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

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.

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Graft Tensioning in Superior Capsular Reconstruction Improves Glenohumeral Joint Kinematics in Massive Irreparable Rotator Cuff Tears: A Biomechanical Study of the Influence of Superior Capsular Reconstruction on Dynamic Shoulder Abduction

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120957424 ◽

2020 ◽

Vol 8 (10) ◽

pp. 232596712095742

Author(s):

Felix Dyrna ◽

Daniel P. Berthold ◽

Lukas N. Muench ◽

Knut Beitzel ◽

Cameron Kia ◽

...

Keyword(s):

Rotator Cuff ◽

Glenohumeral Joint ◽

Shoulder Function ◽

Joint Kinematics ◽

Biomechanical Study ◽

Rotator Cuff Tears ◽

Shoulder Abduction ◽

Mean Values ◽

Superior Capsular Reconstruction ◽

Significant Difference

Background: Superior capsular reconstruction (SCR) for massive, irreparable rotator cuff tears has become more widely used recently; however, ideal tensioning of the graft and the influence on joint kinematics remain unknown. Purpose/Hypothesis: The purpose of this study was to assess the effects of graft tensioning on glenohumeral joint kinematics after SCR using a dermal allograft. The hypothesis was that a graft fixed under tension would result in increased glenohumeral abduction motion and decreased cumulative deltoid forces compared with a nontensioned graft. Study Design: Controlled laboratory study. Methods: A total of 10 fresh-frozen cadaveric shoulders were tested using a dynamic shoulder simulator. Each shoulder underwent the following 4 conditions: (1) native, (2) simulated irreparable supraspinatus (SSP) tear, (3) SCR using a nontensioned acellular dermal allograft, and (4) SCR using a graft tensioned with 30 to 35 N. Mean values for maximum glenohumeral abduction and cumulative deltoid forces were recorded. The critical shoulder angle (CSA) was also assessed. Results: Native shoulders required a mean (±SE) deltoid force of 193.2 ± 45.1 N to achieve maximum glenohumeral abduction (79.8° ± 5.8°). Compared with native shoulders, abduction decreased after SSP tears by 32% (54.3° ± 13.7°; P = .04), whereas cumulative deltoid forces increased by 23% (252.1 ± 68.3 N; P = .04). The nontensioned SCR showed no significant difference in shoulder abduction (54.1° ± 16.1°) and required deltoid forces (277.8 ± 39.8 N) when compared with the SSP tear state. In contrast, a tensioned graft led to significantly improved shoulder abduction compared with the SSP tear state ( P = .04) although abduction and deltoid forces could not be restored to the native state ( P = .01). A positive correlation between CSA and maximum abduction was found for the tensioned-graft SCR state ( r = 0.685; P = .02). Conclusion: SCR using a graft fixed under tension demonstrated a significant increase in maximum shoulder abduction compared with a nontensioned graft; however, abduction remained significantly less than the intact state. The nontensioned SCR showed no significant improvement in glenohumeral kinematics compared with the SSP tear state. Clinical Relevance: Because significant improvement in shoulder function after SCR may be expected only when the graft is adequately tensioned, accurate graft measurement and adequate tension of at least 30 N should be considered during the surgical procedure. SCR with a tensioned graft may help maintain sufficient acromiohumeral distance, improve clinical outcomes, and reduce postoperative complications.

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Can ultrasound suffice for triaging patients requiring surgical correction of rotator cuff tears—a comparative evaluation of ultrasound and magnetic resonance imaging

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00477-2 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Aniket Agarwal ◽

Kavita Vani ◽

Anurag Batta ◽

Kavita Verma ◽

Shishir Chumber

Keyword(s):

Rotator Cuff ◽

Biceps Tendon ◽

Surgical Correction ◽

Statistical Testing ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Partial Thickness ◽

Linear Probe ◽

Significant Difference ◽

Sensitivity Specificity

Abstract Background Objectives: To comparatively evaluate the role of ultrasound and MRI in rotator cuff and biceps tendon pathologies and to establish ultrasound as a consistently reproducible, quick and accurate primary investigation modality sufficient to triage patients requiring surgical correction of full thickness rotator cuff tears. Methods: Fifty patients, clinically suspected to have rotator cuff and/or biceps tendon pathologies, with no contraindications to MRI, were evaluated by US and MRI, in a prospective cross-sectional observational study. US was done with high-frequency linear probe, and MRI was done on a 1.5-T scanner using T1 oblique sagittal, proton density (PD)/T2 fat-suppressed (FS) oblique sagittal, T1 axial, PD/T2 FS axial, T1 oblique coronal, T2 oblique coronal and PD FS oblique coronal sequences. Statistical testing was conducted with the statistical package for the social science system version SPSS 17.0. The sensitivity, specificity, PPV, NPV and accuracy were also calculated to analyze the diagnostic accuracy of US findings correlating with MRI findings. A p value less than 0.05 was taken to indicate a significant difference. Results Mean age was 45 years; 74% patients were males; 77% females and 60% males had tears. Majority of patients with rotator cuff tears were in the sixth decade of life. The frequency of tears was higher among older patients. Fourteen percent of patients had full thickness tears while 64% had partial thickness tears. US was comparable to MRI for detection of full thickness tears with overall sensitivity, specificity, PPV and accuracy of 93.8%, 100%, 100% and 98.2%, respectively (p value < 0.001). For partial thickness tears, US had overall sensitivity, specificity, PPV and accuracy of 75.6%, 82.6%, 89.5% and 78%, respectively (p value < 0.001), as compared to MRI. Subacromial-subdeltoid bursal effusion and long head of biceps tendon sheath effusion were common associated, though, non-specific findings. Conclusion Ultrasound findings in our study were found to be in significant correlation with findings on MRI in detection of rotator cuff tears. US was equivalent to MRI in detection of full thickness tears and fairly accurate for partial thickness tears. Therefore, US should be considered as the first line of investigation for rotator cuff pathologies.

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Nonarthroplasty Surgical Treatment Options for Massive, Irreparable Rotator Cuff Tears

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118805385 ◽

2018 ◽

Vol 6 (11) ◽

pp. 232596711880538 ◽

Cited By ~ 9

Author(s):

Trevor J. Carver ◽

Matthew J. Kraeutler ◽

John R. Smith ◽

Jonathan T. Bravman ◽

Eric C. McCarty

Keyword(s):

Rotator Cuff ◽

Clinical Outcomes ◽

Humeral Head ◽

Latissimus Dorsi ◽

Rotator Cuff Tears ◽

Arthroscopic Debridement ◽

Partial Repair ◽

Latissimus Dorsi Transfer ◽

Superior Capsular Reconstruction ◽

Graft Interposition

Massive, irreparable rotator cuff tears (MIRCTs) provide a significant dilemma for orthopaedic surgeons. One treatment option for MIRCTs is reverse total shoulder arthroplasty. However, other methods of treating these massive tears have been developed. A search of the current literature on nonoperative management, arthroscopic debridement, partial repair, superior capsular reconstruction (SCR), graft interposition, balloon spacer arthroplasty, trapezius transfer, and latissimus dorsi transfer for MIRCTs was performed. Studies that described each surgical technique and reported on clinical outcomes were included in this review. Arthroscopic debridement may provide pain relief by removing damaged rotator cuff tissue, but no functional repair is performed. Partial repair has been suggested as a technique to restore shoulder functionality by repairing as much of the rotator cuff tendon as possible. This technique has demonstrated improved clinical outcomes but also fails at a significantly high rate. SCR has recently gained interest as a method to prohibit superior humeral head translation and has been met with encouraging early clinical outcomes. Graft interposition bridges the gap between the retracted tendon and humerus. Balloon spacer arthroplasty has also been recently proposed and acts to prohibit humeral head migration by placing a biodegradable saline-filled spacer between the humeral head and acromion; it has been shown to provide good clinical outcomes. Both trapezius and latissimus dorsi transfer techniques involve transferring the tendon of these respective muscles to the greater tuberosity of the humerus; these 2 techniques have shown promising restoration in shoulder function, especially in a younger, active population. Arthroscopic debridement, partial repair, SCR, graft interposition, balloon spacer arthroplasty, trapezius transfer, and latissimus dorsi transfer have all been shown to improve clinical outcomes for patients presenting with MIRCTs. Randomized controlled trials are necessary for confirming the efficacy of these procedures and to determine when each is indicated based on specific patient and anatomic factors.

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Biomechanics in an Incomplete Versus Complete Supraspinatus Tear: A Cadaveric Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120964476 ◽

2020 ◽

Vol 8 (12) ◽

pp. 232596712096447

Author(s):

Danil Rybalko ◽

Aimee Bobko ◽

Farid Amirouche ◽

Dmitriy Peresada ◽

Awais Hussain ◽

...

Keyword(s):

Rotator Cuff ◽

Humeral Head ◽

Rotator Cuff Tears ◽

Vertical Position ◽

Study Objective ◽

Supraspinatus Tear ◽

Complete Tear ◽

Significant Difference ◽

Static Conditions ◽

Biomechanical Comparison

Background: Degenerative and traumatic changes to the rotator cuff can result in massive and irreparable rotator cuff tears (RCTs). Purpose/Hypothesis: The study objective was to conduct a biomechanical comparison between a small, incomplete RCT and a large, complete RCT. We hypothesized that the incomplete supraspinatus (SS) tear would lead to an incremental loss of abduction force and preserve vertical position of the humeral head, while a complete SS tear would cause superior humeral migration, decrease functional deltoid abduction force, and increase passive range of motion (ROM). Study Design: Controlled laboratory study. Methods: Six cadaveric shoulders were evaluated using a custom testing apparatus. Each shoulder was subjected to 3 conditions: (1) intact/control, (2) 50%, full-thickness, incomplete SS tear, and (3) 100%, complete SS tear. Deltoid abduction force, superior humeral head migration, and passive ROM were measured in static conditions at 0°, 30°, and 60° of glenohumeral abduction, respectively. Results: The intact SS resulted in a mean deltoid abduction force of 2.5, 3.3, and 3.8 N at 0°, 30°, and 60° of abduction, respectively. Compared with the intact shoulder, there was no significant difference in mean abduction force seen in the incomplete tear, while the force was significantly decreased by 52% at 30° of abduction in the complete tear ( P = .009). Compared with the incomplete tear, there were significant decreases in abduction force seen in the complete tear, by 33% and 48% (0.9 N and 1.1 N) at 0° and 30° of abduction, respectively ( P = .04 and .004). The intact configuration experienced a mean superior humeral head migration of 1.5, 1.4, and 1.1 mm at 0°, 30°, and 60° of abduction, respectively. The complete tear resulted in a superior migration of 3.0 and 4.4 mm greater than the intact configuration at 0° and 30° of abduction, respectively ( P = .001). There was a 5° and 10° increase in abduction ROM with 50% and 100% tears, respectively ( P = .003 and .03). Conclusion: An incomplete SS tear does not significantly alter the biomechanics of the shoulder, while a large, complete SS tear leads to a significant superior humeral migration, a decreased deltoid abduction force, and a mild increase in passive ROM. Clinical Relevance: Our findings demonstrate the effects of large SS tears on key biomechanical parameters, as they progress from partial tears.

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Irreparable Rotator Cuff Tears: A Biomechanical Comparison of Superior Capsuloligamentous Complex Reconstruction Techniques and an Interpositional Graft Technique

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119864590 ◽

2019 ◽

Vol 7 (8) ◽

pp. 232596711986459 ◽

Cited By ~ 1

Author(s):

Tim Leschinger ◽

Katharina Besch ◽

Cansu Aydin ◽

Manfred Staat ◽

Martin Scaal ◽

...

Keyword(s):

Rotator Cuff ◽

Glenohumeral Joint ◽

Supraspinatus Tendon ◽

Rotator Cuff Tears ◽

Neutral Position ◽

Management Options ◽

Significant Difference ◽

Intact Condition ◽

Point Condition ◽

Biomechanical Comparison

Background: Irreparable rotator cuff tears lead to superior translation of the humeral head. Numerous surgical management options are available to treat the condition. Purpose: To compare superior capsule stability among different types of patch grafting in irreparable rotator cuff tears. Methods: Six cadaveric shoulders were tested in a custom-designed shoulder testing system. Superior translation of the humerus and subacromial contact pressure were quantified in an intact condition (condition 1), after cutting the supraspinatus tendon (condition 2), and after additionally cutting the superior capsuloligamentous complex (condition 3). The results were compared among 3 types of patch grafting, in which capsule reconstruction was achieved by glenoidal 3-point (condition 4) or 2-point (condition 5) fixation or by affixing a graft below the acromion (condition 6). Results: No significant difference in subacromial pressure was measured by reconstruction with 2 or 3 anchors compared with conditions 1 and 2 ( P > .05). However, with 3-point fixation, lower levels of pressure were measured than with 2-point fixation. Moreover, superior translation values were lower with 3-point fixation; the same applied for values of the preserved capsule as compared with the torn capsule. In condition 6, a significant increase in pressure in the neutral position was documented ( P < .05). Conclusion: The superior capsuloligamentous complex plays an important role in stabilizing the glenohumeral joint. The results suggest that with additional medial anchoring at the coracoid base, the depressing and centering effect of the superior complex can probably be regained in a more physiological way compared with a reconstructed capsule with 2 glenoid attachments or with an interpositional graft below the acromion.

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Prevalence and Grading of Rotator Cuff and Labral Injuries in Shoulder Pain and Instability using MRI: ACross-sectional Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2021/48773.14845 ◽

2021 ◽

Author(s):

Ashok Srikar Chowdhary ◽

Naresh Babu Lakshmipathi Nikhil ◽

Nidhi Hemendra Chandrakar ◽

Nidhi Raj Buddaraju

Keyword(s):

Rotator Cuff ◽

Shoulder Pain ◽

Biceps Tendon ◽

Supraspinatus Tendon ◽

Sectional Study ◽

Rotator Cuff Injuries ◽

Rotator Cuff Injury ◽

Biceps Pulley ◽

Study Population ◽

Long Head

Introduction: Shoulder joint is a highly mobile joint but is prone for rotator cuff injuries and dislocations. It is necessary to accurately diagnose rotator cuff and labral injuries so that appropriate plan of action for treatment can be taken. Magnetic Resonance Imaging (MRI) can be used to diagnose and describe the extent of rotator cuff tendon and labral injuries and any secondary rotator cuff muscle abnormalities. Aim: To study the demographic profile of patients presenting with shoulder pain and instability, identify the various rotator cuff injuries causing shoulder pain, identify the rotator cuff interval lesions causing microinstability, identify the various labral and bony pathologies in instability, describe the MRI features of the rotator cuff, rotator cuff interval, labral and bony injuries. Materials and Methods: This study was a cross-sectional study of patients with symptoms of either shoulder pain or instability who underwent MRI evaluation of the shoulder in the Department of Radiodiagnosis, Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India, from July 2018 to December 2020. The study population consisted of 54 patients with either shoulder pain or instability who underwent MRI of shoulder. All the MRI scans of the shoulder in this study were performed using 1.5 Tesla Siemens Magnetom Avanto (Tim 76x18) MR machine using a flex coil. Results: The study population consisted of 54 patients comprising of 38 males and 16 females. The age of the patients ranged from 20-77 years. Majority of the patients were older than 50 years constituting about 33.33% of the total study population. Rotator cuff injury was the commonest cause of pain. Tendinosis was the commonest type of rotator cuff injury followed by partial-thickness and full-thickness tendon tears. The commonest grade of tendinosis was mild or grade 1. Supraspinatus tendon was the most commonly affected tendon followed by subscapularis and infraspinatus tendons. Teres minor tendon was normal in all the cases. Anterior instability was the commonest type of instability with equal prevalence of soft tissue Bankart, bony Bankart and Perthes lesions. Biceps pulley lesions resulted in long head of biceps tendon instability, microinstability and internal impingement. Conclusion: Rotator cuff injuries are the commonest cause of shoulder pain and are seen more frequently after the fifth decade. Shoulder instability is most commonly seen in young male adults. Tendinosis is the commonest type of rotator cuff injury. Supraspinatus tendon is the most commonly injured tendon. Anterior instability is the commonest type of shoulder instability. Biceps pulley lesions result in long head of biceps tendon instability, microinstability and internal impingement. MRI can diagnose interstitial or intrasubstance tendon tears which are not visualised on arthroscopy. MRI description of tendon and labral tears, tendon retraction and muscle atrophy can guide the orthopaedician during arthroscopy and in treatmentplanning.

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A Single Knotless-anchor for Bursal-side Ellman III Partial Thinkness Rotar Cuff Tears: A Biomechanical Cadaveric Study

10.21203/rs.3.rs-141471/v1 ◽

2021 ◽

Author(s):

Gang Liu ◽

Baolu Zhang ◽

Qian Zhao ◽

Xiaoguang Guo ◽

Yang Liu ◽

...

Keyword(s):

Rotator Cuff ◽

Surgical Techniques ◽

Supraspinatus Tendon ◽

Rotator Cuff Tears ◽

Loading Test ◽

Double Row ◽

Knotless Anchor ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Background: Bursal-side partial thickness rotator cuff tears (PTRCTs) are frequent lesions with the treatment of multiple surgical techniques. However, to the best of our knowledge, no single knotless-anchor with two Ethicon 2# repair technique has been reported.Methods: Bursal-side PTRCTs (Ellman type III, 75% thickness of tears) were created in the supraspinatus tendon on 16 fresh-frozen cadaveric shoulders. The specimens were randomized into two groups of 8 each: (1) Group A (Transtendon repairs), a single knotless-anchor repair with two Ethicon 2#, (2) Group B, the Conversion repair (Double-row, DR). Each specimen underwent cyclic loading test from 5 to 100 N by 50 cycles, then followed by an ultimate failure test. The displacement of greater tuberosity (mm) and ultimate (N) were recorded.Results: Compared with the load-to-failure test, there was no significant difference between Group A and B (Group A, 359.25±17.91N; Group B, 374.38±13.75 N, P＞0.05). There were also no significant differences in the rotator cuff displacement of 10 mm(Group A, 190.50±8.52N; Group B, 197.25±6.84, P＞0.05) and 15mm (Group A, 282.25±12.20 N; Group B, 291.13±14.74 N, P＞0.05). However, concerning the displacement of 3 mm and 5mm, we found a significant difference in these two groups (P<0.05).Conclusions: A single knotless-anchor with two Ethicon 2# for Bursal-side Ellman III PTRCTs is a simple, cheap, and effective technique that we could choose.

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STRUCTURAL PROPERTIES OF THE SUPRASPINATUS TENDON IN TWO JOINT POSITIONS

Journal of Musculoskeletal Research ◽

10.1142/s0218957701000489 ◽

2001 ◽

Vol 05 (02) ◽

pp. 105-112

Author(s):

Andreas M. Halder ◽

Mark E. Zobitz ◽

Fred Schultz ◽

Kai-Nan An

Keyword(s):

Rotator Cuff ◽

Structural Properties ◽

Ultimate Load ◽

Tensile Force ◽

Testing Machine ◽

Supraspinatus Tendon ◽

Rotator Cuff Tears ◽

Anterior Portion ◽

Arm Position ◽

Significant Difference

The supraspinatus tendon is frequently involved in rotator cuff tears. It has been suggested that joint position affects the structural mechanics of the tendon–bone complex. The purpose of this study was to determine regional variations in structural properties of the supraspinatus tendon in two glenohumeral positions. Supraspinatus tendons from 17 fresh frozen cadavers were divided into three strips of equal width and tested with a material-testing machine. The arm orientation was either in hanging position or 60 degrees glenohumeral abduction corresponding to 90 degrees arm abduction assuming 30 degrees scapular rotation. Tensile force, tendon elongation and failure mode were recorded. Overall, there was no significant difference in structural properties between hanging arm position and 60 degrees of glenohumeral abduction (p>0.05). However, the mean ultimate load (385 N, SD 56 N) and mean ultimate stress (14 MPa, SD 3 MPa) of the anterior tendon section with the arm in glenohumeral abduction were lower in 60 degrees abduction than in the hanging arm position (611 N, SD 276 N; 24 MPa, SD 10 MPa). In hanging arm position, the anterior tendon portion had a significantly greater ultimate load and stiffness than the middle and posterior portions (p<0.05). The regional variation in structural properties substantiates the clinical finding that rotator cuff ruptures easily extend posteriorly. Our study suggests that glenohumeral abduction reduces the failure strength of the supraspinatus tendon, specifically of its anterior portion. In our study, the maximum load of the anterior portion was substantially higher than predicted maximum loads transmitted physiologically through the entire tendon.

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Superior Capsule Reconstruction for Reinforcement Before Arthroscopic Rotator Cuff Repair Improves Cuff Integrity

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00007 ◽

2018 ◽

Vol 6 (3_suppl) ◽

pp. 2325967118S0000

Author(s):

Teruhisa Mihata ◽

Thay Q. Lee ◽

Kunimoto Fukunishi ◽

Takeshi Kawakami ◽

Yukitaka Fujisawa ◽

...

Keyword(s):

Rotator Cuff ◽

Humeral Head ◽

Rotator Cuff Repair ◽

Supraspinatus Tendon ◽

Fatty Degeneration ◽

Fascia Lata ◽

Rotator Cuff Tears ◽

Grade 3 ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Objectives: We developed the superior capsule reconstruction (SCR) technique for surgical treatment of irreparable rotator cuff tears. In these patients, SCR restores shoulder stability and muscle balance, consequently improving shoulder function and relieving pain. In this study, we evaluated whether SCR for reinforcement before arthroscopic rotator cuff repair (ARCR) improves cuff integrity, especially in the case of severely degenerated supraspinatus tendon. Methods: A series of 32 consecutive patients (mean age, 69.0 years) with severely degenerated but reparable rotator cuff tears (medium size: 1-3 cm, and large size: 3-5 cm) underwent SCR using fascia lata autografts for reinforcement before ARCR. To determine the indications for SCR for reinforcement, the severity of degeneration in the torn supraspinatus tendon was assessed. We evaluated fatty degeneration in the muscle by using the Goutallier grade; we also scored retraction of the torn tendon (grade 0: no retraction; grade 1: torn edge on the greater tuberosity; grade 2: torn edge on the lateral half of the humeral head; grade 3: torn edge on the medial half of the humeral head; grade 4: torn edge on the glenoid) and tendon quality (grade 0: normal; grade 1: slightly thin, or slight fatty degeneration in the tendon part; grade 2: severely thin, or severe fatty degeneration in the tendon part; grade 3: severely thin, and severe fatty degeneration in the tendon part; grade 4: no tendon). In patients classified with grade 3 or 4 in at least two of these three categories, arthroscopic SCR was performed for reinforcement, after which the torn tendon was repaired over the fascia lata graft. To assess the benefit of SCR for reinforcement, the results from these 32 patients were compared with those after ARCR alone in 91 consecutive patients with medium (1-3 cm) to large (3-5 cm) rotator cuff tears (mean age, 66.7 years). Torn tendons were repaired by using double-row suture-bridges with and without SCR for reinforcement. By using t- and chi-square tests, we compared the American Shoulder and Elbow Surgeons (ASES) score, active shoulder range of motion (ROM), and cuff integrity (Sugaya MRI classification) between ARCR with and without SCR as well as between before surgery and at final follow-up (mean, 19 months; 12 to 40 months). A significant difference was defined as P < 0.05. Results: All 32 patients who underwent SCR before ARCR had no postoperative re-tear and demonstrated type I cuff integrity (sufficient thickness with homogeneously low intensity), whereas those treated with ARCR without SCR had a 5.5% incidence (5/91 all patients) of postoperative re-tear, and 22.1% (19/86 healed patients) had type II (partial high-intensity area) or III (insufficient thickness) cuff integrity. ASES score, active elevation, active external rotation, and active internal rotation increased significantly after ARCR both with and without SCR ( P < 0.001) (Table). Postoperative ASES score and active ROM did not differ significantly between ARCR with and without SCR, but the Goutallier grade of the supraspinatus was significantly higher for ARCR with SCR (mean, 2.8) than for ARCR alone (mean, 2.1) ( P < 0.0001). Conclusion: SCR for reinforcement prevented postoperative re-tear after ARCR and improved the quality of the repaired tendon on MRI. Furthermore, postoperative functional outcomes were similar in patients who underwent ARCR alone and those who also underwent SCR, even though degeneration of the torn tendons was greater in the latter group. [Table: see text]

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Rates and Risk Factors for Revision Open and Arthroscopic Proximal Biceps Tenodesis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118825473 ◽

2019 ◽

Vol 7 (2) ◽

pp. 232596711882547 ◽

Cited By ~ 5

Author(s):

Brian Forsythe ◽

Avinesh Agarwalla ◽

Richard N. Puzzitiello ◽

Randy Mascarenhas ◽

Brian C. Werner

Keyword(s):

Risk Factors ◽

Rotator Cuff ◽

Protective Factors ◽

Biceps Tendon ◽

Rotator Cuff Tears ◽

Biceps Tenodesis ◽

Level Of Evidence ◽

Significant Difference ◽

Male Sex ◽

Long Head

Background: Biceps tenodesis may be performed for symptomatic tendinopathy or tearing of the long head of the biceps tendon. Biceps tenodesis is also commonly performed as an adjunctive procedure. However, the indications and prevalence of biceps tenodesis have expanded. Purpose: To establish the incidence and risk factors for revision biceps tenodesis. Study Design: Case-control study; Level of evidence, 2. Methods: The PearlDiver database of Humana patient data was queried for patients undergoing arthroscopic or open biceps tenodesis (Current Procedural Terminology [CPT] 29828 and CPT 23430, respectively) from 2008 through the first quarter of 2017. Patients without a CPT laterality modifier were excluded from analysis. Revision biceps tenodesis was defined as patients who underwent subsequent ipsilateral open or arthroscopic biceps tenodesis. The financial impact of revision biceps tenodesis was also calculated. Multivariate binomial logistic regression was performed to identify risk factors for revision biceps tenodesis, such as patient demographics as well as concomitant procedures and diagnoses. Odds ratios (ORs) and 95% CIs were calculated, and all statistical comparisons with P < .05 were considered significant. Results: There were 15,257 patients who underwent biceps tenodesis. Of these, 9274 patients (60.8%) underwent arthroscopic biceps tenodesis, while 5983 (39.2%) underwent open biceps tenodesis. A total of 171 patients (1.8%) and 111 patients (1.9%) required revision biceps tenodesis after arthroscopic and open biceps tenodesis, respectively ( P = .5). Male sex (OR, 1.38 [95% CI, 1.04-1.85]; P = .02) was the only independent risk factor for revision biceps tenodesis after the index open biceps tenodesis. After arthroscopic biceps tenodesis, age >45 years (OR, 0.58 [95% CI, 0.39-0.89]; P = .01) and concomitant rotator cuff tear (OR, 0.58 [95% CI, 0.47-0.71]; P < .001) were independent protective factors for revision biceps tenodesis. The total cost of revision biceps tenodesis after open and arthroscopic biceps tenodesis was US$3427.95 and US$2174.33 per patient, respectively. Conclusion: There was no significant difference in the revision rate between arthroscopic and open biceps tenodesis. Risk factors for revision surgery included male sex for open biceps tenodesis, while age >45 years and rotator cuff tears were protective factors for arthroscopic biceps tenodesis.

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