What is the Optimal Reconstruction Option after the Resection of Proximal Humeral Tumors? A Systematic Review

Purpose: The proximal humerus is a common location for both primary and metastatic bone tumors. There are numerous reconstruction options after surgical resection. There is no consensus on the ideal method of reconstruction. Methods: A systematic review was performed with a focus on the surgical reconstructive options for lesions involving the proximal humerus. Results: A total of 50 articles and 1227 patients were included for analysis. Reoperation rates were autograft arthrodesis (11%), megaprosthesis (10%), RSA (17%), hemiarthroplasty (26%), and osteoarticular allograft (34%). Mechanical failure rates, including prosthetic loosening, fracture, and dislocation, were highest in allograft-containing constructs (APC, osteoarticular allograft, arthrodesis) followed by arthroplasty (hemiarthroplasty, RSA, megaprosthesis) and lowest for autografts (vascularized fibula, autograft arthrodesis). Infections involving RSA (9%) were higher than hemiarthroplasty (0%) and megaprosthesis (4%). Postoperative function as measured by MSTS score were similar amongst all prosthetic options, ranging from 66% to 74%, and claviculo pro humeri (CPH) was slightly better (83%). Patients were generally limited to active abduction of approximately 45° and no greater than 90°. With resection of the rotator cuff, deltoid muscle or axillary nerve, function and stability were compromised even further. If the rotator cuff was sacrificed but the deltoid and axillary nerve preserved, active forward flexion and abduction were superior with RSA. Discussion: Various reconstruction techniques for the proximal humerus lead to relatively similar functional results. Surgical choice should be tailored to anatomic defect and functional requirements.

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Cement augmentation of suture anchors in the proximal humerus during rotator cuff repair improves pullout strength: a systematic review

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2020-000603 ◽

2021 ◽

pp. jisakos-2020-000603

Author(s):

Jeff S Kimball ◽

Anirudh K Gowd ◽

Brian R Waterman ◽

Seth L Sherman ◽

Jorge Chahla ◽

...

Keyword(s):

Systematic Review ◽

Rotator Cuff ◽

Rotator Cuff Repair ◽

Proximal Humerus ◽

Cement Augmentation ◽

Suture Anchors ◽

Inclusion Criteria ◽

Pullout Strength ◽

Pullout Force ◽

Cuff Repair

ImportanceRotator cuff pathology is a growing concern in the ageing population. If cement augmentation of suture anchors improves pullout strength, its application can potentially be applied in cases of poor bone quality to prevent anchor failure.ObjectiveTo evaluate the biomechanical benefits and fixation strength of cement-augmented versus non-augmented suture anchors in the proximal humerus during rotator cuff repair (RCR).Evidence reviewA systematic review of PubMed, Embase and Cochrane Library was performed to identify all published articles reporting on biomechanical analysis of suture anchors in the shoulder in a cadaveric model. Inclusion criteria required fresh-frozen specimens, placement in the footprint of the proximal humerus, and comparative assessment of fixation constructs with or without polymethylmethacrylate (PMMA) or bioabsorbable composite cement augmentation. Biomechanical testing procedure, cement augmentation method and pullout force were assessed.FindingsAfter review of 105 abstracts, seven full manuscripts met inclusion criteria. Six of seven studies reported statistically significant differences in mean pullout force between augmented (three PMMAs, three composites, one PMMA vs composite) and non-augmented anchors. Of two studies evaluating cycles to failure, both found a significant increase in the augmented versus non-augmented anchors. Of two studies stratifying by anchor position, both investigations identified significant differences in mean pullout strength between augmented and non-augmented anchors at the posteromedial and anterolateral anchor positions.Conclusions and relevanceCement augmentation of suture anchors in cadaveric humeri for RCR improves pullout strength regardless of cement type used or anchor position. Cement augmentation may provide a viable option for future clinical application.Level of evidenceIV, systematic review.

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«Terrible triad» of the shoulder. Biomechanicalsemi-natural modeling andjustificationto rotator cuff restoration

EUREKA Health Sciences ◽

10.21303/2504-5679.2021.001838 ◽

2021 ◽

pp. 17-23

Author(s):

Oleksii Sukhin ◽

Sergii Strafun ◽

Andriy Lysak ◽

Igor Lazarev

Keyword(s):

Rotator Cuff ◽

Humeral Head ◽

Shoulder Joint ◽

Tendon Rupture ◽

Deltoid Muscle ◽

Axillary Nerve ◽

Vicious Circle ◽

Terrible Triad ◽

Spiral Computed ◽

Traction Load

The aim of this study: was determine the force of tension and deformation of axillary nerve in rupture rotator cuff and paresis of deltoid muscle of the shoulder joint. Material and methods: Semi-natural modelling based on the axial scans spiral computed tomography of the intact shoulder joint was performed to determine the degree of traction load on the axillary nerve with distal displacement shoulder head and tendon rupture which paresis of the deltoid muscle. Result: The values of deformations for axillary nerve being at the limit of tissue strength at distal displacement of humeral head of the model by 50 %, progressively increased with increasing distal displacement of humeral head to 100 % of its diameter, reaching values 1.7 times higher than the strength nervous tissue. Conclusion: The progressive changes occurring in the axillary nerve under the action of traction loads, and as a consequence of its ischemia, over time can lead not only to demyelination, but also to the defeat of the axons themselves atrophy of its fibers. In turn, deltoid muscle atrophy increases the traction load on the affected axillary nerve, which forms a vicious circle. The only possible option to "break" the vicious circle is restore the stabilizing structures damaged during the injury, among which one of the most important is the tendons of the rotator cuff of the shoulder. Surgical restoration of the integrity rotator cuff of the shoulder reduces the traction load acting on the axillary nerve, which in turn significantly improves the conditions for reinnervation of the deltoid muscle.

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Fibular epiphyseal transfer: the peroneal vessels revisited

Australasian Journal of Plastic Surgery ◽

10.34239/ajops.v1i2.123 ◽

2018 ◽

Vol 1 (2) ◽

pp. 100-102

Author(s):

Adrian D Murphy ◽

Christopher J Coombs

Keyword(s):

Rotator Cuff ◽

Peroneal Nerve ◽

Proximal Humerus ◽

Common Peroneal Nerve ◽

Lateral Approach ◽

Peroneal Artery ◽

Fibula Head ◽

Vascularized Fibula ◽

Pedicle Length ◽

The Common

The case of a seven-year-old boy with a Ewing’s sarcoma of the humerus diaphysis extending into the epiphysis proximally. He underwent chemotherapy followed by 12 cm resection of the proximal humerus with preservation of rotator cuff. Reconstruction was performed using a 15 cm vascularized fibula epiphyseal transfer raised using a postero-lateral approach based on the peroneal artery and its venae commitans. The common peroneal nerve was protected proximally and all motor branches were preserved. The pedicle length was 7cm. When isolated on the peroneal artery, bleeding was seen at the level of the epiphysis and periosteum of the fibula head.

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ANTEROLATERAL APPROACHES FOR PROXIMAL HUMERAL OSTEOSYNTHESIS: A SYSTEMATIC REVIEW

Acta Ortopédica Brasileira ◽

10.1590/1413-785220192703215572 ◽

2019 ◽

Vol 27 (3) ◽

pp. 178-182

Author(s):

Guilherme Grisi Mouraria ◽

Américo Zoppi Filho ◽

Fernando Kenji Kikuta ◽

Lucas Moratelli ◽

Márcio Alves Cruz ◽

...

Keyword(s):

Systematic Review ◽

Proximal Humerus ◽

Functional Results ◽

Axillary Nerve ◽

Functional Tests ◽

Level Of Evidence ◽

Safe Alternative ◽

Direct Exposure ◽

Muscular Retraction ◽

Deltopectoral Approach

ABSTRACT Objective: Anterolateral approaches for proximal humerus osteosynthesis have great advantages because they allow direct exposure of the lateral aspect of the humerus without the muscular retraction seen in the deltopectoral approach. However, much resistance is found among surgeons due to the potential risk of iatrogenic injury to the axillary nerve. To identify the incidence of axillary nerve iatrogenic lesions and evaluate the functional results of proximal humerus osteosynthesis with locking plates using anterolateral approaches. Methods: The literature review followed the PRISMA protocol. Results: A total of 23 articles were selected from 786 patients submitted to anterolateral approaches. Three cases (0.38%) of iatrogenic axillary nerve lesions were confirmed. The results of the functional tests were similar to those of the deltopectoral approach. Conclusion: Anterolateral approaches are a viable and safe alternative for proximal humerus osteosynthesis with locking plate. Subacromial impingement was the most frequent complication. Level of Evidence II, Systematic Review.

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Rotator cuff related shoulder pain. Describing home exercise adherence and the use of behavior change interventions to promote home exercise adherence: a systematic review of randomized controlled trials

Physical Therapy Reviews ◽

10.1080/10833196.2021.1935106 ◽

2021 ◽

pp. 1-24

Author(s):

Kevin Hall ◽

Anthony Grinstead ◽

Jeremy S. Lewis ◽

Chris Mercer ◽

Ann Moore ◽

...

Keyword(s):

Systematic Review ◽

Rotator Cuff ◽

Behavior Change ◽

Randomized Controlled Trials ◽

Shoulder Pain ◽

Exercise Adherence ◽

Home Exercise ◽

Controlled Trials ◽

Randomized Controlled ◽

Behavior Change Interventions

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Non-operative orthobiologic use for rotator cuff disorders and glenohumeral osteoarthritis: A systematic review

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-201844 ◽

2020 ◽

pp. 1-16

Author(s):

David M. Robinson ◽

Christine Eng ◽

Steven Makovitch ◽

Joshua B. Rothenberg ◽

Stephanie DeLuca ◽

...

Keyword(s):

Systematic Review ◽

Rotator Cuff ◽

Cohort Studies ◽

Randomized Clinical Trials ◽

Platelet Rich Plasma ◽

Inclusion Criteria ◽

Serious Adverse Events ◽

Bias Risk ◽

Glenohumeral Osteoarthritis ◽

Functional Outcome Measures

BACKGROUND: Shoulder pain from rotator cuff pathology and glenohumeral osteoarthritis is a common entity encountered in musculoskeletal practices. Orthobiologic agents are being increasingly used as a treatment option and understanding their safety and efficacy is necessary. OBJECTIVE: To systematically evaluate the available evidence for orthobiologic use in rotator cuff and glenohumeral pathology. METHODS: A systematic review was undertaken following PRISMA guidelines. Randomized clinical trials (RCTs) and prospective cohort studies evaluating non-operative treatment with prolotherapy, platelet-rich plasma (PRP), or medicinal signaling cells (MSCs) for rotator cuff pathology and glenohumeral osteoarthritis were included. Bias risk assessments used were the Cochrane tool and Newcastle-Ottawa score. RESULTS: The search yielded 852 potential articles, of which 20 met the inclusion criteria with a breakdown of 5 prolotherapy, 13 PRP, and 2 MSC. Sixteen studies were RCTs and 4 were cohort studies. Six studies were deemed “low risk of bias or good quality”. Efficacy results were mixed, and no serious adverse events were reported from orthobiologic treatment. CONCLUSIONS: Orthobiologics offer a relatively safe management option with inconclusive evidence for or against its use for rotator cuff pathology. No studies on glenohumeral osteoarthritis met the inclusion criteria. Adoption of standardized preparation reporting and consistent use of functional outcome measures is imperative for future studies to consider.

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