Anterior Cable Reconstruction Using the Proximal Biceps Tendon for Large Rotator Cuff Defects Limits Superior Migration and Subacromial Contact Without Inhibiting Range of Motion: A Biomechanical Analysis

2018 ◽  
Vol 34 (9) ◽  
pp. 2590-2600 ◽  
Author(s):  
Maxwell C. Park ◽  
Yasuo Itami ◽  
Charles C. Lin ◽  
Adam Kantor ◽  
Michelle H. McGarry ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
Biceps Tendon ◽  
Biomechanical Analysis ◽  
Proximal Biceps Tendon

scholarly journals Anterior Cable Reconstruction Using the Proximal Biceps Tendon for Large Rotator Cuff Defects

2021 ◽  
Vol 10 (3) ◽  
pp. e807-e813
Author(s):  
Anthony F. De Giacomo ◽  
Maxwell C. Park ◽  
Thay Q. Lee
Keyword(s):  
Rotator Cuff ◽  
Biceps Tendon ◽  
Proximal Biceps Tendon

Proximal Biceps Tendon and Rotator Cuff Tears

2016 ◽  
Vol 35 (1) ◽  
pp. 153-161 ◽  
Author(s):  
Mandeep S. Virk ◽  
Brian J. Cole
Keyword(s):  
Rotator Cuff ◽  
Biceps Tendon ◽  
Rotator Cuff Tears ◽  
Proximal Biceps Tendon

Biomechanical Analysis of Normal, Injured and Implanted Shoulder Joint

2014 ◽  
Vol 1030-1032 ◽  
pp. 2309-2312
Author(s):  
Aydin Azizi ◽  
Ali Ashkzari
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
Shoulder Arthroplasty ◽  
Shoulder Joint ◽  
Glenohumeral Joint ◽  
Total Shoulder Arthroplasty ◽  
Biomechanical Analysis ◽  
Collateral Ligaments ◽  
Degree Of Stability ◽  
High Degree

The biomechanics of the glenohumeral joint depend on the interaction of both static and dynamic stabilizing structures. The combined effect of these stabilizers is to support the multiple degrees of motion within the glenohumeral joint. Total shoulder arthroplasty requires release of contracted tissues, repair of rotator cuff defects, reconstruction of normal skeletal anatomy with proper sizing, and positioning of components. Arthroplasty of the shoulder is unlike arthroplasty of the hinge joints when the collateral ligaments afford a high degree of stability and is even distinct from the hip when bony conformity is large and range of motion is less. The goal of this paper is biomechanical analyses of normal, injured and implanted shoulder joint.

Shoulder Instability and the Labrum

2018 ◽  
pp. 171-214
Author(s):  
Joaquin Sanchez-Sotelo
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
Shoulder Instability ◽  
Glenohumeral Joint ◽  
Biceps Tendon ◽  
Posterior Instability ◽  
Joint Dislocation ◽  
Glenoid Labrum ◽  
Multidirectional Instability ◽  
Labral Tears

The glenohumeral joint architecture allows for a very ample range of motion. This same architecture, so beneficial for shoulder mobility, also makes the glenohumeral joint particularly prone to instability. Damage to the glenoid labrum is present in many patients with shoulder instability, although the complexity of the pathology involved in shoulder instability goes beyond labral tears. The rotator cuff and the biceps tendon, discussed in chapter 6, The Rotator Cuff and Biceps Tendon, are intimately involved with instability and the labrum; some of the concepts described in chapter 6 will apply here as well. This chapter covers shoulder instability and the labrum, including management of the acute glenohumeral joint dislocation, recurrent posterior instability and posterior labral tears, multidirectional instability, superior labral tears, failed instability surgery, and salvage procedures.

scholarly journals Anterior Cable Reconstruction Using the Proximal Biceps Tendon for Large Rotator Cuff Defects Limits Superior Migration and Subacromial Contact Without Restricting Range of Motion

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0016
Author(s):  
Maxwell C. Park ◽  
Charles Lin ◽  
Adam Kantor ◽  
Yasuo Itami ◽  
Michelle H. McGarry ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Range Of Motion ◽  
Contact Pressure ◽  
Repeated Measures ◽  
External Rotation ◽  
Biceps Tendon ◽  
Statistical Significance ◽  
Total Range ◽  
Peak Contact Pressure ◽  
Unbalanced Load

Objectives: Large rotator cuff defects involving the supraspinatus and infraspinatus tendons, either due to irreparability or after partial repair lack superior capsule support. Any remaining tendon is at risk for tear progression as the tendon must function as both a dynamic tendon and static ligamentous structure. Our purpose was to biomechanically assess an anterior cable reconstruction (ACR) using autologous biceps tendon. We hypothesized that ACR will normalize superior migration and subacromial contact, without limiting range of motion. Methods: Nine cadaveric shoulders were tested using a custom testing system. Glenohumeral kinematics and subacromial contact pressure were measured using a MicroScribe 3DLX and a Tekscan pressure sensor. Each specimen was tested in five conditions: Intact, Stage 2 tear (supraspinatus), Stage 2 tear + ACR, Stage 3 tear (supraspinatus + anterior half of infraspinatus), Stage 3 tear + ACR. ACR involved a biceps tendon tenotomy at the transverse humeral ligament preserving its labral attachment. ACR included “loop-around” suture fixation using two side-to-side sutures and an anchor at the articular margin in order to restore anatomy and secure the tendon along the anterior edge of the cuff defect. ACR was performed in glenohumeral 20° abduction and 60° external rotation. Specimens were tested at 0°, 20°, and 40° of glenohumeral abduction. Total rotational range of motion was measured with 2.2 Nm of torque under a physiologic muscle load. A superiorly unbalanced load was applied to measure superior translation and contact pressure. Repeated measures analysis of variance was used for statistical significance (P < 0.05). Results: The average specimen age was 58 years (range 33-77). Stage 2 and 3 tears showed increased total range of motion at all abduction angles (P < 0.007). ACR after both Stage 2 and 3 tears showed greater total range of motion at 20° abduction (P = 0.035 and P = 0.040) and 40° abduction (P = 0.003 and P < 0.001). The ACR conditions showed significantly higher total ranges of motion compared to Intact (P ≤ 0.007). Superior translation increased significantly from Intact for Stage 2 tears at 7/12 positions (P ≤ 0.014) and Stage 3 tears at all positions except 40° abduction, 90° external rotation (ER) (P < 0.001). At 0° abduction, ACR significantly decreased superior translation for Stage 2 tears at 0°, 30°, and 60° ER (P < 0.01) and Stage 3 tears at 0° and 30° ER (P < 0.001). At 20° abduction, ACR significantly reduced superior translation for Stage 2 tears at 0°, 30°, and 60° ER (P < 0.013) and Stage 3 tears at 0° and 30° ER (P < 0.004). At 40° abduction, ACR significantly decreased superior translation only for Stage 3 tears at 0° ER (P = 0.006). Peak contact pressure significantly increased with Stage 3 tears at 7/12 positions (P ≤ 0.023). ACR significantly reduced peak subacromial contact pressure for Stage 3 tears at: 0° abduction, 30° and 60° ER (P < 0.007); 20° abduction, 30° ER (P < 0.041); 40° abduction, 30° and 60° (peak only) ER (P < 0.024). Conclusion: ACR using autologous biceps tendon can biomechanically normalize superior migration and subacromial contact pressure, without limiting range of motion, similar to superior capsule reconstruction. ACR may improve rotator cuff tendon longevity by providing basic static ligamentous support while helping to maintain normal glenohumeral kinematics.

The prevalence of rotator cuff pathology in the setting of acute proximal biceps tendon rupture

2018 ◽  
Vol 27 (7) ◽  
pp. 1258-1262 ◽  
Author(s):  
George L. Vestermark ◽  
Bryce A. Van Doren ◽  
Patrick M. Connor ◽  
James E. Fleischli ◽  
Dana P. Piasecki ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Tendon Rupture ◽  
Biceps Tendon ◽  
Biceps Tendon Rupture ◽  
Proximal Biceps Tendon

scholarly journals SLAP Tears

2021 ◽  
Vol 1 (3) ◽  
pp. 263502542110007
Author(s):  
Steven B. Cohen ◽  
John R. Matthews
Keyword(s):  
Rotator Cuff ◽  
Shoulder Arthroscopy ◽  
Biceps Tendon ◽  
Full Range ◽  
Contralateral Side ◽  
Highly Active ◽  
Slap Repair ◽  
Biceps Tenotomy ◽  
Labral Tears ◽  
Anterior Posterior

Background: Superior labral tears are frequently encountered during shoulder arthroscopy. Outcomes following superior labral anterior-posterior (SLAP) repairs in young athletes have been well documented. Superior labral repairs in older patient population continue to remain controversial due to concerns of postoperative complications including persistent preoperative symptoms, pain, stiffness, and higher rates of revision surgery. Indications: We present a case of a highly active 38-year-old woman who failed 1½ years of nonoperative management of a type IIB SLAP tear with extension to the posterior labrum. Her symptoms continued to limit her hobbies and work. Technique: A knotless single-anchor SLAP repair was performed along with debridement of the posterior frayed labrum. No biceps tenotomy or tenodesis was performed after full evaluation of the tendon failed to demonstrate evidence of synovitis, tendinopathy, or tear. The patient also did not have any concomitant shoulder pathology, including a rotator cuff tear or chondral lesion. Results: At 6 months, the patient had regained full range of motion similar to the contralateral side. She had returned to her normal activities and sports, including tennis. Discussion/Conclusion: Successful outcomes following SLAP repairs in patients over 35 years can be achieved, but treatment should be individualized with particular attention to concomitant pathology involving the rotator cuff, chondral surface, or biceps tendon which may require tenodesis or tenotomy.

scholarly journals Can ultrasound suffice for triaging patients requiring surgical correction of rotator cuff tears—a comparative evaluation of ultrasound and magnetic resonance imaging

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Aniket Agarwal ◽  
Kavita Vani ◽  
Anurag Batta ◽  
Kavita Verma ◽  
Shishir Chumber
Keyword(s):  
Rotator Cuff ◽  
Biceps Tendon ◽  
Surgical Correction ◽  
Statistical Testing ◽  
Rotator Cuff Tears ◽  
Full Thickness ◽  
Partial Thickness ◽  
Linear Probe ◽  
Significant Difference ◽  
Sensitivity Specificity

Abstract Background Objectives: To comparatively evaluate the role of ultrasound and MRI in rotator cuff and biceps tendon pathologies and to establish ultrasound as a consistently reproducible, quick and accurate primary investigation modality sufficient to triage patients requiring surgical correction of full thickness rotator cuff tears. Methods: Fifty patients, clinically suspected to have rotator cuff and/or biceps tendon pathologies, with no contraindications to MRI, were evaluated by US and MRI, in a prospective cross-sectional observational study. US was done with high-frequency linear probe, and MRI was done on a 1.5-T scanner using T1 oblique sagittal, proton density (PD)/T2 fat-suppressed (FS) oblique sagittal, T1 axial, PD/T2 FS axial, T1 oblique coronal, T2 oblique coronal and PD FS oblique coronal sequences. Statistical testing was conducted with the statistical package for the social science system version SPSS 17.0. The sensitivity, specificity, PPV, NPV and accuracy were also calculated to analyze the diagnostic accuracy of US findings correlating with MRI findings. A p value less than 0.05 was taken to indicate a significant difference. Results Mean age was 45 years; 74% patients were males; 77% females and 60% males had tears. Majority of patients with rotator cuff tears were in the sixth decade of life. The frequency of tears was higher among older patients. Fourteen percent of patients had full thickness tears while 64% had partial thickness tears. US was comparable to MRI for detection of full thickness tears with overall sensitivity, specificity, PPV and accuracy of 93.8%, 100%, 100% and 98.2%, respectively (p value < 0.001). For partial thickness tears, US had overall sensitivity, specificity, PPV and accuracy of 75.6%, 82.6%, 89.5% and 78%, respectively (p value < 0.001), as compared to MRI. Subacromial-subdeltoid bursal effusion and long head of biceps tendon sheath effusion were common associated, though, non-specific findings. Conclusion Ultrasound findings in our study were found to be in significant correlation with findings on MRI in detection of rotator cuff tears. US was equivalent to MRI in detection of full thickness tears and fairly accurate for partial thickness tears. Therefore, US should be considered as the first line of investigation for rotator cuff pathologies.

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