Arthroscopic Superior Capsular Reconstruction with Achilles Tendon Allograft for Massive and Revision Rotator Cuff Tears

Llanos-Rodríguez, Álvaro; Escandón-Almazán, Pilar; Espejo-Reina, Alejandro; Nogales-Zafra, José; Espejo-Baena, Alejandro

doi:10.1016/j.eats.2021.10.017

Cited by 7 publications

(3 citation statements)

References 16 publications

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“…The original technique by Mihata et al utilized 2 suture anchors to fix the graft at the glenoid neck at the superior and posterosuperior locations, while other authors propose variations in this technique with 3 anchors or anchors in the anterosuperior and posterosuperior locations. 2 , 13 , 16 , 22 , 25 The results of this study demonstrated no significant difference in anchor strength at the anterosuperior, superior, or posterosuperior locations, suggesting that any 2 of the 3 positions can provide effective fixation during SCR. This would indicate that selection of anchor location is based on surgeon preference and factors such as access to the glenoid neck may be more important when selecting where to place the glenoid anchors.…”

Section: Discussionmentioning

confidence: 62%

A biomechanical study to optimize superior capsular reconstruction operative technique

Dasari¹,

Vadhera²,

Menendez³

et al. 2024

JSES International

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Section: Discussionmentioning

confidence: 62%

A biomechanical study to optimize superior capsular reconstruction operative technique

Dasari¹,

Vadhera²,

Menendez³

et al. 2024

JSES International

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“…Patients with severe ligament and tendon injuries often undergo autograft or allograft tendon transplantation [4,8,12,15,23]. However, concerns about potential viral, bacterial, and fungal contamination of implanted allografts have arisen [3,7].…”

Section: Discussionmentioning

confidence: 99%

Can the Sterilization Protocol Be Improved to Enhance the Healing of Allograft Tendons? An In Vivo Study in Rabbit Tendons

Zhang,

Xu,

Zhao

et al. 2024

Clin Orthop Relat Res

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Background Peracetic acid and irradiation are common sterilization methods for allograft tendons; however, under some conditions, both methods adversely affect the fiber arrangement and ultimate load of the tendon. An in vitro study showed that low-dose peracetic acid combined with irradiation may be less detrimental to allograft tendon structure and properties, possibly because the breakdown of peracetic acid can lead to an enlargement of the interstitial spaces and an increase in porosity. Questions/purposes Using a rabbit Achilles tendon model, we asked: What is the effect of peracetic acid-ethanol combined irradiation on (1) the histopathology and fiber diameter of the allograft tendon, (2) tensile creep and load-to-failure biomechanical properties of allograft tendons, and (3) healing of the treated tendon in vivo compared with fresh-frozen allograft and peracetic acid-ethanol sterilization at 4 and 8 weeks? Methods The Achilles tendons used in this study were sourced from euthanized 10-week-old male New Zealand White rabbits previously used for ophthalmic experiments. All allografts were divided into three groups: fresh-frozen group (control group, n = 20), peracetic acid-ethanol sterilization group (n =20), and peracetic acid-ethanol combined irradiation group (n = 20). The sterilization protocols were performed per a predetermined plan. In the peracetic acid-ethanol sterilization group, the tendon tissues were covered with the peracetic acid-ethanol sterilization solution (1% peracetic acid for 30 minutes). In the peracetic acid-ethanol combined irradiation group, the tendon tissues were covered with the peracetic acid-ethanol sterilization solution (0.2% peracetic acid for 30 minutes) and were subjected to 15 kGy gamma irradiation. Thirty 10-week-old male New Zealand White rabbits received bilateral Achilles tendon allografts surgically. Tendon samples from each group were harvested at 4 weeks (n = 30) and 8 weeks (n = 30) postoperatively. For each timepoint, eight tissues were used for histologic staining and electron microscopy, 15 tissues were used for biomechanical testing, and seven tissues were used for hydroxyproline assay and quantitative polymerase chain reaction. Histopathology was determined qualitatively by hematoxylin and eosin and Masson staining, while fiber diameter was measured quantitatively by transmission electron microscopy. Biomechanical properties were measured using cyclic loading tests and load-to-failure tests. The healing outcome was quantitatively judged through healing-related genes and proteins. Results At 4 weeks and 8 weeks postoperatively, the peracetic acid-ethanol combined irradiation group visually demonstrated the best continuity and minimal peripheral adhesions. Histologic staining showed that tendon fibers in the peracetic acid-ethanol combined irradiation group maintained consistent alignment without notable disruptions or discontinuities, and there was a qualitatively observed increase in the number of infiltrating cells compared with the control group at the 4-week timepoint (444 ± 49 /mm2 versus 256 ± 43 /mm2, mean difference 188 /mm2 [95% confidence interval 96 to 281]; p < 0.001). At 8 weeks postoperatively, the tendon fiber diameter in the peracetic acid-ethanol combined irradiation groups was similar to that of the control group (0.23 ± 0.04 µm versus 0.21 ± 0.03 µm, mean difference 0.02 µm [95% CI -0.04 to 0.08]; p = 0.56). At 8 weeks postoperatively, the peracetic acid-ethanol combined irradiation group exhibited better properties in terms of both ultimate load (129 ± 15 N versus 89 ± 20 N, mean difference 40 N [95% CI 7 to 73]; p = 0.02) and energy absorption density (17 ± 6 kJ/m2 versus 8 ± 4 kJ/m2, mean difference 8 kJ/m2 [95% CI 0.7 to 16]; p = 0.004) compared with the control group. Gene expression analysis revealed higher expression levels of COL1A1 (2.1 ± 0.8 versus 1.0 ± 0, mean difference 1.1 [95% CI 0.1 to 2.1]; p = 0.003) and MMP13 (2.0 ± 0.8 versus 1.0 ± 0, mean difference 1.0 [95% CI 0.4 to 1.6]; p = 0.03) in the peracetic acid-ethanol combined irradiation group than in the control group. There was a higher amount of collagen Type I in tendons treated with peracetic acid-ethanol combined irradiation than in the control group (0.36 ± 0.03 versus 0.31 ± 0.04, mean difference 0.05 [95% CI 0.01 to 0.09]; p = 0.02). Conclusion Treatment with peracetic acid-ethanol combined irradiation did not have any discernible adverse effect on the histology, fiber diameter, enzymatic resistance, collagen content, or biomechanical strength of the allograft tendons compared with the control group. Peracetic acid-ethanol combined irradiation treatment had a positive impact on remodeling of the extracellular matrix and realignment of collagen fibers. Clinical Relevance This sterilization method could be helpful to expand the scope and frequency with which allogeneic materials are applied. The long-term healing effect and strength of allograft tendons must be tested before clinical use, and it is necessary to conduct comparative studies on autografts and synthetic materials that are currently widely used clinically.

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“…Alternative grafting options for SCR have recently expanded to include the long head of the biceps (LHB) tendon autograft ( 63 , 64 , 65 , 66 , 67 ), FL autograft layered over polyethylene terephthalate scaffold ( 68 ), FL allograft ( 69 ), Achilles tendon allograft ( 70 , 71 ), dermal xenograft ( 72 , 73 ), and synthetic grafts ( 74 ). Based on the available literature, we have found that using alternative grafts can lead to adequate results that are comparable to those of more conventional grafting options.…”

Section: Technical Considerationsmentioning

confidence: 99%

Superior capsular reconstruction: current evidence and limits

Claro

Fonte

2023

EFORT Open Reviews

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The treatment of rotator cuff tears (RCTs) has evolved. Nonsurgical treatment is adequate for many patients; however, for those for whom surgical treatment is indicated, rotator cuff repair provides reliable pain relief and good functional results. However, massive and irreparable RCTs are a significant challenge for both patients and surgeons. Superior capsular reconstruction (SCR) has become increasingly popular in recent years. It works by passively restoring the superior restriction of the humeral head, thus restoring the pair of forces and improving the kinematics of the glenohumeral joint. Early clinical results using fascia lata (FL) autograft were promising in terms of pain relief and function. The procedure has evolved, and some authors have suggested that FL autografts could be replaced by other methods. However, surgical techniques for SCR are highly variable, and patient indications remain undefined. There are concerns that the available scientific evidence does not support the popularity of the procedure. This review aimed to critically evaluate the biomechanics, indications, procedural considerations, and clinical outcomes associated with the SCR procedure.

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Arthroscopic Superior Capsular Reconstruction with Achilles Tendon Allograft for Massive and Revision Rotator Cuff Tears

Cited by 7 publications

References 16 publications

A biomechanical study to optimize superior capsular reconstruction operative technique

A biomechanical study to optimize superior capsular reconstruction operative technique

Can the Sterilization Protocol Be Improved to Enhance the Healing of Allograft Tendons? An In Vivo Study in Rabbit Tendons

Superior capsular reconstruction: current evidence and limits

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