yaying Sun
- Department of Sports Medicine, Fudan University Huashan Hospital Huashan Hospital, Shanghai, China
| | - Kesen Zhu
- Department of Sports Medicine, Fudan University Huashan Hospital Huashan Hospital, Shanghai, China
| | - Chenghui Wang
- Department of Sports Medicine, Fudan University Huashan Hospital Huashan Hospital, Shanghai, China
| | - Jiwu Chen
- Department of Sports Medicine, Fudan University Huashan Hospital Huashan Hospital, Shanghai, China
| |
Collapse
|
18
|
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
|
19
|
Cunningham JG, Ebert JR, Campbell P, Falconer T. Does subscapularis integrity influence outcome following latissimus dorsi tendon transfer for irreparable cuff tears? A comparative series of 48 patients. J Orthop 2022; 31:129-133. [PMID: 35574214 PMCID: PMC9092063 DOI: 10.1016/j.jor.2022.04.017] [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: 01/05/2022] [Revised: 03/01/2022] [Accepted: 04/27/2022] [Indexed: 11/15/2022] Open
Abstract
Background Latissimus dorsi tendon transfer (LDTT) remains a surgical option for massive irreparable rotator cuff tears. Despite a lack of comparative studies, subscapularis insufficiency has been reported as a contraindication. This study investigated the clinical outcome at a minimum 2-years post-surgery, in patients undergoing LDTT with varied subscapularis integrity. Methods This retrospective study included 48 patients, of which 22 underwent LDTT with an intact subscapularis (age 56.9 years, review time 79.6 months, males 68.2%) and 26 with partial (16 patients) or full-thickness (10 patients) subscapularis tearing (age 57.4 years, review time 73.3 months, males 73.1%) between 2004 and 2018. Pre-operative imaging ascertained subscapularis status. Outcomes included the Upper Extremity Functional Index (UEFI), Global Rating of Change (GRC) and patient satisfaction. Results No significant group differences were observed in age (p = 0.617) or review time (p = 0.555), nor the UEFI (intact 69.6, not intact 67.0, p = 0.265) or GRC (intact 3.6, not intact 2.9, p = 0.265). High levels of patient satisfaction were observed in both groups for pain relief, improving the ability to undertake daily and recreational activities, and overall satisfaction (intact 95.5-100.0%, not intact 92.3-96.2%). Conclusion LDTT resulted in encouraging clinical scores and high satisfaction levels, irrespective of the degree of untreated, underlying subscapularis integrity. Level of evidence Therapeutic Level III.
Collapse
Affiliation(s)
- James G. Cunningham
- Sir Charles Gairdner Hospital, North Metropolitan Health Service (WA Health), Nedlands, Perth, Western Australia, 6009, Australia
| | - Jay R. Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Crawley, Perth, Western Australia, 6009, Australia
- Corresponding author. The School Human Sciences (M408), The University of Western Australia, 35 Stirling Highway, Crawley, 6009, Western Australia, Australia.
| | - Peter Campbell
- Western Orthopaedic Clinic, St John of God Hospital, Subiaco, Perth, Western Australia, 6008, Australia
| | - Travis Falconer
- Perth Orthopaedic & Sports Medicine Centre, West Perth, Perth, Western Australia, 6005, Australia
| |
Collapse
|
20
|
Thangarajah T, Tsuchiya S, Lukenchuk J, Lo IK. Arthroscopic Revision Rotator Cuff Repair of Large and Massive Retears using an Interpositional Bridging Dermal Allograft. JSES Int 2022; 6:643-648. [PMID: 35813153 PMCID: PMC9264011 DOI: 10.1016/j.jseint.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
21
|
Thangarajah T, Lo IKY. Management of the failed rotator cuff repair. Br J Hosp Med (Lond) 2022; 83:1-10. [DOI: 10.12968/hmed.2021.0446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Rotator cuff repair is increasingly being performed, and this is likely to continue to given the ageing population. An improvement in functional outcome can be achieved, with the best results noted in those tendons that go on to heal. Failure of repair following surgery can be associated with debilitating symptoms that are not always amenable to non-operative measures, so further surgery may be indicated for these patients. Several operative strategies have been described, but careful evaluation is required to determine the most suitable option. This review describes the decision-making strategies and treatment options available during management of a failed rotator cuff repair.
Collapse
Affiliation(s)
- Tanujan Thangarajah
- Department of Trauma and Orthopaedic Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Ian KY Lo
- Department of Trauma and Orthopaedic Surgery, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
22
|
Shah NS, Suriel Peguero E, Umeda Y, Crawford ZT, Grawe BM. Long-Term Outcomes of Massive Rotator Cuff Tear Repair: A Systematic Review. HSS J 2022; 18:130-137. [PMID: 35087343 PMCID: PMC8753535 DOI: 10.1177/15563316211008137] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND With an increase in the treatment options available for massive rotator cuff tears, understanding the long-term outcomes of the chosen modality is important. QUESTIONS/PURPOSE The purpose of this study was to systematically review the available literature on repair of massive rotator cuff repairs and learn the longevity of outcomes, the failure rate, outcomes after failure, and any contributing factors to poor outcomes or failure. METHODS We conducted a systematic review of the MEDLINE, Cochrane, and Embase databases to find studies that investigated the long-term results of repair of massive rotator cuff repairs. Studies were excluded if they did not stratify results of massive tears, provide a definition for a massive rotator cuff tear, or report isolate patients with long-term follow-up. RESULTS Six studies met the inclusion criteria, for a total of 472 shoulders; average patient age was 57.6 years. Follow-up ranged from 119 to 240 months. Outcome scores improved significantly following repair and were maintained throughout follow-up. The repair failure rate across studies was 39.2%. Patients who suffered retear had significantly worse outcome scores than patients with intact tendons at long-term follow-up. CONCLUSIONS The existing literature on long-term follow-up after massive rotator cuff repair is scarce and not of high level of evidence. This review found repair of massive rotator cuff tears leads to long-term maintained improvements in outcome measures. Failure of repair is quite common, but results following failure are superior to preoperative outcomes.
Collapse
Affiliation(s)
- Nihar S. Shah
- Department of Orthopaedics & Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA,Nihar S. Shah, MD, Department of Orthopaedics & Sports Medicine, University of Cincinnati Medical Center, 231 Albert Sabin Way, Cincinnati, OH 45267-0212, USA.
| | | | - Yuta Umeda
- Department of Orthopaedics & Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Zachary T. Crawford
- Department of Orthopaedics & Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Brian M Grawe
- Department of Orthopaedics & Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| |
Collapse
|
23
|
Péan F, Favre P, Goksel O. Computational analysis of subscapularis tears and pectoralis major transfers on muscular activity. Clin Biomech (Bristol, Avon) 2022; 92:105541. [PMID: 34999390 DOI: 10.1016/j.clinbiomech.2021.105541] [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: 04/16/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pectoralis major is the most common muscle transfer procedure to restore joint function after subscapularis tears. Limited information is available on how the neuromuscular system adjusts to the new configuration, which could explain the mixed outcomes of the procedure. The purpose of this study is to assess how muscles activation patterns change after pectoralis major transfers and report their biomechanical implications. METHODS We compare how muscle activation change with subscapularis tears and after its treatment by pectoralis major transfers of the clavicular, sternal, or both these segments, during three activities of daily living and a computational musculoskeletal model of the shoulder. FINDINGS Our results indicate that subscapularis tears require a compensatory activation of the supraspinatus and is accompanied by a reduced co-contraction of the infraspinatus, both of which can be partially recovered after transfer. Furthermore, although the pectoralis major acts asynchronously to the subscapularis before the transfer, its activation pattern changes significantly after the transfer. INTERPRETATION The capability of a transferred muscle segment to activate similarly to the intact subscapularis is found to be dependent on the given motion. Differences in the activation patterns between intact subscapularis and the segments of pectoralis major may explain the difficulty in adapting psycho-motor patterns during the rehabilitation period. Thereby, rehabilitation programs could benefit from targeted training on specific motion and biofeedback programs. Finally, the condition of the anterior deltoid should be considered to improve joint function.
Collapse
Affiliation(s)
- Fabien Péan
- Computer-assisted Applications in Medicine, ETH Zurich, Switzerland
| | | | - Orcun Goksel
- Computer-assisted Applications in Medicine, ETH Zurich, Switzerland; Department of Information Technology, Uppsala University, Sweden.
| |
Collapse
|
24
|
MacDonell RT, Wright L, King JJ. Anterior capsular reconstruction for recurrent anterior shoulder instability: a case report using dermal allograft. JSES REVIEWS, REPORTS, AND TECHNIQUES 2022; 2:52-55. [PMID: 37588287 PMCID: PMC10426538 DOI: 10.1016/j.xrrt.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Robert T. MacDonell
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Logan Wright
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Joseph J. King
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL, USA
| |
Collapse
|
25
|
Lafosse L, Protais M, Moody MC, Colas M, Puah KL, Lafosse T. Live Surgery: A retrospective study on the outcomes and complications of 7 orthopedic live surgery events. Orthop Traumatol Surg Res 2021; 107:102871. [PMID: 33639289 DOI: 10.1016/j.otsr.2021.102871] [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: 06/13/2020] [Revised: 09/12/2020] [Accepted: 09/24/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Live surgery has always been an invaluable part of medical education. Live Surgery Events (LSE) have recently been criticized in France, arguing that unnecessary risks have been placed on the patients. HYPOTHESIS We want to report our experience in organizing the last 7 shoulder LSE over the past 12 years focusing on the results and complications during and after the surgeries performed during these courses. MATERIAL AND METHODS 190 patients benefited from live shoulder surgery between 2005 and 2017. 11 of them were lost to follow up, thus 179 patients were included. The mean follow-up was 7,5 years for the instability group, 6,7 years for the rotator cuff group, 7,5 years for the arthroplasty group and 6,8 years for the nerve group. This study is a retrospective analysis of prospectively collected data. We report the epidemiology of the surgeries perfomed and analyzed the patient outcomes: peri and postoperative complications. We evaluated the educational benefit for the attendees of this shoulder LSE through a questionnaire. RESULTS There were 6 (3.1%) peri or immediate postoperative complications. There were 33 (18%) long term complications needing 26 (14%) revisions. 90% of the surgeons audience attending the events evaluated the educational benefit from good to very good. DISCUSSION Over the years, we have standardized the organization of the meeting to ensure maximum safety, while still respecting patient integrity and anonymity. Our complications rates seem within the ranges found in the current literature for each procedure. Our LSE has been an instrument for education, but also for matching patients with complex problems with experienced surgeons, to the benefit of the patient. Our experience has shown that LSE may induce potential dangers and complications can arise. However, these events should follow rigorous rules and not just recommendations. LEVEL OF EVIDENCE IV; retrospective analysis of prospectively collected data.
Collapse
Affiliation(s)
- Laurent Lafosse
- Alps surgery institute: hand, upper limb, brachial plexus, and microsurgery unit (PBMA), clinique générale d'Annecy, 4, chemin de la Tour la Reine, 74000 Annecy, France
| | - Marie Protais
- Department of orthopedics and traumatology-service of hand and upper limb, Saint Antoine hospital, Assistance Publique-hôpitaux de Paris (AP-HP), 184, rue du faubourg Saint Antoine, 75012, Paris, France.
| | - M Christian Moody
- Department of Hand, upper extremity and microsurgery, Prisma Health System, Greenville, SC, USA
| | - Manon Colas
- Department of Orthopedics and Traumatology-Service of Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP), Assistance Publique-Hôpitaux de Paris (APHP), 20, rue Leblanc, 75015 Paris, France
| | - Ken Lee Puah
- Department of Orthopaedic Surgery, Singapore General Hospital, 20, College Road, Academia, Level 4 169856, Singapore
| | - Thibault Lafosse
- Alps surgery institute: hand, upper limb, brachial plexus, and microsurgery unit (PBMA), clinique générale d'Annecy, 4, chemin de la Tour la Reine, 74000 Annecy, France; Department of Orthopedics and Traumatology-Service of Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP), Assistance Publique-Hôpitaux de Paris (APHP), 20, rue Leblanc, 75015 Paris, France
| |
Collapse
|
26
|
LaBelle MW, Mengers S, Strony J, Peck M, Flannery R, Cupp S, Salata MJ, Parsons EM, Gillespie RJ. Evaluating the role of graft integrity on outcomes: clinical and imaging results following superior capsular reconstruction. J Shoulder Elbow Surg 2021; 30:2041-2047. [PMID: 33545335 DOI: 10.1016/j.jse.2020.12.016] [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: 06/09/2020] [Revised: 12/01/2020] [Accepted: 12/17/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Superior capsular reconstruction (SCR) addresses massive, irreparable rotator cuff tears in young patients. The purpose of this study was to retrospectively evaluate clinical outcomes and graft integrity in patients following SCR. METHODS Thirty-four consecutive patients undergoing SCR by 2 surgeons with minimum 2-year follow-up were identified. Functional outcomes were obtained, including Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), visual analog scale (VAS), and Single Assessment Numeric Evaluation (SANE) scores. Graft integrity was evaluated on magnetic resonance images (MRIs). RESULTS Thirty-five shoulders in 34 patients were identified. Four patients underwent subsequent surgery. The mean preoperative scores were SST 21.6 ± 17.6, ASES 28.3 ± 10.1, SANE 50.6 ± 22.1, and VAS 6.6 ± 1.7. The mean postoperative outcomes were SST 79.1 ± 19.6, ASES 79.9 ± 17.4, SANE 74.3 ± 18.7, and VAS 1.5 ± 2.2. There was statistically significant improvement in SST, ASES, and VAS following SCR. MRI revealed graft failure in 62% (n = 13 of 21) of shoulders. Radiographic evidence of graft healing did not have any effect on SST, ASES, SANE, or VAS scores. CONCLUSION Given the high rate of graft failure without a significant difference in clinical outcomes, graft healing after SCR might not be an independent predictor of success. The improved clinical improvement in patients undergoing SCR may be due to other known beneficial aspects of the procedure, including partial rotator cuff repair, débridement, and biceps management.
Collapse
Affiliation(s)
- Mark W LaBelle
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Orthopaedic Surgery, University Hospitals Sports Medicine Institute, Cleveland, OH, USA
| | - Sunita Mengers
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Orthopaedic Surgery, University Hospitals Sports Medicine Institute, Cleveland, OH, USA.
| | - John Strony
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Orthopaedic Surgery, University Hospitals Sports Medicine Institute, Cleveland, OH, USA
| | - Matthew Peck
- Case Western Reserve University Medical School, Cleveland, OH, USA
| | - Robert Flannery
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Orthopaedic Surgery, University Hospitals Sports Medicine Institute, Cleveland, OH, USA
| | - Sean Cupp
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Orthopaedic Surgery, University Hospitals Sports Medicine Institute, Cleveland, OH, USA
| | - Michael J Salata
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Orthopaedic Surgery, University Hospitals Sports Medicine Institute, Cleveland, OH, USA
| | | | - Robert J Gillespie
- Department of Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Department of Orthopaedic Surgery, University Hospitals Sports Medicine Institute, Cleveland, OH, USA
| |
Collapse
|
27
|
Cartaya M, Canales P, Werthel JD, Hovsepian JM, Valenti P. Feasibility of lower trapezius and rhomboid minor transfer for irreparable subscapularis tears: an anatomic cadaveric study. JSES Int 2021; 5:447-453. [PMID: 34136852 PMCID: PMC8178634 DOI: 10.1016/j.jseint.2021.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Previously reported outcomes after tendon transfers to reconstruct the subscapularis are unpredictable and often unsatisfactory, especially in the presence of anterior humeral head subluxation. We studied the anatomic feasibility of the lower trapezius and the rhomboid minor transfer to reconstruct irreparable tendon tears of the subscapularis. The aim of this study was to determine the feasibility of lower trapezius and rhomboid minor transfer to reconstruct irreparable subscapularis tendon tears. Materials and methods We measured the tendons dimensions, muscles excursions, distances to pedicles, and dissection needed to complete a successful lower trapezius and/or rhomboid minor transfer to the subscapularis footprint in 10 cadaveric shoulders. The transferred muscles were detached distally, augmented with a semitendinosus and gracilis autograft, and passed anteriorly between the scapula and the subscapularis remnant through a small serratus window to reach the lesser tuberosity. The risk of pedicle compression was subjectively assessed in all cases. Results The trapezius and rhomboid tendons were asymmetric with an average length of 37.6 mm and 21.7 mm, an average width of 63 mm and 33.4 mm, respectively. The mean distances from each distal insertion to the lesser tuberosity were 109 mm for the trapezius and 144 mm for the rhomboid. Mean distances from tendon to pedicle were 57.9 mm and 33.1 mm, respectively. The mean size of the necessary serratus window was 49.4 mm, which was measured at maximal excursion achieved at maximal external rotation 90° representing two digitations. All of the tendon transfers were feasible, and the risk of pedicle compression was 20% for the trapezius and 10% for the rhomboid. Superior migration of the transfer was observed during passive external rotation if the insertion point was too high. Conclusions Transfer of the lower trapezius and rhomboid minor to the lesser tuberosity to reconstruct an irreparable subscapularis tear is feasible without extensive dissection and with a low risk of nerve compression. We recommend not to transfer the rhomboid minor routinely, owing to the risk of tendon luxation after external rotation of the shoulder.
Collapse
Affiliation(s)
| | | | | | - Jean Michel Hovsepian
- Department of Orthopaedic Sports Medicine, Chirurgisches Klinikum München Süd, Munich, Germany
| | | |
Collapse
|
28
|
Reinares F, Calvo A, Bernal N, Lizama P, Valenti P, Toro F. Arthroscopic-assisted latissimus dorsi transfer for irreparable posterosuperior cuff tears: Clinical outcome of 15 patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:667-674. [PMID: 34081197 DOI: 10.1007/s00590-021-03025-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 04/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We analyzed the clinical and functional results of patients with irreparable posterosuperior rotator cuff tears treated with arthroscopic-assisted latissimus dorsi transfer and the clinical relevance of the addition of partial repair of the remaining cuff to the transfer. METHODS This was a prospective cohort study that included patients diagnosed with irreparable massive rotator cuff tears treated by arthroscopic-assisted latissimus dorsi transfer between 2015 and 2018. Demographic characteristics, clinical and functional outcomes (Constant-Murley (CS) score and subjective shoulder value (SSV)), and the incidence of complications were evaluated. Clinical outcomes were compared between patients treated with transfer alone and transfer with partial cuff repair. RESULTS Fifteen patients were included, with an average follow-up of 37 ± 16 months. The median duration of symptoms before surgery was 66 weeks (24-208). A significant increase in forward elevation of 52° (p < 0.003) and abduction of 48° (p < 0.001) was obtained. The CS score increased by 48 points (p < 0.001), and the SSV changed from 29% preoperatively to 70% postoperatively (p < 0.001), with a significant decrease in the visual analog pain score from 7 to 1 (p < 0.001). In 10 patients, partial repair of the rotator cuff was also performed. No statistically significant differences were found in these patients compared with patients treated with transfer alone. Two patients presented complications, including transient sensitive neuropraxia of the axillary nerve and seroma, which were managed conservatively and did not affect the outcomes. CONCLUSION Arthroscopic-assisted latissimus dorsi transfer is a safe technique that significantly improves clinical and functional outcomes in selected patients. Longer follow-up and comparison with other treatment options are needed to confirm these excellent results in this group of difficult-to-treat patients. LEVEL OF EVIDENCE IV Nil.
Collapse
Affiliation(s)
- Felipe Reinares
- Facultad de Medicina Clínica Alemana Santiago - Universidad del Desarrollo, Santiago, Chile. .,Hospital Clínico Mutual de Seguridad, Santiago, Chile.
| | - Andres Calvo
- Hospital Clínico Mutual de Seguridad, Santiago, Chile
| | - Nazira Bernal
- Facultad de Medicina Clínica Alemana Santiago - Universidad del Desarrollo, Santiago, Chile
| | - Pedro Lizama
- Hospital Clínico Mutual de Seguridad, Santiago, Chile
| | | | - Felipe Toro
- Facultad de Medicina Clínica Alemana Santiago - Universidad del Desarrollo, Santiago, Chile
| |
Collapse
|
29
|
Silberberg JM, Nilo A, Roces-García J. Enhancement of External Rotation after Latissimus Dorsi Tendon Transfer (LDTT): A Cadaveric Study. ACTA ACUST UNITED AC 2021; 57:medicina57040305. [PMID: 33804946 PMCID: PMC8063920 DOI: 10.3390/medicina57040305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/08/2021] [Accepted: 03/21/2021] [Indexed: 11/23/2022]
Abstract
Background and objectives: Massive rotator cuff tears compromise shoulder mobility function and cannot be directly repaired. Latissimus dorsi tendon transfer (LDTT) is a therapeutic alternative suitable for the treatment of rotator cuff tears that helps to restore external shoulder rotation. Cadaver models have been used for studying the effects of LDTT and procedural variations, but, to the best of our knowledge, none of them have been validated. The aim of our study was to validate a novel cadaver model while verifying the effects of LDTT on external rotation. Materials and Methods: Two groups were included in the study: a cadaver group and a control group made up of healthy volunteers, which were used for the validation of the cadaver model. Baseline external rotation measurements were performed with both groups, after which a massive rotator cuff tear was inflicted and repaired with LDTT in the cadaver group. Their postoperative external rotation was evaluated using three different tests. Results: No statistically significant differences were found between the baseline measurements of the two groups, and postoperative external rotation was significantly higher after LDTT in all cases but one. Conclusions: Cadaver models were validated, since they had a similar preoperative external rotation to healthy volunteers. Moreover, they allowed us to demonstrate the effect of LDTT on external shoulder rotation.
Collapse
Affiliation(s)
- José M. Silberberg
- Orthopaedic Surgery and Traumatology Head Department, Sports Medicine Unit, Clínica Universidad de Navarra, 28027 Madrid, Spain
- Correspondence: ; Tel.: +34-985-182-636
| | - Alessandro Nilo
- Orthopaedic Surgery and Traumatology Department, Chief of Upper Limb Unit, Hospital General Regional N1, 97155 Mérida, Mexico;
| | - Jorge Roces-García
- Department of Construction and Manufacturing Engineering, Polytechnic School of Engineering of Gijón, University of Oviedo, Pedro Puig Adam s/n, ED06, 33203 Gijón, Spain;
| |
Collapse
|
30
|
Zheng X, Tang K. [Research progress of treatment for massive rotator cuff tears]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:8-13. [PMID: 33448192 DOI: 10.7507/1002-1892.202004056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To review the research progress of treatment for massive rotator cuff tears. Methods The domestic and foreign literature about the treatment of massive rotator cuff tears was reviewed. The methods and effectiveness were extensively summarized. Results The treatment of massive rotator cuff tears still needs long-term research to promote its continuous improvement. The main goal of treatment is to relieve the symptoms and improve the shoulder joint function. With the development of arthroscopic technique, arthroscopic repair of rotator cuff tears has become a mature surgical protocol. Among these techniques, superior capsule reconstruction and patch augmentation for massive rotator cuff tears acquire more attention in recent years. As for rotator cuff arthropathy, reverse shoulder arthroplasty is considered to be a final choice. Conclusion Surgical treatment is the main choice for massive rotator cuff tears. Patients' age and muscle condition should be taken into consideration to decide the surgical technique.
Collapse
Affiliation(s)
- Xiaolong Zheng
- Department of Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
| | - Kanglai Tang
- Department of Sports Medicine Center, the First Affiliated Hospital of the Army Medical University of Chinese PLA, Chongqing, 400038, P.R.China
| |
Collapse
|
31
|
Hasan SS. Editorial Commentary: Superior Capsular Reconstruction Works Biomechanically but Should Be Used Selectively for Genuinely Irreparable Tears. Arthroscopy 2021; 37:411-414. [PMID: 33384096 DOI: 10.1016/j.arthro.2020.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 02/02/2023]
Abstract
Superior capsular reconstruction (SCR) has undergone extensive biomechanical and clinical study. Systematic review of biomechanical studies has shown that SCR functions to depress the humeral head and improve the glenohumeral register, which provides proof of concept. Clinical studies have shown the short-term effectiveness of SCR, but this is influenced by graft type and thickness, as well as surgical technique. These studies are mostly flawed because follow-up is brief, postoperative imaging is often lacking, and the results may not be generalizable. Multiple systematic reviews pooling the results of these various clinical studies have mostly produced diluted conclusions that are not clinically helpful. To date, there is a dearth of comparative studies to help guide the selection of SCR over other treatment options such as subacromial balloon spacer, partial repair with or without augmentation, tendon transfer, reverse shoulder arthroplasty, or even continued nonoperative care. Additionally, SCR is a salvage operation rather than an expedient alternative to careful mobilization of a rotator cuff tear for primary repair. Ultimately, large-scale, long-term imaging-based comparative clinical studies, rather than additional systematic clinical or biomechanical reviews, must provide the evidence needed to determine the precise indications and optimal technique for SCR.
Collapse
|
32
|
Abstract
Introduction A prerequisite for a satisfying functional result in the treatment of an irreparable rotator cuff rupture is a significant reduction of shoulder pain and better range of motion with an increase in anatomic glenohumeral joint stability. Purpose Prospective study to examine the outcome after superior capsular reconstruction using a porcine extracellular matrix dermal graft. A special emphasis was primarily on the functional outcome, secondarily on radiographic shoulder changes, that superior capsular reconstruction might yield. Methods Clinical results were evaluated using the Constant score and Western Ontario Rotator Cuff (WORC) index over a 2-year period. All patients had magnetic resonance imaging (MRI) of the injured shoulder after 1 year. Graft integration and durability were qualitatively estimated as well as any graft deterioration or resorption. Results Thirteen patients with 13 superior capsular reconstructions were included over a 3-year period. Mean age was 61 years (range 50-70) at the time of surgery. At final follow-up (mean 24 months, range 23-32), the mean Constant score had improved from an average of 24.9-55.7 points. The mean WORC index had increased from a percentage average of 32.3%-61.9%. Eleven of 13 grafts were intact on follow-up MRI. Conclusion Our hypothesis was that successful implantation of a dermal xenograft would correlate with both better functional outcome and stabilized glenohumeral radiographic features. We saw a group of patients with variable but significant increases in functional results and in general with limited pain and with an intact xenograft on an MRI scan. We did not find a positive correlation between functional outcome scores and graft durability nor with single cuff tendon defects vs. larger rotator cuff defects.This study suggests that a superior capsular reconstruction can yield results that are comparable or superior to other known salvage treatment options in patients with large to massive rotator cuff defects without significant cuff tear arthropathy. The hypothesis that superior capsular reconstruction can be a relevant treatment method for irreparable rotator cuff tears could not be refuted despite a fairly low patient inclusion number. With these results, selected patients can be considered for a different treatment than reverse shoulder arthroplasty, débridement, or tendon transfer.
Collapse
Affiliation(s)
- Anton Ulstrup
- Department of Orthopaedic Surgery, Holbæk Hospital, Holbæk, Denmark
| | - Michael Reinhold
- Department of Orthopaedic Surgery, Holbæk Hospital, Holbæk, Denmark
| | - Otto Falster
- Department of Orthopaedic Surgery, Holbæk Hospital, Holbæk, Denmark
| |
Collapse
|
33
|
Bernstein JM, Perez JR, Shah HA, Emerson CP, Sanchez PG, Greditzer HG, Nuño AU, Muñoz J, Baraga MG, Jose J. MRI of Superior Capsular Reconstruction. Radiographics 2020; 40:454-467. [DOI: 10.1148/rg.2020190074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
34
|
Latissimus Dorsi Transposition in Supraspinatus Tendon Retraction (Patte III) and Thomazeau Grade 3 Fatty Degeneration (Clinical Case). ACTA BIOMEDICA SCIENTIFICA 2019. [DOI: 10.29413/abs.2019-4.6.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
35
|
Matsen FA, Whitson A, Jackins SE, Hsu JE. Significant improvement in patient self-assessed comfort and function at six weeks after the smooth and move procedure for shoulders with irreparable rotator cuff tears and retained active elevation. INTERNATIONAL ORTHOPAEDICS 2019; 43:1659-1667. [PMID: 30903255 DOI: 10.1007/s00264-019-04310-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/12/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND It has been documented that the smooth and move procedure-smoothing the proximal humeral surface while maintaining the coracoacromial arch-can provide clinically significant long-term improvement in function for patients having irreparable rotator cuff tears with retained active elevation. This study sought to demonstrate that clinically significant gains in comfort, function, and active motion can be realized as early as 6 weeks after this procedure. METHODS We conducted a prospective cohort study of the 6-week clinical outcomes for 48 patients enrolled prior to a smooth and move procedure for irreparable rotator cuff tears. Prior rotator cuff repair had been attempted in 28 (70%). RESULTS In 40 patients with preoperative and 6-week postoperative measurements, the Simple Shoulder Test scores improved from an average of 3.4 ± 2.8 preoperatively to 5.7 ± 3.5 at 6 weeks (p < 0.001), an improvement that exceeded the published values for the minimal clinically important difference (MCID). The clinical outcomes were not worse for the 18 shoulders with irreparable tears of both the supraspinatus and infraspinatus. In 30 patients with preoperative and 6-week postoperative objective measurements of active motion, the average abduction improved from 93(± 43) to 123(± 47)° (p = 0.005) and the average flexion improved from 102(± 46) to 126(± 44)° (p = 0.023). CONCLUSIONS In addition to its previously documented long-term effectiveness for shoulders with irreparable rotator cuff tears and retained active elevation, this study demonstrates that the smooth and move procedure provides clinically significant improvement as early as 6 weeks after surgery.
Collapse
Affiliation(s)
- Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA.
| | - Anastasia Whitson
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA
| | - Sarah E Jackins
- Department of Rehabilitation, University of Washington, 1959 NE Pacific St., Box 354745, Seattle, WA, 98195, USA
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA
| |
Collapse
|
36
|
Clinical Faceoff: Irreparable Rotator Cuff Tears in Young, Active Patients: Tendon Transfer versus Superior Capsular Reconstruction? Clin Orthop Relat Res 2018; 476:2313-2317. [PMID: 30422964 PMCID: PMC6259883 DOI: 10.1097/corr.0000000000000503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
37
|
de Campos Azevedo CI, Ângelo ACLPG, Vinga S. Arthroscopic Superior Capsular Reconstruction With a Minimally Invasive Harvested Fascia Lata Autograft Produces Good Clinical Results. Orthop J Sports Med 2018; 6:2325967118808242. [PMID: 30505873 PMCID: PMC6259077 DOI: 10.1177/2325967118808242] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Painful dysfunctional shoulders with irreparable rotator cuff tears (IRCTs)
in active patients are a challenge. Arthroscopic superior capsular
reconstruction (ASCR) is a new treatment option originally described using a
fascia lata autograft harvested through an open approach. However, concerns
about donor site morbidity have discouraged surgeons from using this type of
graft. Hypothesis: ASCR using a minimally invasive harvested fascia lata autograft produces good
6-month and 2-year shoulder outcomes in IRCTs, with low-impact thigh
morbidity at 2 years. Study Design: Case series; Level of evidence, 4. Methods: From 2015 to 2016, a total of 22 consecutive patients (mean age, 64.8 ± 8.6
years) with chronic IRCTs (Hamada grade 1-2; Goutallier cumulative grade ≥3;
Patte stage 1: 2 patients; Patte stage 2: 6 patients; Patte stage 3: 14
patients) underwent ASCR using a minimally invasive harvested fascia lata
autograft. All patients completed preoperative and 6-month evaluations
consisting of the Simple Shoulder Test (SST), subjective shoulder value
(SSV), Constant score (CS), range of motion (ROM), acromiohumeral interval
(AHI), and magnetic resonance imaging. Twenty-one patients completed the
2-year shoulder and donor site morbidity assessments. Results: The mean active ROMs improved significantly (P < .001):
elevation, from 74.8° ± 55.5° to 104.5° ± 41.9° (6 months) and 143.8° ±
31.7° (2 years); abduction, from 53.2° ± 43.3° to 86.6° ± 32.9° (6 months)
and 120.7° ± 37.7° (2 years); external rotation, from 13.2° ± 18.4° to 27.0°
± 16.1° (6 months) and 35.6° ± 17.3° (2 years); and internal rotation, from
1.2 ± 1.5 points to 2.6 ± 1.5 points (6 months) and 3.8 ± 1.2 points (2
years). The mean functional shoulder scores improved significantly
(P < .001): SST, from 2.1 ± 2.9 to 6.8 ± 3.5 (6
months) and 8.6 ± 3.5 (2 years); SSV, from 33.0% ± 17.4% to 55.7% ± 25.6% (6
months) and 70.0% ± 23.0% (2 years); CS, from 17.5 ± 13.4 to 42.5 ± 14.9 (6
months) and 64.9 ± 18.0 (2 years). The mean shoulder abduction strength
improved significantly (P < .001) from 0.0 to 1.1 ± 1.4
kg (6 months) and 2.8 ± 2.6 kg (2 years). The mean AHI improved from 6.4 ±
3.3 mm to 8.0 ± 2.5 mm (6 months) and decreased to 7.1 ± 2.5 mm (2 years).
This 0.7 ± 1.5–mm overall decrease was statistically significant
(P = .042). At 6 months, 20 of 22 patients (90.9%) had
no graft tears. At 2 years, 12 of 21 patients (57.1%) were bothered by their
harvested thigh, 16 (76.2%) noticed donor site changes, 16 (76.2%)
considered that the shoulder surgery’s end result compensated for the
thigh’s changes, and 18 (85.7%) would undergo the same surgery again. Conclusion: ASCR using a minimally invasive harvested fascia lata autograft produced good
6-month and 2-year shoulder outcomes in IRCTs, with low-impact thigh
morbidity at 2 years.
Collapse
Affiliation(s)
- Clara Isabel de Campos Azevedo
- Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.,Hospital dos SAMS, Lisbon, Portugal.,Clínica GIGA Saúde, Lisbon, Portugal
| | | | - Susana Vinga
- Instituto de Engenharia de Sistemas e Computadores-Investigação e Desenvolvimento, Lisbon, Portugal.,INESC - ID, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| |
Collapse
|
38
|
Arthroscopic single-row repair of massive potentially irreparable postero-superior cuff tear. Musculoskelet Surg 2018; 102:13-19. [PMID: 30343476 DOI: 10.1007/s12306-018-0555-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE We retrospectively evaluated the results of complete repair of massive potentially irreparable postero-superior tears in a consecutive cohort of patients. With the increasing and widespread use of superior capsular reconstruction, a complete repair of the superior cuff, also if not functional, may be a valuable option for irreparable cuff lesions. METHODS A consecutive case series of massive potentially irreparable postero-superior cuff tears that underwent complete repair was included in the study. Irreparability of cuff tear was defined when on preoperative MRI images, a positive tangent sign, a Goutallier 3-4 stage of fatty infiltration, and an absent acromion-humeral distance were present. A single-row complete repair was performed using triple-loaded titanium suture anchors. Operative time was recorded, as well as intra- and postoperative complications. Patients were followed for 12 months post-op; they were clinically evaluated with the use of constant score (CS) and subjective shoulder value (SSV) at 3, 6, and 12 months; a 12-month postoperative ultrasound evaluation was obtained. RESULTS Thirty-two patients satisfying the inclusion criteria were enrolled. The mean age was 52 years (range 41-58). The repair was completed with a mean use of 2.4 triple-loaded suture anchors (range 2-4); the mean operative time was 70 min (range 45-90). The mean preoperative CS was 55 (range 45-75, SD 17), while the SSV was 40 (range 30-70, SD 22). At the final follow-up, the mean CS and SSV were 72 (range 62-85, SD 8) and 80 (range 60-90, SD 10) (p < 0.001 with respect to the preoperative scores), respectively. At the final follow-up, sonography showed a complete healing of the cuff in 20 cases (62.5%). No intra-operative complications occurred; at the final follow-up, five patients (15, 6%) were not satisfied of the results and asked for revision surgery. CONCLUSIONS The complete repair of massive potentially irreparable rotator cuff tear in patients younger than 60 years old yielded good results at a short-term follow-up, with a sonographic re-tear rate of about 20%. Even if it is logical to consider a tendon with severe fatty degeneration as non-functional, the superior soft tissue reconstruction we achieved may have at least the same results of a superior capsular reconstruction, with obvious lower costs. LEVEL OF EVIDENCE Level 4, case series with no comparison group.
Collapse
|