scholarly journals Editorial Commentary: Results of Biplanar Fluoroscopy With 3-Dimensional Analysis in Patients With Rotator Cuff Tears Challenge the Concept of Superior Translation of the Humeral Head and Must Be Interpreted With Caution

2016 ◽  
Vol 32 (3) ◽  
pp. 452 ◽  
Author(s):  
Michael J. Rossi
Keyword(s):  
Rotator Cuff ◽  
Dimensional Analysis ◽  
Humeral Head ◽  
Rotator Cuff Tears ◽  
3 Dimensional ◽  
Editorial Commentary ◽  
Biplanar Fluoroscopy

In vivo 3-dimensional analysis of scapular and glenohumeral kinematics: comparison of symptomatic or asymptomatic shoulders with rotator cuff tears and healthy shoulders

2015 ◽  
Vol 24 (11) ◽  
pp. 1817-1826 ◽  
Author(s):  
Takehiro Kijima ◽  
Keisuke Matsuki ◽  
Nobuyasu Ochiai ◽  
Takeshi Yamaguchi ◽  
Yu Sasaki ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Dimensional Analysis ◽  
Rotator Cuff Tears ◽  
3 Dimensional

scholarly journals Comparison of Dynamic In Vivo Shoulder Kinematics Before and After Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears

2021 ◽  
Vol 9 (1) ◽  
pp. 232596712097050
Author(s):  
Seung-Jun Lee ◽  
Young-Kyoung Min ◽  
Il-Kwon Chung ◽  
Suk-Woong Kang ◽  
Scott A. Banks
Keyword(s):  
Rotator Cuff ◽  
Humeral Head ◽  
Case Series ◽  
Rotator Cuff Tears ◽  
Level Of Evidence ◽  
3 Dimensional ◽  
Superior Capsular Reconstruction ◽  
Before And After ◽  
Shoulder Kinematics

Background: Superior capsular reconstruction (SCR) is an alternative surgical option for young active patients with irreparable rotator cuff tears without arthritis. Although cadaveric studies have shown superior stability of the humerus, it remains unclear whether the humerus migrates superiorly after SCR in vivo. Purpose: To analyze the change in glenohumeral translation in patients before and after SCR. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 patients who underwent SCR by a single surgeon for irreparable rotator cuff tears were included. Among them, 14 patients had intact grafts, and 8 patients were diagnosed with retears on 1-year postoperative magnetic resonance imaging (MRI) scans. Fluoroscopy was performed in all patients preoperatively and at 3-month, 6-month, and 1-year follow-up. Moreover, 3-dimensional bone models from computed tomography, MRI, and fluoroscopic scans during scapular plane abduction of the shoulder joints were analyzed. Results: In the intact graft group, 3-dimensional dynamic shoulder kinematics at 6 months ( P = .026) and 1 year ( P = .032) postoperatively showed statistically significant decreases in humeral head superior translation compared with preoperatively. The ≥6-mm acromiohumeral distance (AHD) subgroup had a larger decrease in humeral head superior translation from preoperatively than did the <6-mm AHD subgroup (6 months: P = .026; 1 year: P = .032). The retear group had significantly greater humeral head superior translation at 1 year postoperatively than did the ≥6-mm and <6-mm AHD subgroups (post hoc test: P < .001; ≥6-mm AHD vs retear group: P = .001; <6-mm AHD vs retear group: P = .012). Conclusion: SCR with intact grafts resulted in decreased humeral head superior translation after 6 months. Patients with retears showed no improvement in humeral head superior translation. Patients with a preoperative AHD <6 mm had less improvement in humeral head superior translation than did those with a preoperative AHD ≥6 mm. Early surgical treatment before an excessive decrease in preoperative AHD could be helpful for postoperative humeral head translation recovery.

Clinical Y-view versus 3-dimensional assessments of intramuscular fat in patients with full-thickness rotator cuff tears

2021 ◽  
Vol 77 ◽  
pp. 13-16
Author(s):  
Logan M. Hansen ◽  
Ankur Garg ◽  
Rajan Khanna ◽  
Michael Thayer ◽  
Matthew D. Saltzman ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Intramuscular Fat ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
3 Dimensional

scholarly journals Nonarthroplasty Surgical Treatment Options for Massive, Irreparable Rotator Cuff Tears

2018 ◽  
Vol 6 (11) ◽  
pp. 232596711880538 ◽  
Author(s):  
Trevor J. Carver ◽  
Matthew J. Kraeutler ◽  
John R. Smith ◽  
Jonathan T. Bravman ◽  
Eric C. McCarty
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Humeral Head ◽  
Latissimus Dorsi ◽  
Rotator Cuff Tears ◽  
Arthroscopic Debridement ◽  
Partial Repair ◽  
Latissimus Dorsi Transfer ◽  
Superior Capsular Reconstruction ◽  
Graft Interposition

Massive, irreparable rotator cuff tears (MIRCTs) provide a significant dilemma for orthopaedic surgeons. One treatment option for MIRCTs is reverse total shoulder arthroplasty. However, other methods of treating these massive tears have been developed. A search of the current literature on nonoperative management, arthroscopic debridement, partial repair, superior capsular reconstruction (SCR), graft interposition, balloon spacer arthroplasty, trapezius transfer, and latissimus dorsi transfer for MIRCTs was performed. Studies that described each surgical technique and reported on clinical outcomes were included in this review. Arthroscopic debridement may provide pain relief by removing damaged rotator cuff tissue, but no functional repair is performed. Partial repair has been suggested as a technique to restore shoulder functionality by repairing as much of the rotator cuff tendon as possible. This technique has demonstrated improved clinical outcomes but also fails at a significantly high rate. SCR has recently gained interest as a method to prohibit superior humeral head translation and has been met with encouraging early clinical outcomes. Graft interposition bridges the gap between the retracted tendon and humerus. Balloon spacer arthroplasty has also been recently proposed and acts to prohibit humeral head migration by placing a biodegradable saline-filled spacer between the humeral head and acromion; it has been shown to provide good clinical outcomes. Both trapezius and latissimus dorsi transfer techniques involve transferring the tendon of these respective muscles to the greater tuberosity of the humerus; these 2 techniques have shown promising restoration in shoulder function, especially in a younger, active population. Arthroscopic debridement, partial repair, SCR, graft interposition, balloon spacer arthroplasty, trapezius transfer, and latissimus dorsi transfer have all been shown to improve clinical outcomes for patients presenting with MIRCTs. Randomized controlled trials are necessary for confirming the efficacy of these procedures and to determine when each is indicated based on specific patient and anatomic factors.

Zoledronic Acid Substantially Improves Bone Microarchitecture and Biomechanical Properties After Rotator Cuff Repair in a Rodent Chronic Defect Model

2020 ◽  
Vol 48 (9) ◽  
pp. 2151-2160
Author(s):  
Jakob E. Schanda ◽  
Claudia Keibl ◽  
Patrick Heimel ◽  
Xavier Monforte ◽  
Stefan Tangl ◽  
...  
Keyword(s):  
Zoledronic Acid ◽  
Rotator Cuff ◽  
Humeral Head ◽  
Bone Microarchitecture ◽  
Intervention Group ◽  
Maximum Load ◽  
Biomechanical Properties ◽  
Rotator Cuff Tears ◽  
Mineral Density ◽  
Load To Failure

Background: Bone mineral density at the humeral head is reduced in patients with chronic rotator cuff tears. Bone loss in the humeral head is associated with repair failure after rotator cuff reconstruction. Bisphosphonates (eg, zoledronic acid) increase bone mineral density. Hypothesis: Zoledronic acid improves bone mineral density of the humeral head and biomechanical properties of the enthesis after reconstruction of chronic rotator cuff tears in rats. Study Design: Controlled laboratory study. Methods: A total of 32 male Sprague-Dawley rats underwent unilateral (left) supraspinatus tenotomy with delayed transosseous rotator cuff reconstruction after 3 weeks. All rats were sacrificed 8 weeks after rotator cuff repair. Animals were randomly assigned to 1 of 2 groups. At 1 day after rotator cuff reconstruction, the intervention group was treated with a single subcutaneous dose of zoledronic acid at 100 µg/kg bodyweight, and the control group received 1 mL of subcutaneous saline solution. In 12 animals of each group, micro–computed tomography scans of both shoulders were performed as well as biomechanical testing of the supraspinatus enthesis of both sides. In 4 animals of each group, histological analyses were conducted. Results: In the intervention group, bone volume fraction (bone volume/total volume [BV/TV]) of the operated side was higher at the lateral humeral head ( P = .005) and the medial humeral head ( P = .010) compared with the control group. Trabecular number on the operated side was higher at the lateral humeral head ( P = .004) and the medial humeral head ( P = .001) in the intervention group. Maximum load to failure rates on the operated side were higher in the intervention group ( P < .001). Cortical thickness positively correlated with higher maximum load to failure rates in the intervention group ( r = 0.69; P = .026). Histological assessment revealed increased bone formation in the intervention group. Conclusion: Single-dose therapy of zoledronic acid provided an improvement of bone microarchitecture at the humeral head as well as an increase of maximum load to failure rates after transosseous reconstruction of chronic rotator cuff lesions in rats. Clinical Relevance: Zoledronic acid improves bone microarchitecture as well as biomechanical properties after reconstruction of chronic rotator cuff tears in rodents. These results need to be verified in clinical investigations.

scholarly journals Biomechanics in an Incomplete Versus Complete Supraspinatus Tear: A Cadaveric Study

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096447
Author(s):  
Danil Rybalko ◽  
Aimee Bobko ◽  
Farid Amirouche ◽  
Dmitriy Peresada ◽  
Awais Hussain ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Humeral Head ◽  
Rotator Cuff Tears ◽  
Vertical Position ◽  
Study Objective ◽  
Supraspinatus Tear ◽  
Complete Tear ◽  
Significant Difference ◽  
Static Conditions ◽  
Biomechanical Comparison

Background: Degenerative and traumatic changes to the rotator cuff can result in massive and irreparable rotator cuff tears (RCTs). Purpose/Hypothesis: The study objective was to conduct a biomechanical comparison between a small, incomplete RCT and a large, complete RCT. We hypothesized that the incomplete supraspinatus (SS) tear would lead to an incremental loss of abduction force and preserve vertical position of the humeral head, while a complete SS tear would cause superior humeral migration, decrease functional deltoid abduction force, and increase passive range of motion (ROM). Study Design: Controlled laboratory study. Methods: Six cadaveric shoulders were evaluated using a custom testing apparatus. Each shoulder was subjected to 3 conditions: (1) intact/control, (2) 50%, full-thickness, incomplete SS tear, and (3) 100%, complete SS tear. Deltoid abduction force, superior humeral head migration, and passive ROM were measured in static conditions at 0°, 30°, and 60° of glenohumeral abduction, respectively. Results: The intact SS resulted in a mean deltoid abduction force of 2.5, 3.3, and 3.8 N at 0°, 30°, and 60° of abduction, respectively. Compared with the intact shoulder, there was no significant difference in mean abduction force seen in the incomplete tear, while the force was significantly decreased by 52% at 30° of abduction in the complete tear ( P = .009). Compared with the incomplete tear, there were significant decreases in abduction force seen in the complete tear, by 33% and 48% (0.9 N and 1.1 N) at 0° and 30° of abduction, respectively ( P = .04 and .004). The intact configuration experienced a mean superior humeral head migration of 1.5, 1.4, and 1.1 mm at 0°, 30°, and 60° of abduction, respectively. The complete tear resulted in a superior migration of 3.0 and 4.4 mm greater than the intact configuration at 0° and 30° of abduction, respectively ( P = .001). There was a 5° and 10° increase in abduction ROM with 50% and 100% tears, respectively ( P = .003 and .03). Conclusion: An incomplete SS tear does not significantly alter the biomechanics of the shoulder, while a large, complete SS tear leads to a significant superior humeral migration, a decreased deltoid abduction force, and a mild increase in passive ROM. Clinical Relevance: Our findings demonstrate the effects of large SS tears on key biomechanical parameters, as they progress from partial tears.

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