Primary Rotator Cuff Bridging Reconstruction Shows Better Clinical and Radiographic Results Than Revision Bridging Reconstruction
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PROVIDER: S-EPMC10839609 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:A revision rotator cuff repair is a technically challenging surgical procedure. This can be further complicated by the presence of poor quality of the cuff tissue, as well as a large greater tuberosity cyst, typically located at the rotator cuff footprint. This Technical Note discusses the surgical approach to deal with a revision rotator cuff tear with a large humeral head cyst. This described arthroscopic technique is performed in a single-stage procedure using a human dermal allograft (GraftJacket) for augmentation. This technique was specifically designed to (1) address the limited area for anchor placement, (2) use a bone graft, demineralized bone matrix, for repairing the bone cyst, and (3) optimize the biology for healing by augmenting the reconstruction with GraftJacket.
| S-EPMC5799591 | biostudies-literature
Project description:Irreparable posterior-superior rotator cuff tear is encountered quite often in clinical practice. Bridging the tendon defect with various materials is reasonable. However, optimal bridging structures and techniques are still being pursued. We introduce a rotator cuff bridging technique, rooting rotator cuff reconstruction. In this technique, autogenous tendon is used to make grafts. On the medial side, the graft tendons are suspended on the rotator cuff tendon. On the lateral side, the graft tendons are placed into tunnels through the tuberosities. The most critical steps of this technique are properly fabricating the humeral tunnels and suspending the graft tendons onto the rotator cuff tendon. We believe this technique will shed light on rotator cuff reconstruction.
| S-EPMC7953171 | biostudies-literature
Project description:Massive irreparable rotator cuff tears (RCT) in younger and active patients remain a significant clinical challenge to orthopaedic surgeons. Superior capsular reconstruction (SCR) has been presented as a way to restore the restraining effect of the superior joint capsule and the balanced force couples necessary for dynamic shoulder function; furthermore, it does not exclude future treatment options. The purpose of this article is to show a technical modification of the SCR in massive and revision RCT using Achilles tendon allograft as an effective static restraint to prevent superior migration of the humeral head due to its thickness and robustness, and performing a side-to-side repair on the greater tuberosity between the graft and the residual infraspinatus tendon to completely restore the superior stability of the shoulder joint.
| S-EPMC8821895 | biostudies-literature
Project description:Latissimus dorsi tendon transfer is a nonanatomic tendon transfer that is often considered a salvage procedure for failed repairs of massive rotator cuff tears. A rupture of the transferred latissimus tendon is an uncommon complication and there is limited literature on its management, especially in the young, active population without cuff arthropathy. In this article, we present a technique of managing a failed latissimus dorsi tendon transfer for a massive rotator cuff tear with an arthroscopic, anatomic bridging reconstruction using an acellular human dermal matrix allograft.
| S-EPMC6950775 | biostudies-literature
Project description:PurposeTo use a finite element method to construct a patch-bridge repair model for massive rotator cuff tears (MRCTs) and investigate the effects of different suture methods and knot numbers on postoperative biomechanics.MethodsA finite element model based on intact glenohumeral joint data was used for a biomechanical study. A full-thickness defect and retraction model of the supraspinatus tendon simulated MRCTs. Patch, suture, and anchor models were constructed, and the Marlow method was used to assign the material properties. Three suturing models were established: 1-knot simple, 1-knot mattress, and 2-knot mattress. The ultimate failure load, failure mode, stress distribution of each structure, and other biomechanical results of the different models were calculated and compared.ResultsThe ultimate failure load of the 1-knot mattress suture (71.3 N) was 5.6 % greater than that of the 1-knot simple suture (67.5 N), while that (81.5 N) of the 2-knot mattress was 14.3 % greater than that of the 1-knot mattress. The stress distribution on the patch and supraspinatus tendon was concentrated on suture perforation. Failure of the bridging reconstruction mainly occurred at the suture perforation of the patch, and the damage forms included cutting-through and isthmus pull-out.ConclusionA finite element model for the patch-bridging reconstruction of MRCTs was established, and patch-bridging restored the mechanical integrity of the rotator cuff. The 2-knot mattress suture was optimal for patch-bridging reconstruction of MRCTs.
| S-EPMC11635007 | biostudies-literature
Project description:A large to massive rotator cuff tear is a common issue that lacks reliable options to return a patient's range of motion and function when conservative treatment has failed. With up to 96% of massive rotator cuff repairs failing within the first 6 months of repair, surgeons have been searching for a reliable treatment option for this difficult subset of patients. Surgical options for massive, retracted rotator cuff tears include re-establishing the counterforce coupling of the rotator cuff with techniques such as a partial repair or superior capsular reconstruction, preventing superior humeral migration as seen with balloon spacer implantation, and eliminating pain generators with techniques such as biceps tenotomy; however, these do not reconstitute dynamic cuff control. More recently, an acellular dermal allograft, as seen in superior capsular reconstruction, has been used to reconstruct the remaining rotator cuff. We describe a technique using a fascia lata autograft to reconstruct the rotator cuff in the setting of a massive cuff tear. This is of particular importance in centers that lack the funding or institutional approval to use acellular dermal allografts that have been popularized to date.
| S-EPMC6993264 | biostudies-literature
Project description:Massive rotator cuff tears are particularly challenging to treat and severely limit the function of the shoulder. Compared with a small rotator cuff tear, massive tears are more unpredictable and usually present with low tendon quality. When performing an anatomical repair of the rotator cuff, the surgical treatment is often associated with failure of the construct. An alternative procedure that can be performed in the setting of a massive tear is superior capsular reconstruction (SCR), using an autograft or allograft. This procedure has been shown to be effective and is associated with positive treatment outcomes. Moreover, the combination of an SCR with an anatomic repair of the rotator cuff tendon may provide a stronger fixation for the rotator cuff and ultimately lead to a lower likelihood of retear and failure. The purpose of this Technical Note is to describe our preferred procedure for the treatment of a massive rotator cuff tear through SCR with superimposition of the repair of the native rotator cuff tendons.
| S-EPMC5795266 | biostudies-literature
Project description:BackgroundDespite advances in surgical techniques, the use of maximal repair to treat large or massive rotator cuff tears results in a high retear rate postoperatively. Currently, no randomized controlled trials have compared the outcomes of maximal repair with interposition dermal allograft bridging reconstruction.HypothesisWe hypothesized that large or massive rotator cuff tendon tears reconstructed using bridging dermal allograft would have better clinical outcomes 2 years postoperatively, as measured using the Western Ontario Rotator Cuff (WORC) index, than would those receiving the current gold standard treatment of debridement and maximal repair alone. We also expected that patients treated via bridging reconstruction using dermal allograft would have fewer postoperative failures as assessed using postoperative magnetic resonance imaging scans.Study designRandomized controlled trial; Level of evidence 1.MethodsA sample size of 30 patients (determined using a priori sample size calculation) with massive, retracted rotator cuff tears were randomly allocated to 1 of 2 groups: maximal repair or bridging reconstruction using dermal allograft. All patients completed questionnaires (WORC and Disabilities of the Arm, Shoulder and Hand [DASH]) preoperatively and postoperatively at 3 months, 6 months, 1 year, and 2 years. The primary outcome of this study was the WORC index at 2 years. Secondary outcomes included healing rate, progression of rotator cuff arthropathy, and postoperative acromiohumeral distance in both groups.ResultsPatients treated via bridging reconstruction using dermal allograft had better postoperative WORC and DASH scores (23.93 ± 24.55 and 15.77 ± 19.27, respectively) compared with patients who received maximal repair alone (53.36 ± 31.93 and 34.32 ± 23.31, respectively). We also noted increased progression to rotator cuff arthropathy in the maximal repair group with an increased retear rate when compared with the reconstruction group (87% and 21%, respectively; P < .001). The acromiohumeral distance was maintained in the reconstruction group but significantly decreased in the maximal repair group.ConclusionRotator cuff bridging reconstruction using a dermal allograft demonstrated improved patient-reported outcomes as measured using the WORC index 2 years postoperatively. This technique also showed favorable structural healing rates and decreased progression to arthropathy compared with maximal repair.Trial registrationClinicalTrials.gov (NCT01987973).
| S-EPMC8485417 | biostudies-literature
Project description:The indications for and techniques to accomplish revision rotator cuff repair continue to be challenging problems that surgeons face. Complexity of tears, poor tissue quality, retained hardware, and adhesions are routinely encountered during surgical intervention for failed rotator cuff repairs. A successful outcome for any revision rotator cuff repair is determined, in part, by the surgeon's ability to address these intraoperative issues in an optimum manner. The surgical technique described in this article outlines a comprehensive and stepwise approach that can aid the surgeon in developing an effective strategy to accomplish revision rotator cuff repair.
| S-EPMC8322629 | biostudies-literature
Project description:Irreparable rotator cuff tears in young patients can be challenging for the patient and orthopaedic surgeon. Interposition rotator cuff reconstruction has gained popularity in patients with retracted tears and a viable rotator cuff muscle belly. Superior capsular reconstruction is an emerging treatment option that was developed to restore native glenohumeral joint mechanics by creating a superior constraint, which provides a stable glenohumeral fulcrum. Reconstructing both the superior capsule and rotator cuff tendon in the setting of an irreparable tear may improve clinical results in younger patients with viable rotator cuff muscle belly and a maintained acceptable acromiohumeral distance.
| S-EPMC10323923 | biostudies-literature