Combining fascia lata autograft bridging repair with artificial ligament internal brace reinforcement

2021 ◽  
Vol 103-B (10) ◽  
pp. 1619-1626
Author(s):  
Mingguang Bi ◽  
Ke Zhou ◽  
Kaifeng Gan ◽  
Wei Ding ◽  
Ting Zhang ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Fascia Lata ◽  
Patch Repair ◽  
Rotator Cuff Tears ◽  
Artificial Ligament ◽  
Massive Rotator Cuff Tears ◽  
Number Of Patients ◽  
Superior Capsular Reconstruction ◽  
Internal Brace

Aims The aim of this study is to provide a detailed description of cases combining bridging patch repair with artificial ligament “internal brace” reinforcement to treat irreparable massive rotator cuff tears, and report the preliminary results. Methods This is a retrospective review of patients with irreparable massive rotator cuff tears undergoing fascia lata autograft bridging repair with artificial ligament “internal brace” reinforcement technique between January 2017 and May 2018. Inclusion criteria were: patients treated arthroscopically for an incompletely reparable massive rotator cuff tear (dimension > 5 cm or two tendons fully torn), stage 0 to 4 supraspinatus fatty degeneration on MRI according to the Goutallier grading system, and an intact or reparable infraspinatus and/or subscapularis tendon of radiological classification Hamada 0 to 4. The surgical technique comprised two components: first, superior capsular reconstruction using an artificial ligament as an “internal brace” protective device for a fascia lata patch. The second was fascia lata autograft bridging repair for the torn supraspinatus. In all, 26 patients with a mean age 63.4 years (SD 6.2) were included. Results All patients underwent more than two years of follow-up (mean 33.5 months (24 to 45)). All clinical scores were also improved at two-year follow-up (mean visual analogue scale 0.7 (SD 0.5) vs 6.1 (SD 1.2); p < 0.001; mean American Shoulder and Elbow Surgeons score 93.5 (SD 5.3) vs 42.5 (SD 10.8); p < 0.001; mean University of California, Los Angeles score, 31.7 (SD 3.7) vs 12.0 (SD 3.1); p < 0.001; and mean Constant-Murley score 88.7 (SD 3.5) vs 43.3 (SD 10.9); p < 0.001), and 24 of 26 fascia lata grafts were fully healed on MRI (92%). One patient had haematoma formation at the harvesting side of the fascia lata at two days postoperatively. Conclusion The fascia lata autograft bridging repair combined with artificial ligament internal brace reinforcement technique achieved good functional outcomes, with a high rate of graft healing at two-year follow-up. Although the short-term results are promising, further studies with a greater number of patients would provide clearer results. Cite this article: Bone Joint J 2021;103-B(10):1619–1626.

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 Latissimus Dorsi Tendon Transfer Vs. Superior Capsular Reconstruction for Treatment of Irreparable Massive Rotator Cuff Tears: A Retrospective Comparison Study with Short-Term Clinical Results

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0038
Author(s):  
Tiffany Kadow ◽  
Daniel Garcia ◽  
Rebecca Minorini ◽  
Mark Baratz ◽  
Ruth Delaney ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Patient Reported Outcomes ◽  
External Rotation ◽  
Rotator Cuff Tears ◽  
Short Term ◽  
Forward Flexion ◽  
Massive Rotator Cuff Tears ◽  
Superior Capsular Reconstruction ◽  
Patient Reported

Objectives: Irreparable massive rotator cuff tears, particularly those that occur in younger patients, represent a particularly challenging clinical scenario with limited options. Treatments such as reverse total shoulder arthroplasty are typically not well indicated for this patient population. We compared two treatment methods, latissimus dorsi tendon transfer (LDTT) vs arthroscopic superior capsular reconstruction (SCR), to determine if one is superior to the other regarding improvement in range of motion (ROM) and patient reported outcomes (PROs). We hypothesize that both treatments would have similar outcomes regarding functional restoration and subjective outcomes. Methods: A retrospective cohort study assessed 43 patients with an irreparable posterosuperior rotator cuff tear after failed conservative or surgical treatment who underwent either LDTT (14 patients, 16 shoulders) or SCR (27 patients, 27 shoulders). Patients with a minimum of 6 month follow-up were included (mean follow up: 17.9 months, 14.9 months respectively). Changes in preoperative and postoperative forward flexion and external rotation were evaluated. Patient reported outcomes (PROs) including ASES, VAS, and SSV were assessed. T-test and Chi-Square statistical tests were performed. Results: The mean age at the time of surgery was 59.9yo vs 60yo for LDTT and SCR respectively (p=0.98). There were significantly more patients in the LDTT group that had undergone prior rotator cuff surgery (p<0.005) and significantly greater number of patients who had subscapularis tears which required repair in patients that underwent SCR (p<0.01). There was no difference in gender (p=0.75). Both cohorts demonstrated similar improvement in forward flexion with mean active forward flexion improving from 123° (90-160°) pre-operatively to 139° (80-180°) postoperatively in the LDTT group (p=0.157) and 85° (0-170°) preoperatively to 138° (40-175°) postoperatively in the SCR group (p =0.001). The average improvement in forward flexion was significantly greater in the SCR group with an improvement of 52° for SCR vs 14° for LDTT (p=0.035). External rotation improved in the LDTT cohort from 41° preoperatively (10-60°) to 62° (10-80°) (p=0.032) while external rotation stayed unchanged for the SCR cohort with 43° preoperatively (0-70°) to 44° (20-80°) postoperatively (p=0.868). The improvement in external rotation was significantly greater in the LDTT cohort with improvement of 19° vs 0.5° in the SCR group (p=0.011). There was no significant difference in reported ASES scores (LDTT: 65.6 vs SCR:70.9)(p=0.569), VAS (LDTT:1.78 vs SCR 2.26) (p=0.645), or SSV (LDTT:55 vs SCR:72.6) (p=0.087). Conclusion: LDTT and SCR both result in functional improvement of motion with SCR improving forward flexion to a greater extent and LDTT improving external rotation to a greater extent. Patient reported outcomes are similar between the two groups at short term follow up. Longer term outcomes are necessary before determining whether one treatment is optimal over the other as well as establishing the appropriate indications for each. [Table: see text]

scholarly journals Massive Rotator Cuff Tear Bridging Reconstruction Using Acellular Dermal Matrix: Mid-term Results (219)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0032
Author(s):  
Moayd Awad ◽  
Sara Sparavalo ◽  
Jie Ma ◽  
Ivan Wong
Keyword(s):  
Rotator Cuff ◽  
Total Shoulder Arthroplasty ◽  
Acellular Dermal Matrix ◽  
Rotator Cuff Tears ◽  
Dermal Matrix ◽  
Massive Rotator Cuff Tears ◽  
Superior Capsular Reconstruction ◽  
Patient Reported ◽  
Reverse Total Shoulder

Objectives: Management of massive rotator cuff tears remains a challenge despite development of different surgical techniques. Bridging reconstruction was developed to improve clinical outcomes and to avoid the morbidity associated with tendon transfers and arthroplasty. To date, there have been no studies assessing the mid-term clinical outcome for patients undergoing this procedure. The objective of this study was to evaluate the mid-term clinical outcomes of patients who underwent bridging reconstruction using acellular dermal matrix for large/massive rotator cuff tears (> 3 cm). Methods: A retrospective chart review was conducted for patients who underwent bridging reconstruction between 2010 and 2018 by one surgeon (IW). Patients with a minimum follow-up of two years were included. All patients completed self-reported questionnaires (Western Ontario Rotator Cuff (WORC) Index and the Disabilities of the Shoulder, Arm and Hand (DASH) score) pre-operatively and post-operatively at six months, one year and annually thereafter. Results: One hundred charts were reviewed, and 20 patients were excluded due to lack of pre- or post-operative outcome scores. This cohort of patients consisted of 80 patients mean age of 58.6 ± 9.1 years and an average follow-up of 5.1 ± 1.6 years. The mean pre- and post-operative WORC scores (± SD) were 61.4 ± 20.6 and 28.1 ± 25.5 (p < 0.001), respectively. The mean pre- and post-operative DASH scores were 52.2 ± 19.7 and 23.1 ± 22.4 (p < 0.001), respectively. There was an improvement in WORC and DASH over time with the most significant improvement during the first year post-operatively (Figure 1). Seventy-eight percent of patients met the minimal clinically important difference (MCID) for WORC while 77% of patients met the MCID for DASH. Our results show significant mid-term clinical improvement in WORC and DASH scores that is similar to previously published data that showed significant improvements in other patient-reported outcome scores. We believe these positive outcomes to be a result of better force coupling within the shoulder as compared to other surgical treatments such as maximal repair, superior capsular reconstruction, and reverse total shoulder arthroplasty. Conclusions: Arthroscopic bridging reconstruction for the treatment of massive rotator cuff tears results in significant improvement of patient reported outcomes (as measured using the WORC and DASH scores) at a mean follow up of five years. This may suggest that bridging reconstruction is a good treatment alternative as compared to superior capsular reconstruction or reverse total shoulder arthroplasty. Longer follow-up with a prospective study design is necessary to determine the longevity of these outcomes.

scholarly journals Arthroscopic Superior Capsular Reconstruction in Males Provides Superior Outcomes to Reverse Total Shoulder or Debridement for Irreparable Rotator Cuff Tears

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0010
Author(s):  
John M. Tokish ◽  
Michael J. Kissenberth ◽  
Ellen Shanley ◽  
Stefan John Tolan ◽  
Kyle J. Adams ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Patient Reported Outcomes ◽  
Rotator Cuff Tears ◽  
Preliminary Results ◽  
Biceps Tenotomy ◽  
Superior Capsular Reconstruction ◽  
Patient Reported ◽  
Male Patients ◽  
Reverse Total Shoulder

Objectives: Early results following arthroscopic superior capsular reconstruction(SCR) in patients with massive, irreparable rotator cuff tears are promising. However, no studies have compared patient reported outcomes between SCR or reverse total shoulder(rTSA) and rotator cuff debridement for these patients. Therefore, the purpose of this study was to compare 1-year outcomes between patients with massive irreparable rotator cuff tears who underwent a SCR, rTSA, or rotator cuff debridement with a concurrent biceps tenotomy or tenodesis. Methods: Patients(n=63) who underwent either SCR(n=21), rTSA(21), or cuff debridement(n=21) and biceps tenotomy or tenodesis for a massive, irreparable rotator cuff tear treated with a minimum 1-year follow up were retrospectively reviewed. Age, sex, BMI, smoking status, Charlson Index, Hamada classification, and ASES scores were recorded and compared using a multivariate ANOVA were used to compare between surgical approaches. A Chi Square analyses were used to compare sex distribution and the Charlson Deyo Index between groups (α=0.05). Results: Overall, patients across the 3 groups were not statistically different in age or follow up ASES score at minimum 14 month follow up ( P> 0.05). There was a significant interaction effect between surgery group and sex (P=0.02) on ASES score but not age ( P=0.08). Univariate F tests revealed that male patients who received an SCR displayed a 10-14% better outcome at follow up compared to other groups (Table 1) which exceeds the reported ASES score MCID. Conclusion: Our results show comparable results across surgical options for massive irreparable cuff tears with good patient reported outcomes. Male patients displayed clinically important greater ASES scores at 1 year follow up. Future studies should evaluate these preliminary results to assess if these preliminary results hold up at longer follow up times.

scholarly journals Superior Capsular Reconstruction Patients Have High Rates of Return to Sports and Similar Functional Outcomes Compared to a Reverse Shoulder Arthroplasty Matched Cohort

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0027
Author(s):  
Brandon C. Cabarcas ◽  
Grant Hoerig Garcia ◽  
Joseph Liu ◽  
Gregory Louis Cvetanovich ◽  
Anirudh K. Gowd ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Return To Work ◽  
Functional Outcomes ◽  
Return To Sport ◽  
Postoperative Outcome ◽  
Rotator Cuff Tears ◽  
Return To Sports ◽  
Superior Capsular Reconstruction ◽  
One Year

Objectives: Superior capsular reconstruction (SCR) is a relatively new procedure to address irreparable rotator cuff tears and rotator cuff arthropathy. Biomechanical studies have produced favorable results on cadaveric models, but few studies have evaluated clinical outcomes, and none have addressed return to sport (RTS). The purpose of this study was to evaluate rates of RTS and functional outcomes after SCR compared to a reverse total shoulder arthroplasty (rTSA) matched cohort. Methods: A prospectively collected registry was queried retrospectively for consecutive patients who underwent SCR from 2015 to 2016. Inclusion criteria were ≥2 tendon irreparable rotator cuff tear by arthroscopic evaluation and minimum one-year follow up. All eligible SCR patients were matched by gender, age, handedness, and follow up time to patients that underwent rTSA with a similar preoperative diagnosis. All surgeries were performed by a single surgeon at one institution with consistent operative techniques. Patients were evaluated with the ASES questionnaire, VAS Pain Scale, as well as VR/SF-12 and VR6D. Patients were also administered a detailed outcomes survey regarding surgical history and return to sport and work activities. Results: Overall 75.0% of 32 eligible patients were available at follow up. Average age at surgery and follow up did not significantly differ between cohorts (p>0.500 both). Postoperative outcome scores for ASES, VAS, VR/SF-12, and VR6D did not differ (p>0.310 for all) between cohorts. Overall RTS rate was 77.8% for SCR and 87.5% for rTSA (p > 0.610). Average months to return to sports was significantly greater after SCR (7.3 ± 3.0) compared to rTSA (3.5 ± 2.2; p = 0.032). Patients in both cohorts participated in golf, weight-lifting, gym activity, basketball and cycling postoperatively. Direct RTS for these sports are displayed in Fig. 1. Return to work rate was 71.4% (10/14) SCR and 50.0% (4/8) rTSA (p = 0.326) at average 2.7 ± 2.8 and 1.9 ± 1.9 months, respectively (p = 0.591). Stratified by duty status, rates of return to work were sedentary (100% both SCR and rTSA), light (100% both SCR and rTSA), moderate (0% SCR and 66.67% rTSA), and heavy (0% both SCR and rTSA). Overall, 85.71% SCR patients and 90.0% rTSA patients were satisfied or very satisfied with their general postoperative outcome. Conclusion: At short-term follow-up, SCR patients had RTS rates comparable to rTSA patients with irreparable rotator cuff tears. However, time to RTS was more prolonged after SCR. Outcome scores did not significantly differ between the two cohorts, suggesting that SCR may achieve postoperative function and pain reduction similar to rTSA at one year. Return to work was also similar, although rates were not as high as return to sport. When stratified by duty status, return to more intense physical work demands was not consistent in either cohort. Despite this, over 85% of SCR and rTSA patients were satisfied postoperatively. The findings of this study demonstrate that SCR patients have high RTS levels, as well as similar functional outcomes and satisfaction compared to rTSA for irreparable rotator cuff tears. Clinicians can utilize this information for preoperative counseling, particularly with younger more athletic patients, considering SCR or rTSA for an irreparable rotator cuff tear.

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