Dataset Information

Transtendinous Rotator Cuff Tear Repair with Bone Marrow Aspirate Concentrate Dermal Allograft Augmentation.

ABSTRACT: Rotator cuff tears involving the musculotendinous junction with a significant amount of tendon still attached to the footprint laterally represent a challenging scenario for shoulder arthroscopists. Because of these challenges, adjunctive techniques to bridge tissue gaps may be required, and biologic augmentation may be considered to improve the healing environment. The following technique presents a stepwise approach to accomplishing the dual goals of a stable anatomic repair and biologic augmentation of this difficult pattern of rotator cuff pathology.

SUBMITTER: Neff P

PROVIDER: S-EPMC8085041 | biostudies-literature | 2021 Apr

REPOSITORIES: biostudies-literature

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Publications

Transtendinous Rotator Cuff Tear Repair with Bone Marrow Aspirate Concentrate Dermal Allograft Augmentation.

Neff Peter P Franklin Don B DB Jones Daniel L DL Lang Sarah D SD Nadone Haley R HR Gilmer Brian B BB Guttmann Dan D

Arthroscopy techniques 20210302 4

Rotator cuff tears involving the musculotendinous junction with a significant amount of tendon still attached to the footprint laterally represent a challenging scenario for shoulder arthroscopists. Because of these challenges, adjunctive techniques to bridge tissue gaps may be required, and biologic augmentation may be considered to improve the healing environment. The following technique presents a stepwise approach to accomplishing the dual goals of a stable anatomic repair and biologic augme ...[more]

PMID: 33981539

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Project description:Arthroscopic rotator cuff repair (RCR) is a popular treatment for rotator cuff tears. Retear after RCR remains a significant concern even with modern techniques. Augmentation of RCR has been described using multiple different grafts, one option including a cannulated dermal allograft implant (DePuy Mitek). The utilization of this implant avoids significantly increased surgical time, allows for augmentation at the weakest area of repair, and does not lead to any wasted allograft material. Technique Video Video 1 In this video, augmented arthroscopic rotator cuff repair with cannulated dermal allograft is performed on a patient’s right shoulder. Diagnostic arthroscopy is first performed, addressing any associated intra-articular pathology. Preparation for repair is performed in the standard fashion, debriding the footprint of the tear and decorticating the greater tuberosity. A double-row, transosseus equivalent repair construct is used. The medial row anchor is double loaded with a #2 suture and 2.5 mm suture tape. Sutures are passed through the anterior and posterior aspect of the tear. The suture tapes are passed through the central aspect of the tear together using a separate looped suture. The posterior suture and one of the tapes are shuttled into the posterolateral portal for preparation of placement for the posterolateral row anchor. The cannulated dermal allograft is placed onto the suture tape using the applicator and pushed into place near the cannula. The implant is reduced inside the shoulder using a knot pusher. The sutures are loaded on a self-punching anchor and malleted into place. Sutures are sequentially tightened, and when the tear is reduced, the anchor is screwed down to the final position. This process is repeated for the anterolateral row anchor but with the implant being placed on the suture for that anchor. The repair is then inspected, ensuring acceptable reduction and good position of the cannulated dermal allograft implant.

Project description:Myosteatosis is the pathological accumulation of lipid that occurs in conjunction with atrophy and fibrosis following skeletal muscle injury or disease. Little is known about the mechanisms by which lipid accumulates in myosteatosis, but many studies have demonstrated the degree of lipid infiltration negatively correlates with muscle function and regeneration. Our goal was to identify biochemical pathways that lead to muscle dysfunction and lipid accumulation in injured rotator cuff muscles, a model that demonstrates severe myosteatosis. Adult rats were subjected to a massive tear to the rotator cuff musculature. After a period of either 0 (healthy control), 10, 30, or 60 days, muscles were prepared for RNA sequencing, shotgun lipidomics, metabolomics, biochemical measures, electron microscopy, and muscle fiber contractility. Following rotator cuff injury, there was a decrease in muscle fiber specific force production that was lowest at 30d. There was a dramatic time dependent increase in triacylglyceride content. Interestingly, genes related to not only triacylglyceride synthesis, but also lipid oxidation were largely downregulated over time. Using bioinformatics techniques, we identified that biochemical pathways related to mitochondrial dysfunction and reactive oxygen species were considerably increased in muscles with myosteatosis. Long chain acyl-carnitines and L-carnitine, precursors to beta-oxidation, were depleted following rotator cuff tear. Electron micrographs showed injured muscles displayed large lipid droplets within mitochondria at early time points, and an accumulation of peripheral segment mitochondria at all time points. Several markers of oxidative stress were elevated following rotator cuff tear. The results from this study suggest that the accumulation of lipid in myosteatosis is not a result of canonical lipid synthesis, but occurs due to decreased lipid oxidation in mitochondria. A failure in lipid utilization by mitochondria would ultimately cause an accumulation of lipid even in the absence of increased synthesis. Further study will identify whether this process is required for the onset of myosteatosis.

Dataset Information

Transtendinous Rotator Cuff Tear Repair with Bone Marrow Aspirate Concentrate Dermal Allograft Augmentation.

Publications

Transtendinous Rotator Cuff Tear Repair with Bone Marrow Aspirate Concentrate Dermal Allograft Augmentation.

Similar Datasets

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