EXPERIENCIA CLINICA EN PROTESIS REVERSA DE HOMBRO EN CENTRO MEDICO NAVAL

Problem Statement: The total reverse arthroplasty of man is a suitable therapeutic option for shoulder osteoarthritis associated with cuff rotator tear, massive rotator cuff tear mainly, medializing the rotation center of the shoulder joint, thus replacing the supraspinatus, recovering degree of freedom of movement of the shoulder with the promising clinical results described in the literature, interest has arisen on the part of the traumatology and orthopedics service to evaluate the clinical evolution of the patients operated with this procedure, and generate the knowledge that can be integrated later in studies of May scientific validity. Objective: Objective: to describe the clinical outcome of patients undergoing surgery, with total reverse shoulder arthroplasty, after 6 months of surgery in a naval medical center. Methodology: Type of study: an observational, cross-sectional, retrospective study was carried out. Population: 8 patients que fueron intervenidos quirúrgicamente con artroplastia total reversa de hombro. The DASH, Constan and Simple Shoulder Test tests were applied, which were applied preoperatively and after 6 months of the surgical intervention, and the description and analysis of data was carried out with a statistical program. Results: there was clinical improvement in most patients on the DASH scale with average disability improvement of 59% to 36%, Constan scale from 25.7 to 49.6, Simple Shoulder Test from 3.1 to 5.6. Conclusion. The total reverse shoulder prosthesis is a suitable alternative with adequate clinical results for patients with rotator cuff tear, massive rotator cuff tear.

A NEW TECHNIQUE FOR AUGMENTATION OF MASSIVE ROTATOR CUFF RECONSTRUCTION USING THE BICEPS TENDON ALONG WITH TENODESIS

The purpose of this study is to describe a new, minimally invasive massive rotator cuff tear reconstruction technique that uses the biceps tendon and to compare the results of this novel technique with primer repair. Eighteen patients were operated on a minimally invasive biological reconstruction of the massive rotator cuff tear using the biceps tendon, together with tenodesis. A further 23 patients underwent operations using anchors during the same period. The difference in postoperative UCLA scores between the two groups was not statistically signicant, but the postoperative Constant score was signicantly higher for the new technique, while the postoperative VAS score was signicantly lower for the new technique. Massive rotator cuff tear reconstruction using the biceps tendon as a graft, together with tenodesis, was feasible using the technique described here and was associated with good middle term clinical and functional outcomes, with a low re-rupture rate.

The choice of the optimal graft for superior capsule reconstruction of the shoulder with massive rotator cuff tear.

Background. The hypothesis of the study was that knowledge about the mechanical properties of biological tissues will help surgeons to choose a transplant. Аim: to determine the optimal type of graft, based on the assessment of the mechanical properties of three types of grafts used for the superior capsule reconstruction of the shoulder joint with massive rotator cuff tear. Methods. In the experimental work, 3 types of biological tissues were studied: allografts fascia lata and dura mater, DX Reinforcement Matrix, Arthrex. The experiment was divided into two parts. In the first part, the mechanical strength at rupture of the samples was evaluated and compared, in the second for resistance to the applied vertical stitch. The type of tests performed included uniaxial stretching. Results. Fascia lata allograft has the maximum tensile strength, and the dura mater allograft has the minimum. All three materials showed a good value of elongation before fracture. The largest value of the maximum force during eruption was recorded for DX Reinforcement Matrix and was 33.5 N. The minimum value was recorded in the fascia lata allograft and is almost 10 N. Conclusion. Fascia lata allograft and DX Reinforcement Matrix, Arthrex have optimal mechanical characteristics and can be recommended as grafts for the superior capsule reconstruction of the shoulder joint with massive rotator cuff tear

Acute massive rotator cuff rupture with posterior shoulder dislocation: arthroscopic novel repair of a rare injury. A case report

Acute massive rotator cuff tears and posterior shoulder dislocations are an extremely rare association, and a vast majority are treated by open surgery. We present a case of a man in his 20s who suffered closed left shoulder trauma after a road traffic accident. He was initially diagnosed with posterior shoulder dislocation and a reduction was successfully performed. However, the patient still complained of persistent weakness during active movements. We found a massive rotator cuff tear involving all the rotator cuff tendons, with significant supraspinatus retraction and persistent posterior shoulder subluxation. He underwent an all-arthroscopic repair of the rotator cuff with a double-row technique in the subscapularis, supraspinatus and infraspinatus muscles. Capsular repair and tenodesis of the biceps tendon were also performed. The patient had good recovery, reaching full preinjury function 3 months after surgery with a successful return to his regular activities.

Anchor Site Fracture Following Arthroscopic Rotator Cuff Repair – A Case Report and Review of the Literature

Introduction: Fractures at the anchor site following arthroscopic rotator cuff repair are rare and only a few case reports have been described. We report two additional well-documented cases of this uncommon post-operative complication and provide a review of the current literature. Case Report: A 48-year-old male underwent arthroscopic rotator cuff repair (ARCR) due to a massive rotator cuff tear. Nine weeks postoperatively, the patient suffered a humeral head fracture at the anchor site of the ARCR after trauma. Despite subsequent surgical treatment with open reduction and internal fixation, the patient demonstrates with excellent functional outcome scores at 2-year follow-up. Conclusion: Humeral head fractures are a rare complication after ARCR. The use of intraosseous anchors requires careful consideration regarding positioning and quantity used. Keywords: Rotator cuff, arthroscopy, complication, anchor, Speed Bridge, fracture, osteochondral defect.

Long-Term Outcomes of Massive Rotator Cuff Tear Repair: A Systematic Review

Background: With an increase in the treatment options available for massive rotator cuff tears, understanding the long-term outcomes of the chosen modality is important. Questions/Purpose: The purpose of this study was to systematically review the available literature on repair of massive rotator cuff repairs and learn the longevity of outcomes, the failure rate, outcomes after failure, and any contributing factors to poor outcomes or failure. Methods: We conducted a systematic review of the MEDLINE, Cochrane, and Embase databases to find studies that investigated the long-term results of repair of massive rotator cuff repairs. Studies were excluded if they did not stratify results of massive tears, provide a definition for a massive rotator cuff tear, or report isolate patients with long-term follow-up. Results: Six studies met the inclusion criteria, for a total of 472 shoulders; average patient age was 57.6 years. Follow-up ranged from 119 to 240 months. Outcome scores improved significantly following repair and were maintained throughout follow-up. The repair failure rate across studies was 39.2%. Patients who suffered retear had significantly worse outcome scores than patients with intact tendons at long-term follow-up. Conclusions: The existing literature on long-term follow-up after massive rotator cuff repair is scarce and not of high level of evidence. This review found repair of massive rotator cuff tears leads to long-term maintained improvements in outcome measures. Failure of repair is quite common, but results following failure are superior to preoperative outcomes.