scholarly journals Arthroscopic Compaction Bone Grafting for Uncontained Bone Defects of the Greater Tuberosity Associated With a Rotator Cuff Retear

2021 ◽  
Author(s):  
Tanujan Thangarajah ◽  
Ian K. Lo
Keyword(s):  
Rotator Cuff ◽  
Bone Grafting ◽  
Bone Defects ◽  
Greater Tuberosity

scholarly journals Use of Gracile and semi-tendinosus tendons (GRAST) for the reconstruction of irreparable rotator cuff tears

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Marie Protais ◽  
Maxime Laurent-Perrot ◽  
Mickaël Artuso ◽  
M. Christian Moody ◽  
Alain Sautet ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Donor Site ◽  
Anatomical Study ◽  
Donor Site Morbidity ◽  
Rotator Cuff Tears ◽  
Subacromial Space ◽  
Greater Tuberosity ◽  
Working Zone ◽  
Superior Capsular Reconstruction

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.

scholarly journals Effect of Systemic Zoledronic Acid Dosing Regimens on Bone Regeneration in Osteoporotic Rats

2021 ◽  
Vol 11 (4) ◽  
pp. 1906
Author(s):  
Marwa Y. Shaheen ◽  
Amani M. Basudan ◽  
Abdurahman A. Niazy ◽  
Jeroen J. J. P. van den Beucken ◽  
John A. Jansen ◽  
...  
Keyword(s):  
Bone Graft ◽  
Bone Grafting ◽  
Femoral Condyle ◽  
Bone Defects ◽  
Histological Evaluation ◽  
Favorable Effect ◽  
Osteoporotic Bone ◽  
Bovine Bone ◽  
Graft Placement ◽  
Regeneration Of Bone

The aim of this study was to evaluate the regeneration of bone defects created in the femoral condyle of osteoporotic rats, following intravenous (IV) zoledronate (ZA) treatment in three settings: pre-bone grafting (ZA-Pre), post-bone grafting (ZA-Post), and pre- plus post-bone grafting (ZA-Pre+Post). Twenty-four female Wistar rats were ovariectomized (OVX). After 12 weeks, bone defects were created in the left femoral condyle. All defects were grafted with a particulate inorganic cancellous bovine bone substitute. ZA (0.04 mg/kg, weekly) was administered to six rats 4 weeks pre-bone graft placement. To another six rats, ZA was given post-bone graft placement creation and continued for 6 weeks. Additional six rats received ZA treatment pre- and post-bone graft placement. Control animals received weekly saline intravenous injections. At 6 weeks post-bone graft placement, samples were retrieved for histological evaluation of the bone area percentage (BA%) and remaining bone graft percentage (RBG%). BA% for ZA-Pre (50.1 ± 3.5%) and ZA-Post (49.2 ± 8.2%) rats was significantly increased compared to that of the controls (35.4 ± 5.4%, p-value 0.031 and 0.043, respectively). In contrast, ZA-Pre+Post rats (40.7 ± 16.0%) showed similar BA% compared to saline controls (p = 0.663). For RBG%, all experimental groups showed similar results ranging from 36.3 to 47.1%. Our data indicate that pre- or post-surgical systemic IV administration of ZA improves the regeneration of bone defects grafted with inorganic cancellous bovine-bone particles in osteoporotic bone conditions. However, no favorable effect on bone repair was seen for continued pre- plus post-surgical ZA treatment.

scholarly journals 702 The Role of Scapular Morphology in Traumatic Rotator Cuff Tears and Greater Tuberosity Fractures: A Retrospective Study

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K de Stadler ◽  
O Musbahi ◽  
E Ibrahim
Keyword(s):  
Retrospective Study ◽  
Rotator Cuff ◽  
High Reliability ◽  
Outcome Measurement ◽  
Area Under The Curve ◽  
Rotator Cuff Tears ◽  
High Morbidity ◽  
Treatment Pathways ◽  
Greater Tuberosity ◽  
Patient Pathways

Abstract Aim Traumatic Rotator Cuff Tears(RCT) and Greater Tuberosity fractures(GT) are associated with high morbidity and reduced quality of life. Diagnostic and treatment pathways for both RCT and GT fractures are different. In this study we look at whether scapular morphology features can aid in our understanding of these traumatic injuries and influence patient pathways. Method A retrospective study was conducted at 2 hospitals. All patients between the period of 2010 and 2020 with Traumatic GT fractures or RCT were identified. Patients were case matched by age and laterality of injury. Primary outcome measurement was the Critical Shoulder Angle(CSA) and timing to further imaging. Statistical analysis was conducted using STATA™. Results Eighty patients met the inclusion criteria(40 traumatic RCT and 40 GT). Mean age was 61.8 years with 58(72.5%) left sided injuries. The difference between RCT and GT was 3.96 degrees(95% CI 2.5 to 5.41, p < 0.05). An CSA of 33.73 gave a sensitivity of 0.68 and a specificity of 0.8 to differentiate between RCT and GT fractures. The Area under the Curve(AUC) was 0.8 indicating high reliability. The overall difference in presentation to further scan between the 2 groups was 78. 3 days( P < 0.05, 95% CI 48.7 – 108). Conclusions Patients with a traumatic RCT and GT fractures have different scapular morphology and radiographic features which predisposes them to have these injuries. Patients presenting with a traumatic RCT are more likely to have a higher CSA and have a greater delay to further scan.

Greater Tuberosity Decortication Decreases Load to Failure of All-Suture Anchor Constructs in Rotator Cuff Repair

2018 ◽  
Vol 34 (10) ◽  
pp. 2777-2781 ◽  
Author(s):  
John A. Ruder ◽  
Ephraim Y. Dickinson ◽  
Richard D. Peindl ◽  
Nahir A. Habet ◽  
James E. Fleischli
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Suture Anchor ◽  
Greater Tuberosity ◽  
Load To Failure ◽  
Cuff Repair

Impaction bone grafting in hip re-revision surgery

2021 ◽  
Vol 103-B (3) ◽  
pp. 492-499
Author(s):  
Eduardo Garcia-Rey ◽  
Laura Saldaña ◽  
Eduardo Garcia-Cimbrelo
Keyword(s):  
Aseptic Loosening ◽  
Acetabular Component ◽  
Revision Surgery ◽  
Bone Grafting ◽  
Bone Defects ◽  
Bone Stock ◽  
Impaction Bone Grafting ◽  
Acetabular Bone ◽  
Acetabular Bone Defects

Aims Bone stock restoration of acetabular bone defects using impaction bone grafting (IBG) in total hip arthroplasty may facilitate future re-revision in the event of failure of the reconstruction. We hypothesized that the acetabular bone defect during re-revision surgery after IBG was smaller than during the previous revision surgery. The clinical and radiological results of re-revisions with repeated use of IBG were also analyzed. Methods In a series of 382 acetabular revisions using IBG and a cemented component, 45 hips (45 patients) that had failed due to aseptic loosening were re-revised between 1992 and 2016. Acetabular bone defects graded according to Paprosky during the first and the re-revision surgery were compared. Clinical and radiological findings were analyzed over time. Survival analysis was performed using a competing risk analysis. Results Intraoperative bone defect during the initial revision included 19 Paprosky type IIIA and 29 Paprosky type IIIB hips; at re-revision, seven hips were Paprosky type II, 27 type IIIA and 11 were type IIIB (p = 0.020). The mean preoperative Harris Hip Score was 45.4 (SD 6.4), becoming 80.7 (SD 12.7) at the final follow-up. In all, 12 hips showed radiological migration of the acetabular component, and three required further revision surgery. The nine-year cumulative failure incidence (nine patients at risk) of the acetabular component for further revision surgery was 9.6% (95% confidence interval (CI) 2.9 to 21.0) for any cause, and 7.5% (95% CI 1.9 to 18.5) for aseptic loosening. Hips with a greater hip height had a higher risk for radiological migration (odds ratio 1.09, 95% CI 1.02 to 1.17; p = 0.008). Conclusion Bone stock restoration can be obtained using IBG in revision hip surgery. This technique is also useful in re-revision surgery; however, a better surgical technique including a closer distance to hip rotation centre could decrease the risk of radiological migration of the acetabular component. A longer follow-up is required to assess potential fixation deterioration. Cite this article: Bone Joint J 2021;103-B(3):492–499.

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