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Baek G, Kim JG, Baek GR, Hui AT, McGarry MH, Baek CH, Lee TQ. Middle trapezius tendon transfer using Achilles allograft for irreparable isolated supraspinatus tendon tears effectively restores the superior stability of the humeral head without restricting range of motion: a biomechanical study. J Shoulder Elbow Surg 2024; 33:1366-1376. [PMID: 38104718 DOI: 10.1016/j.jse.2023.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/17/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Middle trapezius tendon (MTT) transfer has been suggested for promising treatment of irreparable isolated supraspinatus tendon tears (IISTTs). However, there have been no attempts to assess the biomechanical efficacy of MTT transfer. This study aims to evaluate the biomechanical efficacy of MTT transfer in the setting of IISTTs. METHODS Eight fresh frozen cadaveric shoulders were tested in 3 conditions: (1) intact rotator cuff, (2) IISTT, and (3) MTT transfer using Achilles allograft for IISTTs. Total humeral rotational range of motion (ROM), superior translation of the humeral head, and subacromial contact characteristics were measured at 0°, 20°, and 40° glenohumeral abduction (representing 0°, 30°, and 60° shoulder abduction). Superior translation and subacromial contact pressures were measured at 0°, 30°, 60°, and 90° external rotation (ER). Two different MTT muscle loading conditions were investigated. A linear mixed effects model and Tukey post hoc test were used for statistical analysis. RESULTS Total ROM was significantly increased after IISTT at 20° abduction (P = .037). There were no changes in total ROM following MTT transfer compared to the IISTT condition (P > .625 for all comparisons). The IISTT condition significantly increased superior translation compared to the intact rotator cuff condition in 0° and 20° abduction with all ER angles (P < .001), 40° abduction-30° ER (P = .016), and 40° abduction-60° ER (P = .002). MTT transfer significantly decreased superior translation of the humeral head at all abduction angles compared to the IISTT condition (P < .026). MTT transfer significantly decreased peak contact pressure by 638.7 kPa (normal loading) and 726.8 kPa (double loading) at 0° abduction-30° ER compared to the IISTT condition (P < .001). Mean contact pressure was decreased by 102.8 kPa (normal loading) and 118.0 kPa (double loading) at 0° abduction-30° ER (P < .001) and 101.0 kPa (normal loading) and 99.2 kPa (double loading) at 0° abduction-60° ER (P < .001). MTT transfer at 20° abduction-30° ER with 24 N loading significantly decreased contact pressure by 91.2 kPa (P = .035). CONCLUSIONS The MTT transfer biomechanically restored the superior humeral head translation and reduced the subacromial contact pressure in a cadaveric model of IISTT, while not restricting total ROM. These findings suggest that MTT transfer may have potential as a surgical treatment for IISTTs.
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Affiliation(s)
- Gyuna Baek
- Orthopedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Jung Gon Kim
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu-si, Jeollanam-do, Republic of Korea
| | - Gyu Rim Baek
- Orthopedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Aaron T Hui
- Orthopedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Michelle H McGarry
- Orthopedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Chang Hee Baek
- Department of Orthopaedic Surgery, Yeosu Baek Hospital, Yeosu-si, Jeollanam-do, Republic of Korea
| | - Thay Q Lee
- Orthopedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA.
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Shah SS, Kontaxis A, Jahandar A, Bachner E, Gulotta LV, Dines DM, Warren RF, Dines JS, Taylor SA. Superior capsule reconstruction using a single 6-mm-thick acellular dermal allograft for massive rotator cuff tears: a biomechanical cadaveric comparison to fascia lata allograft. J Shoulder Elbow Surg 2021; 30:2166-2176. [PMID: 33418091 DOI: 10.1016/j.jse.2020.11.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/08/2020] [Accepted: 11/16/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Success of superior capsule reconstruction (SCR) using both fascia lata (FL) and human acellular dermal (ACD) allografts have been reported. One possible explanation for a discrepancy in outcomes may be attributed to graft thickness. SCR with commercially available 3-mm-thick ACD allograft is not biomechanically equivalent to FL. Our hypothesis was that SCR with a single 6-mm-thick ACD allograft will restore the subacromial space distance (SubDist) and peak subacromial contact pressures (PSCPs) to intact shoulder and will be comparable to SCR with an 8-mm FL allograft. METHODS Eight cadaveric shoulders were tested in 4 conditions: intact, irreparable supraspinatus tear (SST), SCR FL allograft (8-mm-thick), and SCR single ACD allograft (6-mm-thick). SubDist and PSCP were measured at 0°, 30°, and 60° of glenohumeral abduction in the scapular plane. Parameters were compared using a repeated measures analysis of variance with Tukey post hoc test, and graft dimensions were compared using a Student t test. RESULTS SST had decreased SubDist (P < .05) and increased PSCP (P < .05) compared with the intact state. At all angles, the SCR ACD allograft demonstrated increased SubDist compared with the tear condition (P < .001), with no difference between grafts. Furthermore, there was decreased PSCP after both ACD and FL SCR compared with the intact condition, with no difference between grafts at 0° (P = .006, P = .028) and 60° abduction (P = .026, P = .013). Both ACD and FL grafts elongated during testing. CONCLUSIONS Our results suggest SCR with a single 6-mm-thick ACD allograft is noninferior to FL regarding SubDist and PSCP while completely restoring the superior stability of the glenohumeral joint compared with the intact state.
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Affiliation(s)
| | | | | | - Emily Bachner
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Vredenburgh ZD, Prodromo JP, Tibone JE, Dunphy TR, Weber J, McGarry MH, Chae S, Adamson GJ, Lee TQ. Biomechanics of tensor fascia lata allograft for superior capsular reconstruction. J Shoulder Elbow Surg 2021; 30:178-187. [PMID: 32778385 DOI: 10.1016/j.jse.2020.04.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/06/2020] [Accepted: 04/12/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND We hypothesized that in a cadaveric massive rotator cuff tear (MCT) model, a fascia lata (FL) allograft superior capsular reconstruction (SCR) would restore subacromial contact pressure and humeral head superior translation without limiting range of motion (ROM). Therefore, the objective of this study was to compare these parameters between an intact rotator cuff, MCT, and allograft FL SCR. METHODS Eight fresh cadavers were studied using a custom shoulder testing system. ROM, superior translation, and subacromial contact pressure were measured in each of 3 states: (1) intact rotator cuff, (2) MCT, and (3) MCT with SCR. RESULTS Total ROM was increased in the MCT state at 60° of abduction (P = .037). FL SCR did not restrict internal or external rotational ROM. Increased superior translation was observed in the MCT state at 0° and 30° of humeral abduction, with no significant difference between the intact cuff and FL SCR states. The MCT state significantly increased mean subacromial contact pressure at 0° of abduction with 30° and 60° of external rotation, and FL SCR restored this to intact levels. Peak subacromial contact pressure was increased for the MCT state at 0° of abduction with 30° and 60° of external rotation, as well as 30° of abduction with 30° of external rotation. CONCLUSION This study demonstrates a tensor FL allograft preparation technique for use in SCR. After MCT, FL SCR restores ROM, superior translation, and subacromial contact pressure to the intact state.
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Affiliation(s)
- Zachary D Vredenburgh
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | | | - James E Tibone
- Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | | | - Joel Weber
- Evergreen Health Orthopedics & Sports Care, Kirkland, WA, USA
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Seungbum Chae
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA; Department of Orthopaedic Surgery, Daegu Catholic University Hospital School of Medicine, Daegu, Republic of Korea
| | - Gregory J Adamson
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA.
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Omid R, Stone MA, Lin CC, Patel NA, Itami Y, McGarry MH, Lee TQ. Biomechanical analysis of latissimus dorsi tendon transfer with and without superior capsule reconstruction using dermal allograft. J Shoulder Elbow Surg 2019; 28:1523-1530. [PMID: 31029520 DOI: 10.1016/j.jse.2019.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 01/22/2019] [Accepted: 01/27/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Irreparable rotator cuff tears (ICTs) remain a challenging treatment dilemma. Superior capsule reconstruction (SCR) acts as a static stabilizer to decrease superior humeral head migration. Latissimus dorsi tendon transfers (LDTs) dynamically decrease superior humeral head migration and improve external rotation. We hypothesized that the dynamic stabilizing effect of the latissimus transfer plus the static stabilizing effect of SCR would improve shoulder kinematics in shoulders with ICTs. MATERIALS AND METHODS Eight fresh-frozen cadaveric shoulders were tested in 5 conditions: (1) intact, (2) ICT (supraspinatus plus anterior half of infraspinatus), (3) SCR with dermal allograft, (4) SCR plus LDT, and (5) LDT alone. Rotational range of motion, superior translation, anteroposterior translation, and peak subacromial contact pressure were measured at 0°, 30°, and 60° of glenohumeral abduction in the scapular plane. Statistical analysis was performed using a repeated-measures analysis of variance test, followed by a Tukey post hoc test for pair-wise comparisons. RESULTS ICTs increased total shoulder rotation, superior translation, posterior translation, and peak subacromial contact pressure. SCR plus LDT significantly decreased internal rotation only at 60° of abduction. The effect of SCR plus LDT was most evident at lower levels of abduction. At the mid range of abduction (30°), the static stabilizing effect diminished but the dynamic stabilizing effect remained, allowing SCR plus LDT to reduce superior translation more effectively than SCR with dermal allograft alone. CONCLUSIONS Adding SCR to LDT adds static stabilization to a dynamic stabilizer. Therefore, SCR plus LDT may provide additional stability at the low to mid ranges of abduction.
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Affiliation(s)
- Reza Omid
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael A Stone
- Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Charles C Lin
- University of California Irvine, School of Medicine, Irvine, CA, USA; Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Nilay A Patel
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA; Department of Orthopaedic Surgery, University of California, Irvine, Orange, CA, USA
| | - Yasuo Itami
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA; Department of Orthopaedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
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Mihata T, Bui CNH, Akeda M, Cavagnaro MA, Kuenzler M, Peterson AB, McGarry MH, Itami Y, Limpisvasti O, Neo M, Lee TQ. A biomechanical cadaveric study comparing superior capsule reconstruction using fascia lata allograft with human dermal allograft for irreparable rotator cuff tear. J Shoulder Elbow Surg 2017; 26:2158-2166. [PMID: 29146012 DOI: 10.1016/j.jse.2017.07.019] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 07/10/2017] [Accepted: 07/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Biomechanical and clinical success of the superior capsule reconstruction (SCR) using fascia lata (FL) grafts has been reported. In the United States, human dermal (HD) allograft has been used successfully for SCRs; however, the biomechanical characteristics have not been reported. METHODS Eight cadaveric shoulders were tested in 5 conditions: (1) intact; (2) irreparable supraspinatus tear; (3) SCR using FL allograft with anterior and posterior suturing; (4) SCR using HD allograft with anterior and posterior suturing; and (5) SCR using HD allograft with posterior suturing. Rotational range of motion, superior translation, glenohumeral joint force, and subacromial contact were measured at 0°, 30°, and 60° of glenohumeral abduction in the scapular plane. Graft dimensions before and after testing were also recorded. Biomechanical parameters were compared using a repeated-measures analysis of variance with Tukey post hoc test, and graft dimensions were compared using a Student t-test (P < .05). RESULTS Irreparable supraspinatus tear significantly increased superior translation, superior glenohumeral joint force, and subacromial contact pressure, which were completely restored with the SCR FL allografts. Both SCR HD allograft repairs partially restored superior translation and completely restored subacromial contact and superior glenohumeral joint force. The HD allografts significantly elongated by 15% during testing, whereas the FL allograft lengths were unchanged. CONCLUSIONS Single-layered HD SCR allografts partially restored superior glenohumeral stability, whereas FL allograft SCR completely restored the superior glenohumeral stability. This may be due to the greater flexibility of the HD allograft, and the SCR procedure used was developed on the basis of FL grafts.
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Affiliation(s)
- Teruhisa Mihata
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA; Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Christopher N H Bui
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA; Department of Orthopaedic Surgery, University of California, Irvine, CA, USA
| | - Masaki Akeda
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | | | - Michael Kuenzler
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Alexander B Peterson
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA
| | - Yasuo Itami
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA; Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | | | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center, Long Beach, CA, USA; Department of Orthopaedic Surgery, University of California, Irvine, CA, USA.
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