Irreparable rotator cuff tears: challenges and solutions

Novi, Michele; Kumar, Avinash G.; Paladini, Paolo; Porcellini, Giuseppe; Merolla, Giovanni

doi:10.2147/orr.s151259

Cited by 30 publications

(27 citation statements)

References 64 publications

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“… 3 , 4 To address this problem, multiple techniques have been proposed in the literature, including partial repair, tenotomy of the long head of the biceps, latissimus dorsi tendon transfer, and reverse total shoulder arthroplasty. 5 , 6 , 7 , 8 , 9 Recently, several studies have indicated a paramount role of the superior capsule of the glenohumeral joint in stabilization of the joint, which has been shown to be disrupted in the pathology of irreparable rotator cuff tear. 10 Reconstruction of the superior capsule of the glenohumeral joint, which has been suggested to restore its role in balancing the superior migration of the humeral head and maintaining the acromiohumeral distance, has been proven to be a promising technique for the management of irreparable rotator cuff tear.…”

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confidence: 99%

The Elongation of Biceps Muscle Tendon Unit After Rerouting of the Long Head of Biceps Tendon as Superior Capsular Augmentation: A Quantitative Measurement

Zhang

Jiang

2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose The purpose of this study was to investigate the elongation of the biceps muscle tendon unit after rerouting of the long head of the biceps tendon without transection, with and without release of the transverse humeral ligament in a 3-dimensional model. Methods A total of 60 sets of computed tomography images of shoulders were acquired, and a point-cloud model was generated after 3-dimensional reconstruction. Simulation of rerouting of the long head of the biceps tendon was performed by assuming that the long head of the biceps tendon travels to the center of the greater tuberosity from the supraglenoid tubercle and then back to the bicipital groove distally, with or without the release of the transverse humeral ligament. The elongation of the biceps muscle tendon unit by both manners was measured and correlated with age, height, weight, body mass index, gender, and hand dominance. Results The mean length of the long head of the biceps tendon is 74.22 ± 3.06 mm, and the length is significantly longer, at 112.23 ± 4.92 mm ( P = 0.0002) and 96.47 ± 2.58 mm ( P = 0.0004). The absolute elongation of the biceps muscle tendon unit after rerouting of the long head of the biceps tendon, without or with transverse humeral ligament release, showed significant differences, which were 38.73 ± 3.03 mm and 22.28 ± 3.25 mm, respectively ( P = 0.0008). No significant correlations were observed between the amount of the elongation and the subject’s age, height, weight, or body mass index. No significant difference was observed in the amount of the elongation between differing gender and hand dominance. Conclusions Rerouting of the long head of the biceps tendon resulted in significant elongation of the biceps muscle tendon unit. Release of the transverse humeral ligament partially decreased this elongation. Clinical Relevance Rerouting of the long head of the biceps tendon may lead to overtension of the biceps. If it is adopted in clinical use, transverse humeral ligament release is recommended.

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confidence: 99%

The Elongation of Biceps Muscle Tendon Unit After Rerouting of the Long Head of Biceps Tendon as Superior Capsular Augmentation: A Quantitative Measurement

Zhang

Jiang

2020

Arthroscopy, Sports Medicine, and Rehabilitation

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“…O ur case was classified as a massive irreparable RCT based on the definition described above [1][2][3][4] . Previous clinical reports have documented that repair of this kind of RCT should involve the restoration of both cuff and capsule anatomy to maximize clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…M assive rotator cuff tears (RCT) have been historically considered tears with a diameter ≥5 cm and/or that are involved in the detachment of at least two entire tendons 1,2 . An irreparable RCT is defined as a tear is unable to be reapproximated to its insertion on the tuberosities despite application of conventional release techniques, due to the degeneration, retraction, and fatty infiltration of cuff tissue 3,4 .…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic Superior Capsule Reconstruction and Rotator Cuff Repair to Restore Static and Dynamic Stability of the Shoulder

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Hou

Tang

et al. 2020

Orthopaedic Surgery

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Objective: Treatment of massive irreparable rotator cuff tears (RCT) has shown limited clinical success and a variety of subsequent complications. Superior capsule reconstruction (SCR) has been proved to reestablish superior stability but does not restore the dynamic force or shoulder kinematics. There are numerous reports of the short-term failure of SCR grafts at the glenoid side, which relate to the non-biological healing of grafts. To restore both dynamic and static stability and to provide biologic augmentation, an integrated procedure for massive irreparable RCT using an Achilles tendon-bone allograft (ATBA) was developed. Method: This was a retrospect study completed between October 2019 and April 2020. A 71-year-old woman with massive and irreparable rotator cuff tears was enrolled in our study. The ATBA was folded into a double-layer structure. The superior layer (proximal portion) served as a bridge patch to dynamic the glenohumeral joint, while the inferior layer (distal portion) served as the superior capsule to restore static stability of glenohumeral joint. To enhance biologic healing on the glenoid side, we fixed the calcaneus of the graft on the superior-posterior side of the superior glenoid rim. The recovery of shoulder function (including strength, range of motion, acromiohumeral interval, and fatty infiltration) was assessed at 6 months postoperation. Result: At 6-month follow-up, the patient's strength had improved significantly (from abduction of grade 3 preoperatively to grade 4 at 6 months). Radiographic analysis showed an increase in the acromiohumeral interval from 3 to 7 mm. Magnetic resonance imaging revealed an intact graft, with the thickness of the ligament part maintained (at 6-7 mm). Most importantly, recovery of atrophy and fatty infiltration of the supraspinatus were observed. No graft tears were observed on the glenoid side. Conclusion: This technique could provide a preferable treatment option by restoring shoulder kinematics and augmentating biological healing for patients with massive irreparable RCT.

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“…Irreparable posterior-superior rotator cuff tears (IPSRCTs) are common pathologies related to shoulder pain and dysfunction. Although many methods address IPSRCTs, 1 , 2 , 3 a method that has predictable results still needs to be explored. 4 Rotator cuff reconstruction means using a structure or structures to bridge the rotator cuff and the greater tuberosity and restore the force chain of the defect rotator cuff.…”

mentioning

confidence: 99%

Rooting Rotator Cuff Reconstruction for Irreparable Posterior-Superior Rotator Cuff Tear

Tang

Zhao

2021

Arthroscopy Techniques

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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.

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Irreparable rotator cuff tears: challenges and solutions

Cited by 30 publications

References 64 publications

The Elongation of Biceps Muscle Tendon Unit After Rerouting of the Long Head of Biceps Tendon as Superior Capsular Augmentation: A Quantitative Measurement

The Elongation of Biceps Muscle Tendon Unit After Rerouting of the Long Head of Biceps Tendon as Superior Capsular Augmentation: A Quantitative Measurement

Arthroscopic Superior Capsule Reconstruction and Rotator Cuff Repair to Restore Static and Dynamic Stability of the Shoulder

Rooting Rotator Cuff Reconstruction for Irreparable Posterior-Superior Rotator Cuff Tear

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