Early Efficacy Assessment of Arthroscopic Lower Trapezius Transfer With Tendon Autograft in the Management of Massive Irreparable Posterosuperior Rotator Cuff Tears

Objectives: To explore the indications and surgical techniques for arthroscopic lower trapezius transfer (LTT) with tendon autograft in managing massive irreparable posterosuperior rotator cuff tears (PSRCTs); to validate the feasibility, safety, and efficacy of this technique.Methods: This study retrospectively enrolled 23 patients with massive irreparable PSRCTs, admitted to and followed up by the Taizhou Hospital of Zhejiang province between July 2020 and April 2021, and treated with ipsilateral LTT and ipsilateral hamstring tendon autograft. The control group consisted of 23 patients with massive RCTs receiving conventional repair procedures within the same frame. Follow-up data at the preoperative visit, and postoperative month 3 were collected to assess the active range of motion, Constant–Murley Score (CMS),American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), University of California, Los Angeles (UCLA)shoulder score, visual analog scale (VAS)and the post-operative MRI results, all of which could provide a comprehensive postoperative early efficacy assessment.Results: Three months follow-up visits were completed for all patients, revealing improvements in all aspects compared to the preoperative state, with no complications, such as postoperative infection of surgical sites and nerve injuries of infection and nerve injury. The distribution of active shoulder range of motion of patients and function scores with two types of operation was as follow: angles of flexion and lifting (130.00° ± 31.55° vs. 90.78° ± 19.85°), abduction (123.26° ± 30.47°vs. 85.87° ± 18.74°), external rotation at side (101.74° ± 14.74° vs. 91.74° ± 11.92°), external rotation at 90° abduction (41.52° ± 21.97° vs. 24.57° ±12.60°), VAS (0.74± 0.81 vs. 1.87 ±0.87), CMS(56.3 ± 13.01 vs. 48.30 ± 8.38), UCLA shoulder score (24.04 ± 2.88 vs.20.96 ± 3.47), ASES (72.91 ± 9.99 vs.60.74 ± 8.84). Significantly better improvements were found in the study group on month 3.19 of 23 patients in the study group and 17 of 23 patients in the control group underwent MRI on the 3 months follow up. Retear was found in only one patient who had grade 4 subscapularis tendon injury, However, revision was not performed due to postoperative pain relief and functional improvement.Conclusion: Compared to conventional repair procedures, in the early postoperative period, LTT with tendon autograft could achieve better pain relief, more rapid motor functional recovery, and higher functional scores for massive irreparable PSRCTs.

Quadriceps Tendon Autograft in Pediatric ACL Reconstruction: Graft Dimensions and Prediction of Size on Preoperative MRI

Background: There is increased interest in quadriceps autograft anterior cruciate ligament (ACL) reconstruction in the pediatric population. Purpose: To evaluate children and adolescents who underwent ACL reconstruction using a quadriceps autograft to determine the properties of the harvested graft and to assess the value of demographic, anthropometric, and magnetic resonance imaging (MRI) measurements in predicting the graft size preoperatively. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective database search was performed from January 2018 through October 2020 for patients undergoing ACL reconstruction. Patients <18 years old at the time of surgery in whom a quadriceps tendon autograft was used were selected. Demographic data and anthropometric measurements were recorded, and graft measurements were abstracted from the operative notes. Knee MRI scans were reviewed to measure the quadriceps tendon thickness on sagittal cuts. Graft length and diameter were then correlated with anthropometric and radiographic data. Results: A total of 169 patients (98 male) were included in the final analysis, with a median age of 15 years (range, 9-17 years). A tendon length ≥65 mm was harvested in 159 (94%) patients. The final graft diameter was 8.4 ± 0.7 mm (mean ± SD; range, 7-11 mm). All patients had a graft diameter ≥7 mm, and 139 (82%) had a diameter ≥8 mm. Preconditioning decreased the graft diameter by a mean 0.67 ± 0.23 mm. Age ( P = .04) and quadriceps thickness on MRI ( P = .003) were significant predictors of the final graft diameter. An MRI sagittal thickness >6.7 mm was 97.4% sensitive for obtaining a graft ≥8 mm in diameter. Conclusion: Our findings suggest that tendon-only quadriceps autograft is a reliable graft source in pediatric ACL reconstruction, yielding a graft diameter ≥8 mm in 82% of pediatric patients. Furthermore, preoperative MRI measurements can be reliably used to predict a graft of adequate diameter in children and adolescents undergoing ACL reconstruction, with a sagittal thickness >6.7 mm being highly predictive of a final graft size ≥8 mm.

Higher Rate of Return to Preinjury Activity Levels After Anterior Cruciate Ligament Reconstruction With a Bone–Patellar Tendon–Bone Versus Hamstring Tendon Autograft in High-Activity Patients: Results From the New Zealand ACL Registry

Background: In primary anterior cruciate ligament (ACL) reconstruction, a bone–patellar tendon–bone (BTB) autograft is associated with lower ipsilateral failure rates. BTB autografts are associated with a higher rate of contralateral ACL injuries, which some clinicians view as a marker of success of the BTB autograft. However, there is a lack of evidence on whether BTB autografts improve the rate of return to activity and sport. Purpose: To compare the rate of return to preinjury activity levels in high-activity patients after ACL reconstruction with BTB autograft or hamstring tendon autograft. Study Design: Cohort study; Level of evidence, 3. Methods: In a high-activity cohort of patients recorded between 2014 and 2018 in the New Zealand ACL Registry, prospectively collected data on preinjury and postoperative Marx activity scores were analyzed. The proportion of patients who returned to their preinjury activity levels at 1- and 2-year follow-up was compared between graft types. Results: Overall, 11.3% (208/1844) of patients returned to their preinjury activity levels at 1-year follow-up, and 15.5% (184/1190) returned at 2-year follow-up. At 1-year follow-up, 17.2% of patients with a BTB autograft returned to their preinjury activity levels compared with 9.3% of patients with a hamstring tendon autograft (adjusted odds ratio, 1.59 [95% CI, 1.16-2.17]; P = .004). At 2-year follow-up, 23.3% of patients with a BTB autograft had returned to their preinjury activity levels compared with 13.3% of patients with a hamstring tendon autograft (adjusted odds ratio, 1.63 [95% CI, 1.14-2.34]; P = .008). Male sex and younger age were associated with a higher rate of return to activity at both follow-up time points. Conclusion: The use of BTB autografts increased the odds of returning to preinjury activity levels at early follow-up. A higher rate of return to activity is a possible explanation for the higher rate of contralateral ACL injuries with the use of BTB autografts.