Feasibility of lower trapezius transfer extended by the infraspinatus fascia for restoration of external rotation in irreparable posterosuperior rotator cuff tears: an anatomical study

Abstract Background Irreparable rotator cuff tears are common and difficult to treat. Techniques for “filling the loss of substance” require fixation to the rotator cuff stump (tendon augmentation) or to the glenoid (superior capsular reconstruction), which are complicated by the narrow working zone of the subacromial space. The main objective of this study was to determine whether a braided graft of gracilis (GR) and semitendinosus (ST) could fill a loss of tendon substance from an irreparable rupture of the supra- and infraspinatus, by fixing the graft to the greater tuberosity and the spine of the scapula. Methods This was a cadaveric study with the use of ten specimens. The GRA and ST tendons were harvested, braided and reinforced with suture. An experimental tear of the supraspinatus (SS) and upper infraspinatus (IS) retracted at the glenoid was made. The GRAST transplant was positioned over the tear. The transplant was attached to the greater tuberosity by two anchors and then attached to the medial third of the scapular spine by trans-osseous stitching. The percentage of filling obtained was then measured and passive mobility of the shoulder was assessed. We proceeded to the same technique under arthroscopy for a 73 years old patient whom we treated for a painful shoulder with irreparable cuff tear. We inserted a GRAST graft using arthroscopy. Results The Braided-GRAST allowed a 100% filling of the loss of tendon substance. Mobility was complete in all cases. Conclusion This technique simplifies the medial fixation and restores the musculo-tendinous chain where current grafting techniques only fill a tendinous defect. The transplant could have a subacromial “spacer” effect and lower the humeral head. The donor site morbidity and the fate of the transplant in-vivo are two limits to be discussed. This anatomical study paves the way for clinical experimentation.

Download Full-text

Evaluating the Outcomes of Rotator Cuff Repairs With Polytetrafluoroethylene Patches for Massive and Irreparable Rotator Cuff Tears With a Minimum 2-Year Follow-up

The American Journal of Sports Medicine ◽

10.1177/0363546518801014 ◽

2018 ◽

Vol 46 (13) ◽

pp. 3155-3164 ◽

Cited By ~ 9

Author(s):

Vasanth Seker ◽

Lisa Hackett ◽

Patrick H. Lam ◽

George A.C. Murrell

Keyword(s):

Rotator Cuff ◽

Range Of Motion ◽

External Rotation ◽

Case Series ◽

Shoulder Function ◽

Rotator Cuff Tears ◽

Level Of Evidence ◽

Irreparable Tear ◽

Pain At Rest

Background: Massive and irreparable rotator cuff tears are difficult to manage surgically. One technique is to use a synthetic polytetrafluoroethylene (PTFE) patch to bridge the tear. However, there is little information regarding the outcomes of this procedure. Purpose: To determine the ≥2-year outcomes of patients for whom synthetic patches were used as tendon substitutes to bridge irreparable rotator cuff defects. Study Design: Case series; Level of evidence, 4. Methods: This retrospective cohort study used prospectively collected data. Patients included those with a synthetic patch inserted as an interposition graft for large and/or irreparable rotator cuff tears with a minimum 2-year follow-up. Standardized assessment of shoulder pain, function, range of motion, and strength was performed preoperatively, at 6 and 12 weeks, and at 6 months and ≥2 years. Radiograph and ultrasound were performed preoperatively, at 6 months, and ≥2 years. Results: At a mean of 36 months, 58 of 68 eligible patients were followed up, and 53 of 58 (90%) patches remained in situ. Three patches failed at the patch-tendon interface, while 1 patient (2 shoulders/patches) went on to have reverse total shoulder replacements. Patient-ranked shoulder stiffness ( P < .001), frequency of pain with activity and sleep ( P < .0001), level of pain at rest and overhead ( P < .0001), and overall shoulder function improved from bad to very good ( P < .0001) by 6 months. Supraspinatus (mean ± SEM: 29 ± 16 N to 42 ± 13 N) and external rotation (39 ± 13 N to 59 ± 15 N) strength were the most notable increases at the ≥2-year follow-up ( P < .0001). Passive range of motion also improved by 49% to 67%; forward flexion, from 131° to 171°; abduction, from 117° to 161°; external rotation, from 38° to 55°; and internal rotation, from L3 to T10 ( P < .0001) preoperatively to ≥2 years. The most improvement in passive range of motion occurred between 12 months and ≥2 years. The mean (SD) Constant-Murley score was 90 (12), while the American Shoulder and Elbow Surgeons score was 95 (8). Conclusion: At 36 months postoperatively, patients who had synthetic patches used as tendon substitutes to bridge irreparable rotator cuff defects reported less pain and greater overall shoulder function as compared with preoperative assessments. They demonstrated improved range of passive motion and improved strength. The data support the hypothesis that the technique of using a synthetic PTFE patch to bridge a large and/or irreparable tear has good construct integrity and improves patient and clinical outcomes.

Download Full-text

Retraction notice to “Abduction external rotation position in magnetic resonance arthrography for the diagnosis of rotator cuff tears” [J Orthop Sci 21 (2016) 446–451]

Journal of Orthopaedic Science ◽

10.1016/j.jos.2017.06.001 ◽

2017 ◽

Vol 22 (4) ◽

pp. 806

Author(s):

Wenjun Qiu ◽

Xianzhong Tang ◽

Yifan Li ◽

Yunhan Ji ◽

Wei Xu

Keyword(s):

Magnetic Resonance ◽

Rotator Cuff ◽

External Rotation ◽

Magnetic Resonance Arthrography ◽

Rotator Cuff Tears ◽

Retraction Notice

Download Full-text

Outcome of arthroscopically assisted lower trapezius transfer to reconstruct massive irreparable posterior-superior rotator cuff tears

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2020.02.018 ◽

2020 ◽

Vol 29 (10) ◽

pp. 2135-2142 ◽

Cited By ~ 1

Author(s):

Bassem T. Elhassan ◽

Joaquin Sanchez-Sotelo ◽

Eric R. Wagner

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tears ◽

Arthroscopically Assisted ◽

Lower Trapezius

Download Full-text

Does the latissimus dorsi tendon transfer for massive rotator cuff tears remain active postoperatively and restore active external rotation?

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2013.07.055 ◽

2014 ◽

Vol 23 (4) ◽

pp. 553-560 ◽

Cited By ~ 37

Author(s):

Jan Ferdinand Henseler ◽

Jochem Nagels ◽

Rob G.H.H. Nelissen ◽

Jurriaan H. de Groot

Keyword(s):

Rotator Cuff ◽

Latissimus Dorsi ◽

Tendon Transfer ◽

External Rotation ◽

Rotator Cuff Tears ◽

Massive Rotator Cuff Tears

Download Full-text

Muscle Activity of the Latissimus Dorsi after Tendon Transfer in Patients with Rotator Cuff Tears

Journal of Clinical Medicine ◽

10.3390/jcm9020433 ◽

2020 ◽

Vol 9 (2) ◽

pp. 433 ◽

Cited By ~ 1

Author(s):

Pit Hetto ◽

David Spranz ◽

Felix Zeifang ◽

Sebastian I. Wolf ◽

Stefan van Drongelen ◽

...

Keyword(s):

Rotator Cuff ◽

Latissimus Dorsi ◽

Tendon Transfer ◽

Daily Life ◽

External Rotation ◽

Rotator Cuff Tears ◽

Emg Activity ◽

Measurement Protocol ◽

Partial Activity ◽

Perineal Care

Background: Massive irreparable posterosuperior rotator cuff tears may result in the loss of external rotation. Most of the patients with posterosuperior rotator cuff tears suffer from a restriction in their daily life actions. Latissimus dorsi tendon transfer (LDTT) is a method to restore abduction and external rotation in these patients. However, the behavior of the LD after the transfer is not clear yet. Few studies have analyzed the activity of the LD after transfer. The goal of this study was to examine the function of the LD postoperatively in follow-up examinations during activities of daily life (ADLs) and during different movements evaluated by measuring the range of motion (ROM). Methods: We examined 12 patients 4.3 years (1–9 years) after LDTT, using simultaneous 3D motion analysis and surface Electromyography (sEMG) of 12 muscle parts; the opposite, nonaffected side was assessed as a control. The measurement protocol included two standardized movements (exorotation with an adducted arm and exorotation with 90° abduction) as well as two ADLs (combing hair and perineal care). Results: An average of 4.3 years (1–9 years) after LDTT, 9 of the 12 subjects showed EMG activity in the transferred LD during glenohumeral external rotation. During the endorotation phase, either little activity was registered or only the pectoralis major was active. During the ADLs, 6 out of 12 subjects showed EMG activity in the transferred LD while “combing hair”, whereas all subjects showed EMG activity during perineal care. Conclusion: The LD showed partial activity in its new role as an exorotator, but no clear difference was observed between some of the movements as well as in comparison with the healthy shoulder. Further studies will need to be conducted to better differentiate voluntary contractions and co-contractions as well as tension and extension in the muscle.

Download Full-text

Arthroscopically Assisted Mini-Open Rotator Cuff Repairs

The American Journal of Sports Medicine ◽

10.1177/03635465000280030401 ◽

2000 ◽

Vol 28 (3) ◽

pp. 301-311 ◽

Cited By ~ 43

Author(s):

Jonathan C. Hersch ◽

Nicholas A. Sgaglione

Keyword(s):

Los Angeles ◽

Rotator Cuff ◽

External Rotation ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Duration Of Symptoms ◽

Excellent Outcome ◽

Rehabilitation Protocols ◽

Arthroscopically Assisted ◽

Tear Size

The functional outcome of 22 consecutive patients with full-thickness rotator cuff tears repaired using an arthroscopically assisted technique was evaluated. The average follow-up was 39 months (24 to 80), and the average tear size was 3.5 cm (1 to 7). There were 14 men and 8 women, with a mean age of 56 years (29 to 80); 86% of patients (N 19) were satisfied with the results of surgery and 95% (N 21) had improvement of their symptoms. All patients had a statistically significant improvement in pain and active abduction in the scapular plane and in external rotation. Postoperative strength in external rotation and abduction averaged 95% and 97% of the contralateral shoulder, respectively. Preoperative duration of symptoms, strength, age, and tear size were found to be independent predictors of outcome. The average Constant and Murley score was 84 of 100, the average American Shoulder and Elbow Surgeons score was 81 of 100, and the average University of California, Los Angeles, score was 31 of 35. Our results show that an arthroscopically assisted repair of full-thickness, moderate-to-large rotator cuff tears using uniform surgical technique and rehabilitation protocols provides excellent outcome with regard to function, pain, and activities of daily living.

Download Full-text

Arthroscopic Superior Capsule Reconstruction Eliminates Pseudoparalysis in Patients with Irreparable Rotator Cuff Tears

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00119 ◽

2017 ◽

Vol 5 (3_suppl3) ◽

pp. 2325967117S0011 ◽

Cited By ~ 2

Author(s):

Teruhisa Mihata ◽

Thay Q. Lee ◽

AKIHIKO HASEGAWA ◽

Takeshi Kawakami ◽

Kunimoto Fukunishi ◽

...

Keyword(s):

Rotator Cuff ◽

Healing Rate ◽

External Rotation ◽

Shoulder Function ◽

Rotator Cuff Tears ◽

Shoulder Stiffness ◽

Graft Healing ◽

Acromiohumeral Distance ◽

Tear Size ◽

Shoulder Elevation

Objectives: We have developed the superior capsule reconstruction (SCR) technique for surgical treatment of irreparable rotator cuff tears. In these patients, SCR restores shoulder stability and muscle balance, consequently improving shoulder function—particularly deltoid muscle function—and relieving pain. In this study, we evaluated whether arthroscopic SCR reversed preoperative pseudoparalysis in patients with irreparable rotator cuff tears. Methods: A series of 100 consecutive patients with irreparable rotator cuff tears that had failed conservative treatment underwent arthroscopic SCR using fascia lata autografts; 7 patients with deltoid weakness due to cervical or axillary nerve palsy and 3 patients with severe shoulder stiffness (passive shoulder elevation, less than 90°) before surgery were excluded from the study population. The remaining 90 patients were allocated into 3 groups according to their preoperative active shoulder elevation: (1) no pseudoparalysis: more than 90° of active shoulder elevation (48 patients; mean age, 66.3 years; mean tear size in anterioposterior direction, 3.5 cm); (2) moderate pseudoparalysis: no shoulder stiffness, less than 90° of active shoulder elevation, patients maintained more than 90° elevation once the shoulder was elevated passively (27 patients; mean age, 68.1 years, mean tear size, 3.5 cm); and (3) severe pseudoparalysis: no shoulder stiffness, less than 90° of active shoulder elevation, patients had a positive drop-arm sign (15 patients; mean age, 62.3 years, mean tear size, 4.9 cm). Physical examination, radiography, and magnetic resonance imaging were performed before surgery; at 3, 6, and 12 months after surgery; and yearly thereafter. The American Shoulder and Elbow Surgeons (ASES) score, active shoulder range of motion, acromiohumeral distance, and healing rate were compared between patients with and without pseudoparalysis as well as between before surgery and at the final follow-up (mean, 48 months; range, 24 to 88 months) by using the t and chi-square tests. A significant difference was defined as P < 0.05. Results: ASES score, active elevation, active external rotation, and acromiohumeral distance increased significantly after arthroscopic SCR in patients with no pseudoparalysis, moderate pseudoparalysis, or severe pseudoparalysis. The graft healing rate was 96% (43 of 45) in patients with no pseudoparalysis, 96% (26 of 27) in those with moderate pseudoparalysis, and 87% (13 of 15) in the severe pseudoparalysis group. Postoperative ASES score, active elevation, active external rotation, acromiohumeral distance, and healing rate did not differ among the 3 patient groups. Pseudoparalysis was reversed in 96% (26 of 27) of patients with moderate pseudoparalysis and in 93% (14 of 15) patients with severe pseudoparalysis. Patients with residual moderate or severe pseudoparalysis had graft tears postoperatively. Conclusion: Arthroscopic SCR improved shoulder function and achieved superior stability in patients with previously irreparable rotator cuff tears both with and without pseudoparalysis. Providing that the graft did not tear postoperatively, arthroscopic SCR reversed preoperative pseudoparalysis. The graft healing rate after arthroscopic SCR did not differ between patients with and without pseudoparalysis.

Download Full-text