The Biomechanical and Histological Processes of Rerouting Biceps to Treat Chronic Irreparable Rotator Cuff Tears in a Rabbit Model

2022 ◽  
pp. 036354652110629
Author(s):  
Junjie Xu ◽  
Yufeng Li ◽  
Xueying Zhang ◽  
Kang Han ◽  
Zipeng Ye ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Failure Load ◽  
Biceps Tendon ◽  
Rabbit Model ◽  
Rotator Cuff Tears ◽  
Bicipital Groove ◽  
Superior Capsular Reconstruction ◽  
Over Time

Background: Recently, the biceps was rerouted into a newly fabricated bicipital groove for in situ superior capsular reconstruction (SCR), resulting in promising time-zero cadaveric and clinical outcomes. However, no studies have determined the in vivo biomechanical and histological processes after the biceps is transposed to a nonanatomic position. Purpose: To explore the in vivo biomechanical and histological processes of the rerouting biceps tendon to treat chronic irreparable rotator cuff tears (IRCTs) in a rabbit model. Study Design: Controlled laboratory study. Methods: A total of 94 skeletally mature male rabbits were used to create a chronic IRCT model in the supraspinatus tendon. Then, the biceps rerouting procedures were performed in rabbits with chronic IRCT. Eighteen rabbits were sacrificed at 1, 3, 6, 9, and 12 weeks postoperatively for biomechanical testing, micro—computed tomography scanning, and histological analysis. The biomechanical and histological changes of intra- and extra-articular portions of the rerouting biceps were evaluated at each time point, with the contralateral native superior capsule (NSC) and the native biceps (NB) as controls, respectively. The morphology and bone formation of the fabricated bicipital grooves were evaluated, with native grooves as controls. Results: The intra-articular rerouting biceps tendon was progressively remodeled over time, displaying denser fibers and more mature collagen than those of the NSC, with gradual improvements in the tendon-to-bone healing interface from 6 to 12 weeks. Consequently, the failure load and stiffness of the intra-articular rerouting biceps portion increased with time and were significantly higher than those of the NSC from 9 weeks. Similarly, the extra-articular portion of the rerouting biceps progressively healed into a new bicipital groove, as demonstrated by a smaller tendon-to-bone interface from 6 to 12 weeks, resulting in greater failure load and stiffness at 9 and 12 weeks than those of the NB attachment. The newly fabricated bicipital groove showed similar morphology to that of the native groove with sufficient trabecular bone formed underneath. Conclusion: The rerouting biceps could progressively remodel and heal into the newly fabricated bicipital groove over time, resulting in greater biomechanical performances in intra- and extra-articular portions than the NSC and the NB attachment. Clinical Relevance: The biceps rerouting technique may be a feasible procedure to perform in situ SCR to treat IRCT in the future clinical practice; however, more clinical evidence is required.

Biceps Augmentation Outperforms Tear Completion Repair or In Situ Repair for Bursal-Sided Partial-Thickness Rotator Cuff Tears in a Rabbit Model

2021 ◽  
pp. 036354652110533
Author(s):  
Junjie Xu ◽  
Yufeng Li ◽  
Zipeng Ye ◽  
Chenliang Wu ◽  
Kang Han ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Failure Load ◽  
Biceps Tendon ◽  
Rotator Cuff Tears ◽  
Histological Evaluation ◽  
Bicipital Groove ◽  
Partial Thickness ◽  
Over Time ◽  
In Situ Repair

Background: There is an ongoing debate on the treatment of bursal-sided partial-thickness rotator cuff tears (PTRCTs), including ideal repair techniques. Augmentation using a collagen patch has been introduced as a new surgical approach to treat PTRCTs, while the effect of autogenous biceps augmentation (BA) has not been investigated. Purpose: To analyze the effects of BA on bursal-sided PTRCTs and compare its histological and biomechanical results with those of tear completion followed by repair and in situ repair (ISR). Study Design: Controlled laboratory study. Methods: Unilateral chronic PTRCTs were created in 96 mature New Zealand White rabbits, which were randomly divided into 4 groups: no repair, tear completion repair (TCR), ISR, and BA. A new bicipital groove was fabricated in BA for the biceps tendon that was transferred to augment the bursal-sided PTRCT repair. In each group, we sacrificed 6 rabbits for biomechanical testing of the whole tendon-to-bone complex (WTBC) and 6 for histological evaluation of bursal- and articular-sided layers at 6 and 12 weeks postoperatively. Healing responses between the biceps and new bicipital groove in the BA group were determined using histological analysis, and final groove morphologies were evaluated using micro–computed tomography. Results: The remaining tendon and enthesis in bursal-sided PTRCTs progressively degenerated over time. WTBCs of ISR exhibited a larger failure load than those of TCR, although better healing properties in the bursal-sided repaired site were achieved using TCR based on histological scores and superior articular-sided histological scores were observed using ISR. However, WTBCs of BA displayed the best biomechanical results and superior histological scores for bursal- and articular-sided regions. The new bicipital groove in BA remodeled over time and formed similar morphologies to a native groove, which provided a mature bone bed for transferred biceps tendon healing to augment bursal-sided PTRCTs. Conclusion: BA achieved better biomechanical and histological results for repairing bursal-sided PTRCTs as compared with TCR and ISR. When compared with that of TCR, the WTBC of ISR exhibited a higher failure load, showing histological superiority in the articular-sided repair and inferiority in the bursal-sided repair. Clinical Relevance: BA may be an approach to improve bursal-sided PTRCT repair in humans, which warrants further clinical investigation.

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.

Supraspinatus Muscle Architecture and Physiology in a Rabbit Model of Tenotomy and Repair

2021 ◽  
Author(s):  
Sydnee A. Hyman ◽  
Isabella T. Wu ◽  
Laura S. Vasquez-Bolanos ◽  
Mackenzie B. Norman ◽  
Mary C. Esparza ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Isometric Force ◽  
Rabbit Model ◽  
Muscle Length ◽  
Peak Stress ◽  
Structural Data ◽  
Rotator Cuff Tears ◽  
Time Data ◽  
Maximum Isometric Force ◽  
Over Time

Chronic rotator cuff tears can cause severe functional deficits. Addressing the chronic fatty and fibrotic muscle changes is of high clinical interest; however, the architectural and physiological consequences of chronic tear and repair are poorly characterized. We present a detailed architectural and physiological analysis of chronic tear and repair (both over 8 and 16 weeks) compared to age-matched control rabbit supraspinatus (SSP) muscles. Using female New Zealand White Rabbits (N=30, n=6/group) under 2% isofluorane anesthesia, the SSP was surgically isolated and maximum isometric force measured at 4-6 muscle lengths. Architectural analysis was performed, and maximum isometric stress was computed. Whole muscle length-tension curves were generated using architectural measurements to compare experimental physiology to theoretical predictions. Architectural measures are consistent with persistent radial and longitudinal atrophy over time in tenotomy that fail to recover after repair. Maximum isometric force was significantly decreased after 16 wks tenotomy and not significantly improved after repair. Peak isometric force reported here are greater than prior reports of rabbit SSP force after tenotomy. Peak stress was not significantly different between groups and consistent with prior literature of SSP stress. Muscle strain during contraction was significantly decreased after 8-wks of tenotomy and repair, indicating effects of tear and repair on muscle function. The experimental length-tension data was overlaid with predicted curves for each experimental group (generated from structural data), exposing the altered structure-function relationship for tenotomy and repair over time. Data presented here contribute to understanding the physiological implications of disease and repair in the rotator cuff

scholarly journals Biceps tendon properties worsen initially but improve over time following rotator cuff tears in a rat model

2011 ◽  
Vol 29 (6) ◽  
pp. 874-879 ◽  
Author(s):  
Cathryn D. Peltz ◽  
Jason E. Hsu ◽  
Miltiadis H. Zgonis ◽  
Nicholas A. Trasolini ◽  
David L. Glaser ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rat Model ◽  
Biceps Tendon ◽  
Rotator Cuff Tears ◽  
Tendon Properties ◽  
Over Time

scholarly journals The Arthroscopic Intra-Articular Stabilization of the Shoulder for Irreparable Rotator Cuff Tear: A New Technique Proposal

2021 ◽  
Vol 8 ◽  
Author(s):  
Pierfrancesco Luciani ◽  
Luca Farinelli ◽  
Luca De Berardinis ◽  
Antonio Gigante
Keyword(s):  
Rotator Cuff ◽  
Humeral Head ◽  
Biceps Tendon ◽  
Reverse Shoulder Arthroplasty ◽  
Supraspinatus Tendon ◽  
Biomechanical Study ◽  
Rotator Cuff Tears ◽  
Rotator Cuff Injuries ◽  
Superior Capsular Reconstruction ◽  
Significant Difference

Background: Superior capsular reconstruction (SCR) has shown good results in the management of irreparable rotator cuff tears due to the depressive effect on the humeral head, but it is a technically demanding and expensive procedure.Purpose: We hypothesized that an intra-articular neoligament that prevents the superior translation of the humeral head could give similar results in terms of the superior translation of humerus (STH) and range of motion (ROM).Study Design: To compare our proposed technique and the SCR, we conducted a biomechanical study on 10 porcine shoulders in a custom shoulder testing system.Methods: STH and total rotational ROM were quantified in the following four scenarios: (1) when the rotator cuff was intact, (2) after cutting the supraspinatus tendon, (3) after the reconstruction of the superior capsule by long head of the biceps tendon (LHB), and (4) after an arthroscopic intra-articular stabilization by an intra-articular graft. Our proposed technique provides the creation of a humeral and glenoid tunnel, the passage of a graft through these tunnels under arthroscopic guidance, and the graft fixation in the two tunnels. We analyzed the STH and total ROM in each scenario.Results: With respect to the STH, we reported that the present proposed technique is characterized by a significant reduction of superior translation at 0 and 45° compared to scenario 2. In addition, the comparison between our proposed technique and SCR showed a significant difference of the STH at 0° of abduction. Total rotational ROMs of the two tenchinques were similar to scenario 2. Therefore, the use of an intra-articular ligament that prevents the STH can restore shoulder stability in irreparable rotator cuff injuries at both 0 and 45° of glenohumeral abduction without apparently limiting the total rotational ROM.Conclusion: Our proposed technique could be an important treatment option in irreparable rotator cuff tears, especially in patients under 65 years in whom reverse shoulder arthroplasty (RSA) has shown poor results and many complications.

scholarly journals Partial Rotator Cuff Repair With Superior Capsular Reconstruction Using the Biceps Tendon Is as Effective as Superior Capsular Reconstruction Using a Tensor Fasciae Latae Autograft in the Treatment of Irreparable Massive Rotator Cuff Tears

2020 ◽  
Vol 8 (6) ◽  
pp. 232596712092252 ◽  
Author(s):  
Baris Kocaoglu ◽  
Goktug Firatli ◽  
Tekin Kerem Ulku
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Biceps Tendon ◽  
Rotator Cuff Tears ◽  
Massive Rotator Cuff Tears ◽  
Superior Capsular Reconstruction ◽  
Functional Scores ◽  
Tensor Fasciae Latae ◽  
Cuff Repair

Background: Several treatment options are available for stable massive rotator cuff tears, including partial repair with or without tissue augmentation, tendon transfer, superior capsular reconstruction (SCR), and reverse shoulder arthroplasty. Purpose/Hypothesis: The purpose of this study was to compare the outcomes and effectiveness of partial rotator cuff repair with SCR using the long head of the biceps tendon (PRCR-SCRB) and SCR with a tensor fasciae latae autograft (SCRTF) for the treatment of rotator cuff tears with severe fatty degeneration. The hypothesis of this study was that SCRTF would be superior to PRCR-SCRB in functional and anatomic outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 26 consecutive patients with massive and fatty degenerative rotator cuff tears were treated surgically. Patients were divided into either the PRCR-SCRB group (n = 14) or SCRTF group (n = 12). Functional outcomes were assessed at final follow-up, and the acromiohumeral distance (AHD) was measured. Results: All functional scores significantly improved in both groups at final follow-up. The PRCR-SCRB group showed better overall outcomes in terms of the visual analog scale for pain; American Shoulder and Elbow Surgeons score; and Quick Disabilities of the Arm, Shoulder and Hand, but these differences were not statistically significant. Better outcomes were found for only the AHD for the PRCR-SCRB group without statistical significance ( P = .4). No statistical difference was found in terms of retear rate. Conclusion: PRCR-SCRB had comparable outcomes and improvement in AHD compared with SCRTF without the need for additional graft harvesting.

scholarly journals Infraspinatus/Teres Minor Transfer Biceps In Situ Tenodesis Procedure: Initial Results of a Technique for Massive Cuff Tears

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Matt D. A. Fletcher
Keyword(s):  
Rotator Cuff ◽  
Primary Repair ◽  
Biceps Tendon ◽  
Clinical Results ◽  
Rotator Cuff Tears ◽  
Massive Rotator Cuff Tears ◽  
Long Head ◽  
Reconstructive Techniques ◽  
Initial Results

Massive rotator cuff tears may not be primarily repairable with salvage options not necessarily providing acceptable results. Extrinsic tendon transfer is a significant undertaking with prolonged rehabilitation and variable outcome. A novel technique for the reconstruction of massive tears, not amenable to primary repair, by performing a transfer of the intrinsic posterior rotator cuff onto an intact, tenodesed long head of biceps tendon acting as a scaffold for the intrinsic transfer is described. The clinical results at short to medium term in 17 initial patients are presented. Encouraging results from this study suggest that this is a viable option for the management of massive rotator cuff tears with an intact posterior cuff with results equal or superior to other reconstructive techniques.

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.

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

2020 ◽  
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 Purpose 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 (SE) and upper infraspinatus (IE) 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. 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 Long Head Biceps Tendon as Superior Capsular Reconstruction (LHBT-SCR) augmentation for Massive rotator cuff repair: “The Chinese Way

2019 ◽  
Vol 7 (11_suppl6) ◽  
pp. 2325967119S0045
Author(s):  
Shiyi Chen ◽  
Lihong ◽  
Xiliang Shang
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Biceps Tendon ◽  
Rotator Cuff Tears ◽  
Patient Acceptance ◽  
Superior Capsular Reconstruction ◽  
Long Head Biceps Tendon ◽  
Long Head ◽  
Long Head Biceps ◽  
Cuff Repair

Massive or irreparable rotator cuff tears remain a challenging with a high failure rates of the tendon re-tear after surgical treatment in sports medicine practice. Superior capsular reconstruction with either fascia lata autograft or a dermal allograft patch has been described to prevent superior humeral head migration and restore the shoulder muscle force couples to achieve the promising results. A modified and simplified surgical procedure using long head biceps tendon (LHBT) autograft as superior capsular reconstruction (LHBT-SCR) to facilitate the massive rotator cuff repair has been descripted as ”Chinese Way” by a team of French surgeons and Chinese surgeons. The surgical technic has been used in China more than 300 cases. The procedure of this LHBT-SCR has been approved with the advantage of least technical demands, simplifies the original demanding, short the surgical time, satisfy the results and patient acceptance. A multi-center prospective studies with large cohort populations and long-term follow-up has been established in China for its effectiveness. The present will introduce the technic in detail.

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