scholarly journals Rotator cuff irreparability or failure of repair (re-tear): technical note on middle trapezius tendon transfer for reproduction of supraspinatus function

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Amr Abdel-Mordy Kandeel
Keyword(s):  
Rotator Cuff ◽  
Tendon Transfer ◽  
Dynamic Testing ◽  
External Rotation ◽  
Young Patients ◽  
Hamstring Tendon ◽  
Technical Note ◽  
Double Row ◽  
Absorbable Sutures ◽  
Scapular Spine

Abstract Purpose Based on its close anatomic features and nearly-collinear force vector to those of supraspinatus muscle, the current article describes a technique of middle trapezius tendon transfer for reproduction of supraspinatus function in the context of rotator cuff irreparability/re-tear management. Methods While seating the patient in beach-chair position, arthroscopic gleno-humeral examination and sub-acromial decompression are initially performed. Hamstring tendons are harvested and fashioned as flattened quadruple sheet. Through McKenzie approach, infraspinatus and subscapularis tendons are repaired. Then, medial half of middle trapezius insertion tendon is harvested from most medial 5-6 cm of the scapular spine. Through McKenzie approach, hamstring sheet is retrieved via a sub-trapezius/sub-acromial corridor from the scapular wound. Hamstring sheet is re-attached to cuff footprint by double row/suture bridge repair configuration. While retracting the scapula and placing gleno-humeral joint in 45O-abduction/45O-external rotation, hamstring sheet is re-attached to released middle trapezius tendon by non-absorbable sutures. Finally, tendon reconstruct is dynamically-tested in different positions of range of motion. Results Transfer of medial portion of middle trapezius insertion tendon (lengthened by interposition hamstring tendon sheet) to cuff footprint was technically feasible. Dynamic testing showed smooth sub-acromial gliding motion of the tendon reconstruct. Conclusion For reproduction of supraspinatus function, hamstring tendon augmented-middle trapezius tendon transfer to cuff footprint heralds a number of technical and biomechanical advantages; thus offering a potential effective modality of cuff irreparability/re-tear management in relatively young patients of high functional demands. However, current description should be investigated in further biomechanical and clinical studies to validate its long-term outcomes.

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

2020 ◽  
Vol 9 (2) ◽  
pp. 433 ◽  
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.

Improved Rotator Cuff Footprint Contact Characteristics With an Augmented Repair Construct Using Lateral Edge Fixation

2019 ◽  
Vol 48 (2) ◽  
pp. 444-449
Author(s):  
Ekaterina Urch ◽  
Charles C. Lin ◽  
Yasuo Itami ◽  
Nilay A. Patel ◽  
Michelle H. McGarry ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Gold Standard ◽  
External Rotation ◽  
Contact Forces ◽  
Rotator Cuff Tears ◽  
Shoulder Abduction ◽  
Average Difference ◽  
Double Row ◽  
Lateral Edge ◽  
Contact Pressures

Background: The transosseous-equivalent (TOE) rotator cuff repair construct has become the gold standard for the repair of medium and large rotator cuff tears. Repair failure, however, continues to be a problem. One contributing factor may be the inability of the TOE repair to replicate the native footprint contact characteristics during shoulder movement, especially in rotation. This results in higher strain across the repair, which leads to gapping and predisposes the construct to failure. In an effort to better reproduce the native compression forces throughout the footprint, an augmented TOE construct supplemented with lateral edge fixation is proposed, and the contact characteristics were compared with those of the gold standard TOE construct. Hypothesis: The augmented TOE repair will demonstrate improved footprint contact characteristics when compared with the classic TOE repair. Study Design: Controlled laboratory study. Methods: Ten fresh-frozen cadaveric shoulders underwent supraspinatus repair using both the classic TOE double-row construct and the augmented TOE repair. For the augmented repair, 2 luggage tag sutures were used to secure the lateral edge and incorporated into the lateral row anchors. A Tekscan pressure sensor (Tekscan Inc) placed under the repaired tendon was used to collect footprint contact area, force, peak pressure, and contact pressure data for each construct. Results: The augmented construct demonstrated significantly greater contact forces (average difference, 4.9 N) and significantly greater contact pressures (average difference, 23.1 kPa) at all degrees of abduction and all degrees of rotation. At 30° of internal and 30° of external rotation at both 0° and 30° of shoulder abduction, the augmented construct demonstrated significantly greater peak contact pressures. Conclusion: The augmented construct showed superior contact characteristics when compared with the classic TOE technique. The addition of lateral edge fixation to the classic TOE repair significantly improves bone-tendon contact characteristics with minimal additional surgical effort. Clinical Relevance: The results of this study indicate that lateral augmentation of the classic TOE repair produces a biomechanically superior construct that may optimize tendon healing.

scholarly journals Two-year results of double row repair for medium sized rotator cuff tear in elderly patients

2019 ◽  
Vol 6 (2) ◽  
pp. 423
Author(s):  
Afsar T. Ozkut
Keyword(s):  
Rotator Cuff ◽  
Internal Rotation ◽  
Rotator Cuff Tear ◽  
External Rotation ◽  
Constant Score ◽  
Rotator Cuff Tears ◽  
Double Row ◽  
Cuff Tear ◽  
Forward Flexion

Background: Rotator cuff tears are treated surgically when conservative treatment methods fail. Since osteoporosis is common and the cuff is degenerative in nature, it may be a challenge to treat the tears surgically in the elderly. The objective of this study was to evaluate the results rotator cuff repair with double row two anchors (one medial and one lateral) for middle sized tears in patients over 65years old.Methods: 18 patients who are over 65years old treated arthroscopically for medium sized rotator cuff tear were included in the study. Inclusion criteria were patients with MR findings and physical findings consistent with medium sized (1-3cm) rotator cuff tears, patients with follow up period of at least 2years. All of the patients were repaired using (two anchors, one medially and one laterally placed) double row technique arthroscopically.  The patients were evaluated with constant Murley score and ASES scores. All these measurements (both ROM and functional tests) were performed preoperatively and at postoperative third sixth months, first year and after second year.Results: Mean age of the patients was 69.3 (±2.6). The mean follows up period was 34months (±4.1) Preoperative mean forward flexion and external rotation were 127.3±25.3º and 48.9±14.6º respectively. The preoperative mean internal rotation was 9.1±6.9º. Preoperative mean ASES score was 59.1º (±9.6) and mean constant score was 53.7º (±11.2). At the last follow up mean forward flexion was 158.3º (±17.9), external rotation was 63.2º (±11.4) and internal rotation was 9.3º (±7.3).  Mean ASES score and constant score of the patients were 84.3 (±9.1) and 77.3 (±10.8) in the last follow up.Conclusions: It is possible to obtain good results in medium sized rotator cuff tears in patients over 65years old particularly if fatty degeneration over grade II has not prevailed.

scholarly journals Enhancement of External Rotation after Latissimus Dorsi Tendon Transfer (LDTT): A Cadaveric Study

Medicina ◽  
2021 ◽  
Vol 57 (4) ◽  
pp. 305
Author(s):  
José M. Silberberg ◽  
Alessandro Nilo ◽  
Jorge Roces-García
Keyword(s):  
Rotator Cuff ◽  
Healthy Volunteers ◽  
Latissimus Dorsi ◽  
Tendon Transfer ◽  
External Rotation ◽  
Rotator Cuff Tears ◽  
Control Group ◽  
Massive Rotator Cuff Tear ◽  
Cuff Tear ◽  
Mobility Function

Background and objectives: Massive rotator cuff tears compromise shoulder mobility function and cannot be directly repaired. Latissimus dorsi tendon transfer (LDTT) is a therapeutic alternative suitable for the treatment of rotator cuff tears that helps to restore external shoulder rotation. Cadaver models have been used for studying the effects of LDTT and procedural variations, but, to the best of our knowledge, none of them have been validated. The aim of our study was to validate a novel cadaver model while verifying the effects of LDTT on external rotation. Materials and Methods: Two groups were included in the study: a cadaver group and a control group made up of healthy volunteers, which were used for the validation of the cadaver model. Baseline external rotation measurements were performed with both groups, after which a massive rotator cuff tear was inflicted and repaired with LDTT in the cadaver group. Their postoperative external rotation was evaluated using three different tests. Results: No statistically significant differences were found between the baseline measurements of the two groups, and postoperative external rotation was significantly higher after LDTT in all cases but one. Conclusions: Cadaver models were validated, since they had a similar preoperative external rotation to healthy volunteers. Moreover, they allowed us to demonstrate the effect of LDTT on external shoulder rotation.

Three-Dimensional Evaluation of Cyclic Displacement in Single-Row and Double-Row Rotator Cuff Reconstructions Under Static External Rotation

2012 ◽  
Vol 41 (1) ◽  
pp. 153-162 ◽  
Author(s):  
Olaf Lorbach ◽  
Matthias Kieb ◽  
Florian Raber ◽  
Lüder C. Busch ◽  
Dieter M. Kohn ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
External Rotation ◽  
Rotator Cuff Tears ◽  
Gap Formation ◽  
Double Row ◽  
Single Row ◽  
Initial Rupture ◽  
Cyclic Displacement ◽  
Double Row Repair ◽  
Tear Size

Background: The double-row suture bridge repair was recently introduced and has demonstrated superior biomechanical results and higher yield load compared with the traditional double-row technique. It therefore seemed reasonable to compare this second generation of double-row constructs to the modified single-row double mattress reconstruction. Hypothesis: The repair technique, initial tear size, and tendon subregion will have a significant effect on 3-dimensional (3D) cyclic displacement under additional static external rotation of a modified single-row compared with a double-row rotator cuff repair. Study Design: Controlled laboratory study. Methods: Rotator cuff tears (small to medium: 25 mm; medium to large: 35 mm) were created in 24 human cadaveric shoulders. Rotator cuff repairs were performed as modified single-row or double-row repairs, and cyclic loading (10-60 N, 10-100 N) was applied under 20° of external rotation. Radiostereometric analysis was used to calculate cyclic displacement in the anteroposterior (x), craniocaudal (y), and mediolateral (z) planes with a focus on the repair constructs and the initial tear size. Moreover, differences in cyclic displacement of the anterior compared with the posterior tendon subregions were calculated. Results: Significantly lower cyclic displacement was seen in small to medium tears for the single-row compared with double-row repair at 60 and 100 N in the x plane ( P = .001) and y plane ( P = .001). The results were similar in medium to large tears at 100 N in the x plane ( P = .004). Comparison of 25-mm versus 35-mm tears did not show any statistically significant differences for the single-row repairs. In the double-row repairs, lower gap formation was found for the 35-mm tears ( P ≤ .05). Comparison of the anterior versus posterior tendon subregions revealed a trend toward higher anterior gap formation, although this was statistically not significant. Conclusion: The tested single-row reconstruction achieved superior results in 3D cyclic displacement to the tested double-row repair. Extension of the initial rupture size did not have a negative effect on the biomechanical results of the tested constructs. Clinical Relevance: Single-row repairs with modified suture configurations provide comparable biomechanical strength to double-row repairs. Furthermore, as increased gap formation in the early postoperative period might lead to failure of the construct, a strong anterior fixation and restricted external rotation protocol might be considered in rotator cuff repairs to avoid this problem.

Double-Layer Rotator Cuff Repair: Anatomic Reconstruction of the Superior Capsule and Rotator Cuff Improves Biomechanical Properties in Repairs of Delaminated Rotator Cuff Tears

2018 ◽  
Vol 46 (13) ◽  
pp. 3165-3173 ◽  
Author(s):  
Leo Pauzenberger ◽  
Philipp R. Heuberer ◽  
Felix Dyrna ◽  
Elifho Obopilwe ◽  
Bernhard Kriegleder ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Double Layer ◽  
Rotator Cuff Repair ◽  
External Rotation ◽  
Biomechanical Properties ◽  
Rotator Cuff Tears ◽  
Double Row ◽  
Cyclical Loading ◽  
Double Row Repair ◽  
Cuff Repair

Background: Delamination in rotator cuff tears has been identified as a prognostic factor for negative outcome after repair, with a reported prevalence between 38% and 88%. Purpose: To compare biomechanical properties of 3 repair techniques for delaminated rotator cuff tears. Study Design: Controlled laboratory study. Methods: Eighteen fresh-frozen cadaveric shoulders were used to evaluate rotator cuff footprint reconstruction, contact area and pressure, displacement under cyclical loading, and load to failure of 3 double-row repair configurations: double-row suture repair with medial row knots (medially knotted bridge, mkB); knotless double-row repair using suture tapes (knotless bridge, klB); and knotless double-row, double-layer-specific repair (double-layer, DL). Dynamic pressure sensors were used to assess contact patterns at the footprint region in 0°, 30°, and 60° of glenohumeral abduction and 5 rotational positions (0°, 30° of internal rotation, 30° of external rotation, 60° of internal rotation, 60° of external rotation). Optical markers were used to document whole tendon and individual layer displacement after rotator cuff repair under cyclical loading for 200 cycles (10 N to 100 N at 1 Hz). Specimens were then loaded monotonically to failure at a rate of 33 mm/min. Results: Mean contact area and footprint restoration were highest in the DL group at 60° of glenohumeral abduction for all rotational positions (mkB mean ± SD, 195.4 ± 54.3 mm2, 66.7% ± 19.7%; klB, 250.6 ± 34.9 mm2, 76.2% ± 10.3%; DL, 318.4 ± 36.6 mm2, 109.1% ± 24.0%; P < .001). The double-layer-specific repair showed the least displacement under cyclical loading (mkB mean ± SD, 0.53 ± 0.18 mm; klB, 0.79 ± 0.37 mm; DL, 0.31 ± 0.24 mm; P = .029), most closely resembling the native tendon. Peak loads at failure were comparable between repair groups (mkB mean ± SD, 366.92 ± 70.59 N; klB, 280.05 ± 77.66 N; DL, 398.35 ± 109.04 N; P = .083). Conclusion: Anatomic restoration of the superior capsular and tendon insertion in delaminated rotator cuff tears with a double-layer-specific repair configuration demonstrated superior footprint restoration with increasing abduction, while providing construct displacement comparable to the native tendon under cyclical loading. Peak load at failure was comparable between repair constructs. Clinical Relevance: The prevalence and clinical importance of delaminated rotator cuff tears have long been underestimated. Anatomically correct individual reconstruction of the superior capsule and rotator cuff could restore near-native biomechanics and potentially reduce the risk of rotator cuff repair failure.

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