scholarly journals The best options in superior capsular reconstruction

2021 ◽  
Vol 24 (2) ◽  
pp. 114-121
Author(s):  
Dong Hyun Kim ◽  
Young Soo Jung ◽  
Kyung-Rock Kim ◽  
Jong Pil Yoon
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Young Patients ◽  
Surgical Techniques ◽  
Rotator Cuff Tears ◽  
Functional Requirements ◽  
Loss Of Function ◽  
Massive Rotator Cuff Tears ◽  
Superior Capsular Reconstruction ◽  
Surgical Options

Irreparable massive rotator cuff tears cause pain, loss of function, and a decrease in range of motion, which cause serious disturbances in daily life. Young patients, in particular, are active and have relatively high functional requirements, and their surgical options are limited. Superior capsular reconstruction (SCR) was first proposed for irreparable massive rotator cuff tears, good clinical results have been reported in short-term follow up. Since then, SCR has been used increasingly worldwide for irreparable massive rotator cuff tears, and various studies have been published on clinical outcomes, biomechanical outcomes, surgical techniques, and graft types. This article reviews the optimal graft and surgical options for improving clinical outcomes in SCR.

scholarly journals Treatment of irreparable rotator cuff tears with superior capsular reconstruction

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Nobuyuki Yamamoto ◽  
Eiji Itoi
Keyword(s):  
Rotator Cuff ◽  
Fatty Infiltration ◽  
Young Patients ◽  
Surgical Techniques ◽  
Optimal Solution ◽  
Clinical Results ◽  
Rotator Cuff Tears ◽  
Level Of Evidence ◽  
Early Results ◽  
Superior Capsular Reconstruction

Abstract The treatment of irreparable rotator cuff tears with severe muscle atrophy and fatty infiltration remains a challenge, especially in young patients. Many surgical procedures for these tears have been reported. No one surgical treatment has proven to be an optimal solution. Recently, reconstruction of the superior capsule with an allograft or autograft has gained popularity. In this manuscript, we reviewed the biomechanical and clinical reports that have assessed superior capsular reconstruction and clarified the issues about the surgical techniques and indication which have been discussed recently. Reconstruction of the superior capsule has shown promising early results with good clinical outcomes. Biomechanical studies have suggested various mechanisms of this procedure. Although good clinical results and biomechanical data are available, more research is necessary to further define the surgical indications and improve the surgical outcomes of this procedure. Level of evidence Level V.

scholarly journals Nonarthroplasty Surgical Treatment Options for Massive, Irreparable Rotator Cuff Tears

2018 ◽  
Vol 6 (11) ◽  
pp. 232596711880538 ◽  
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.

Massive rotator cuff tears: pathomechanics, current treatment options, and clinical outcomes

2015 ◽  
Vol 24 (9) ◽  
pp. 1493-1505 ◽  
Author(s):  
Joshua A. Greenspoon ◽  
Maximilian Petri ◽  
Ryan J. Warth ◽  
Peter J. Millett
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Treatment Options ◽  
Current Treatment ◽  
Rotator Cuff Tears ◽  
Massive Rotator Cuff Tears

scholarly journals Balloon spacers in the management of massive rotator cuff tears: a focus on clinical outcomes

2021 ◽  
Vol 6 ◽  
pp. 19-19
Author(s):  
Derrick M. Knapik ◽  
Brady T. Williams ◽  
Nikhil N. Verma
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Rotator Cuff Tears ◽  
Massive Rotator Cuff Tears

Irreparable Large to Massive Rotator Cuff Tears With Low-Grade Fatty Degeneration of the Infraspinatus Tendon: Minimum 7-Year Follow-up of Fascia Autograft Patch Procedure and Partial Repair

2021 ◽  
pp. 036354652110435
Author(s):  
Daisuke Mori ◽  
Kazuha Kizaki ◽  
Noboru Funakoshi ◽  
Fumiharu Yamashita ◽  
Yasuyuki Mizuno ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Fatty Degeneration ◽  
Rotator Cuff Tears ◽  
Low Grade ◽  
Partial Repair ◽  
Massive Rotator Cuff Tears ◽  
Infraspinatus Tendon

Background: In shoulders with irreparable massive rotator cuff tears (RCTs) with high-grade fatty degeneration (Goutallier stage 3 or 4) of the supraspinatus tendon and low-grade fatty degeneration (Goutallier stage 1 or 2) of the infraspinatus tendon (ISP), arthroscopic patch grafting (PG) has been reported as superior to partial repair (PR) regarding the ISP retear rate at short-term to midterm follow-up. However, the longer term outcomes are unclear. Purpose: To compare clinical and structural outcomes in the PG and PR groups at a minimum of 7 years postoperatively. Study Design: Cohort study; Level of evidence, 3. Methods: We evaluated 24 patients in the PG group and 24 patients in the PR group. We primarily used the Constant score for clinical outcomes and performed magnetic resonance imaging for structural outcomes in the PG and PR groups. The risk factors for a retear of the ISP were identified by univariate and multivariate (forward stepwise selection method) logistic regression analyses. We primarily compared values at midterm follow-up (<4 years) with values at the final follow-up (minimum 7 years) for each patient. Results: The mean midterm and final follow-up times for the PG group were 41.0 and 95.1 months, respectively, compared with 35.7 and 99.3 months, respectively, for the PR group. We found significant differences for the midterm and final follow-up Constant total scores in the PG and PR groups (midterm follow-up: 79.1 vs 69.9, respectively [ P = .001]; final follow-up: 76.0 vs 65.3, respectively [ P = .006]) and in the Constant strength scores (midterm follow-up: 14.6 vs 8.5, respectively [ P < .001]; final follow-up: 13.1 vs 8.3, respectively [ P = .001]). Treatment group (PR) was a significant predictor of an ISP retear in the logistic regression analysis (odds ratio, 3.545; P = .043). Conclusion: Patients with low-grade massive RCTs treated with PG or PR improved significantly in terms of clinical outcomes at the midterm and final follow-up time points. However, Constant scores were significantly better in the PG group at the final follow-up.

scholarly journals Clinical Outcomes of Arthroscopic Repair for Large or Massive Rotator Cuff Tear with Delamination: Comparison of Three Suture-Bridge Technique

2021 ◽  
Author(s):  
Atsushi Okubo ◽  
Tadahiko Yotsumoto ◽  
Nobuyoshi Watanabe ◽  
Teruyoshi Kajikawa ◽  
Shun Nakajima ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Double Layer ◽  
Rotator Cuff Tear ◽  
Fatty Degeneration ◽  
Rotator Cuff Tears ◽  
Suture Bridge ◽  
Cuff Tear ◽  
Massive Rotator Cuff Tears ◽  
The Mean

Abstract Background: Rotator cuff tear with delamination is considered as a risk factor for postoperative retear after rotator cuff repair. The purpose of this study was to compare clinical outcomes between 3 repair procedures for large or massive rotator cuff tears with delamination: conventional en masse suture bridge (EMSB), double-layer suture bridge (DLSB), and combination of double-layer suture bridge and modified Debyere-Patte (DLSB+DP) methods.Methods: A total of 53 shoulders of 52 patients who had large or massive rotator cuff tears with delamination were included. The patients were categorized into 3 groups: EMSB group comprised 18 patients, DLSB group comprised 24 shoulders of 23 patients, and DLSB+DP group comprised 11 patients. DP was applied for cases in which the rotator cuff was unable to be covered up to the footprint even though it was sufficiently mobilized. The mean postoperative follow-up period was 34.6 months (range, 24-72 months). Pre- and postoperative evaluations included the Constant scores and range of motion (ROM). Tendon integrity according to Sugaya classification, and fatty degeneration were also evaluated by magnetic resonance images (MRI).Results: The ROM significantly improved after the operation in all groups. Mean constant scores significantly improved (from 45.5±14.3 to 77.4±13.6, in the EMSB, from 45.5±11.6 to 87.6±11.4 in the DLSB, and from 46.3±11.2 to , and 88.0±10.5 in the DLSB+DP). Significant differences were noted in the postoperative Constant score (p<0.05: DLSB vs. EMSB , and p<0.05: DLSB+DP vs. EMSB)． The Constant pain score was better in the DLSB+DP than in the EMSB group. The mean pre-operative global fatty degeneration index was 1.52 in the EMSB group, 1.80 in the DLSB group, and 2.28 in the DLSB+DP group. Retear occurred in 27.8% in the EMSB group, 12.5% in the DLSB group, and 9.1% in the DLSB+DP group. Conclusions: Comparison of 3 groups demonstrated that DLSB and DLSB+DP achieved better clinical outcome than EMSB. DLSB+DP is useful for large or massive rotator cuff tears with severe fatty degeneration or for cases where presence of excessive tension is anticipated when repairing the torn cuff.

Sign in / Sign up

Export Citation Format

Share Document