High Clinical Failure Rate After Latissimus Dorsi Transfer for Revision Massive Rotator Cuff Tears

Muench, Lukas N.; Kia, Cameron; Williams, Ariel A.; Avery, Daniel; Cote, Mark P.; Reed, Nicholas; Arciero, Robert A.; Chandawarkar, Rajiv Y.; Mazzocca, Augustus D.

doi:10.1016/j.arthro.2019.07.034

Cited by 36 publications

(32 citation statements)

References 34 publications

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“…However, a lack of clear evidence-based guidelines and high clinical failure rates emphasize the incertitude on how to best treat this challenging patient cohort. 41…”

Section: Discussionmentioning

confidence: 99%

Comparison of Different Fixation Techniques of the Long Head of the Biceps Tendon in Superior Capsule Reconstruction for Irreparable Posterosuperior Rotator Cuff Tears: A Dynamic Biomechanical Evaluation

et al. 2021

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Background: In the past decade, superior capsular reconstruction has emerged as a potential surgical approach in young patients with irreparable posterosuperior rotator cuff tears (RCT) and absence of severe degenerative changes. Recently, the use of locally available and biological viable autografts, such as the long head of the biceps tendon (LHBT) for SCR has emerged, with promising early results. Purpose/Hypothesis: The purpose of this study was to investigate the effect of using the LHBT for reconstruction of the superior capsule on shoulder kinematics, along with different fixation constructs in a dynamic biomechanical model. The authors hypothesized that each of the 3 proposed fixation techniques would restore native joint kinematics, including glenohumeral superior translation (ghST), maximum abduction angle (MAA), maximum cumulative deltoid force (cDF), and subacromial peak contact pressure (sCP). Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric shoulders (mean age, 53.4 ± 14.2 years) were tested using a dynamic shoulder simulator. Each specimen underwent the following 5 conditions: (1) intact, (2) irreparable posterosuperior rotator cuff tear (psRCT), (3) V-shaped LHBT reconstruction, (4) box-shaped LHBT reconstruction, and (5) single-stranded LHBT reconstruction. MAA, ghST, cDF and sCP were assessed in each tested condition. Results: Each of the 3 LHBT techniques for reconstruction of the superior capsule significantly increased MAA while significantly decreasing ghST and cDF compared with the psRCT ( P < .001 and P < .001, respectively). Additionally, the V-shaped and box-shaped techniques significantly decreased sCP ( P = .009 and P = .016, respectively) compared with the psRCT. The V-shaped technique further showed a significantly increased MAA ( P < .001, respectively) and decreased cDF ( P = .042 and P = .039, respectively) when compared with the box-shaped and single-stranded techniques, as well as a significantly decreased ghST ( P = .027) when compared with the box-shaped technique. Conclusion: In a dynamic biomechanical cadaveric model, using the LHBT for reconstruction of the superior capsule improved shoulder function by preventing superior humeral migration, decreasing deltoid forces and sCP. As such, the development of rotator cuff tear arthropathy in patients with irreparable psRCTs could potentially be delayed. Clinical Relevance: Using a biologically viable and locally available LHBT autograft is a cost-effective, potentially time-saving, and technically feasible alternative for reconstruction of the superior capsule, which may result in favorable outcomes in irreparable psRCTs. Moreover, each of the 3 techniques restored native shoulder biomechanics, which may help improve shoulder function by preventing superior humeral head migration and the development of rotator cuff tear arthropathy in young patients with irreparable rotator cuff tears.

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“…However, a lack of clear evidence-based guidelines and high clinical failure rates emphasize the incertitude on how to best treat this challenging patient cohort. 41…”

Section: Discussionmentioning

confidence: 99%

Comparison of Different Fixation Techniques of the Long Head of the Biceps Tendon in Superior Capsule Reconstruction for Irreparable Posterosuperior Rotator Cuff Tears: A Dynamic Biomechanical Evaluation

et al. 2021

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“…However, a lack of clear evidence-based guidelines and high clinical failure rates emphasize the incertitude on how to best treat this challenging patient cohort. 34 Additionally, no consensus regarding which technique may result in the most favorable shoulder function has been elucidated to date. As such, recent studies have focused on using locally available and biologically viable autografts for reconstruction of the superior capsule.…”

Section: Discussionmentioning

confidence: 99%

A new approach to superior capsular reconstruction with hamstring allograft for irreparable posterosuperior rotator cuff tears: a dynamic biomechanical evaluation

Berthold¹,

Bell²,

Muench³

et al. 2021

Journal of Shoulder and Elbow Surgery

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Background: Superior capsular reconstruction (SCR) treatment of massive, symptomatic, irreparable rotator cuff tears (RCTs) has become a more recently used procedure. However, there is a lack of consensus surrounding optimal graft choice for the SCR technique, and current dermal grafts have increased cost and are technically challenging because of a need for multiple implants. The purpose of this study was to biomechanically investigate a biological lower-cost alternative as a support for the superior capsule reconstruction concept: an isolated semitendinosus tendon (STT) allograft and a combination graft with the long head of the biceps tendon (LHBT) in an established massive posterosuperior RCT cadaver model. Methods: Ten fresh-frozen cadaveric shoulders (53.3 AE 12.4 years: range: 26-65) were tested on an established dynamic shoulder simulator using dynamic muscle loading. Cumulative deltoid forces, maximum abduction angle, and superior humeral head translation were compared across 4 testing conditions: (1) intact state, (2) massively retracted (Patte III), irreparable posterosuperior RCT, (3) SCR repair using an STT allograft, and (4) SCR repair using a combined STT-LHBT repair. Results: Intact shoulders required a mean deltoid force of 154.2 AE 20.41 N to achieve maximum glenohumeral abduction (55.3 AE 2.3 ). Compared with native shoulders, the maximum abduction angle decreased following a massively retracted posterosuperior RCT by 52% (28.3 AE 8.4 ; P < .001), whereas the cumulative deltoid forces increased by 48% (205.3 AE 40.9 N; P ¼ .001). The STT repair and the STT-LHBT repair improved shoulder function compared with the tear state, with a mean maximum abduction angle of 30.6 AE 9.0 and 31.8 AE 7.7 and a mean deltoid force of 205.3 AE 40.9 N and 201.0 AE 34.0 N, respectively, but this was not statistically significant (P > .05). The STT-LHBT repair significantly improved the range of motion with respect to the tear state (P ¼ .04). Conclusions: In a dynamic shoulder simulator model, both the STT and the STT-LHBT repair techniques improved glenohumeral joint kinematics in an amount similar to previously reported ''traditional'' SCR techniques for treatment of an irreparable posterosuperior RCT.Ethical approval was obtained via Human Research Determination Form to the institutional review board (IRB) of the University of Connecticut, and it was documented that no IRB approval was required (deidentified specimen do not constitute human subjects research).

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“…Besides, tendon transfers are noted to be technically difficult surgical procedures, with high learning curves being needed. 20 Interestingly, high failure rates have been reported in patients who historically seem to be well chosen, 21 even though the reduced compliance of these patients may be a point of discussion.…”

Section: How the Biomechanical Complexity Of Tendon Transfers In Shoulder Surgery Is Still Robbing Us Of Sleep In 2021mentioning

confidence: 99%

How the Biomechanical Complexity of Tendon Transfers in Shoulder Surgery is Still Robbing us of Sleep in 2021

Berthold

Muench

Elhassan

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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High Clinical Failure Rate After Latissimus Dorsi Transfer for Revision Massive Rotator Cuff Tears

Cited by 36 publications

References 34 publications

Comparison of Different Fixation Techniques of the Long Head of the Biceps Tendon in Superior Capsule Reconstruction for Irreparable Posterosuperior Rotator Cuff Tears: A Dynamic Biomechanical Evaluation

Comparison of Different Fixation Techniques of the Long Head of the Biceps Tendon in Superior Capsule Reconstruction for Irreparable Posterosuperior Rotator Cuff Tears: A Dynamic Biomechanical Evaluation

A new approach to superior capsular reconstruction with hamstring allograft for irreparable posterosuperior rotator cuff tears: a dynamic biomechanical evaluation

How the Biomechanical Complexity of Tendon Transfers in Shoulder Surgery is Still Robbing us of Sleep in 2021

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