Pseudoparalysis From a Massive Rotator Cuff Tear Is Reliably Reversed With an Arthroscopic Rotator Cuff Repair in Patients Without Preoperative Glenohumeral Arthritis

Denard, Patrick J.; Lädermann, Alexandre; Brady, Paul C.; Narbona, Pablo; Adams, Christopher R.; Arrigoni, Paolo; Huberty, Dave; Zlatkin, Michael B.; Sanders, Timothy G.; Burkhart, Stephen S.

doi:10.1177/0363546515597486

Cited by 79 publications

(51 citation statements)

References 33 publications

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“…The repair or partial repair of MRCT leads to pain reduction in over 80% of the patients [ 2 , 5 ]. Even a high rate of reversion of pseudoparalysis for repairs of MRCT in the absence of osteoarthritis has been described [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Subacromial spacer implantation for massive rotator cuff tears

2016

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BackgroundMassive rotator cuff tears (MRCT) can be treated arthroscopically by partial reconstruction, tenotomy/tenodesis of the long head of the biceps, and debridement. A new treatment option is the additional implantation of a biodegradable spacer (InSpace Balloon®; ISB) into the subacromial space, which reduces subacromial shear forces to keep the humeral head centered in the glenoid. The aim of this study is to investigate the clinical outcome of patients with MRCT who were treated arthroscopically with or without an additional ISB.MethodsThe clinical outcome of patients treated with conventional arthroscopic techniques (n = 11, group A, partial repair, biceps tenotomy, and debridement) and that of patients treated with a supplementary ISB (n = 12, group B) was retrospectively analyzed. Preoperatively and postoperatively, shoulder function was assessed with the Constant and American Shoulder and Elbow Surgeons (ASES) scores. At follow-up after a mean of 22 months, patients filled out a questionnaire about their subjective satisfaction.ResultsPreoperative shoulder function was lower in patients treated with an ISB (ASES score: group A, 59.1; group B, 31.5; Constant score: group A, 60.7; group B, 36.8). At follow-up, both groups had improved shoulder function (Constant score: group A, 60.7–77.6; p < 0.001; group B, 36.8–69.5; p < 0.001; ASES score: group A, 59.1–88.6; p < 0.001; group B, 31.5–85.7; p < 0.001). Patients in both groups were subjectively satisfied with their outcome.ConclusionThe ISB is a feasible treatment option for MRCT, providing subjective pain relief and improved shoulder function. Further studies with larger patient collectives and longer follow-up are needed to confirm whether it is a safe and cost-effective treatment.

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Section: Discussionmentioning

confidence: 99%

Subacromial spacer implantation for massive rotator cuff tears

2016

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“…We have previously reported that massive cuff tears are usually completely reparable, 2 and that even in patients with massive tears associated with pseudoparalysis, the pseudoparalysis is reversible in >90% of cases after cuff repair. 1 However, we freely admit that some tears are not fully reparable. In such cases, the surgical choices are partial cuff repair versus rTSA.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] The vast majority of massive tears have been fully reparable in our hands. In the small percentage of tears that have not been fully reparable, we have done partial repairs.…”

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confidence: 99%

Arthroscopic Superior Capsular Reconstruction for Massive Irreparable Rotator Cuff Repair

Burkhart

Denard²,

Adams

et al. 2016

Arthroscopy Techniques

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157

147

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Abstract:We have been performing arthroscopic superior capsular reconstruction (SCR) with acellular dermal allograft for almost 2 years. Our techniques are based on Mihata's original concept for SCR, in which he used fascia lata autograft. In this report, we describe our standard arthroscopic technique as well as 2 variations of a "zip-line" technique, which we have found particularly useful for large dermal allografts (grafts that are !40 mm in any dimension).

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“…The most common definition is less than 90 of active shoulder elevation. [8][9][10] However, this definition includes limited active elevation due to shoulder pain. In our previous publication addressing pseudoparalysis with fascia lata autograft SCR, we divided pseudoparalysis into 2 subgroups: (1) moderate pseudoparalysis, that is, no shoulder stiffness, less than 90 of active shoulder elevation, and the ability of patients to maintain more than 90 of elevation once the shoulder is elevated passively, and (2) severe pseudoparalysis, that is, no shoulder stiffness, less than 90 of active shoulder elevation, and the presence of a positive drop-arm sign (patients cannot maintain the abducted position because of muscle weakness).…”

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confidence: 99%

Editorial Commentary: Superior Capsular Reconstruction—Improved Superior Stability and Functional Deltoid Reverse Pseudoparalysis in Patients With Irreparable Rotator Cuff Tears

Mihata

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Since I reported clinical and biomechanical improvement after superior capsular reconstruction (SCR) for irreparable rotator cuff tears in 2012 and 2013, many shoulder surgeons around the world have started to perform SCR. However, most of these surgeons are still on the learning curve, and their clinical results are not consistent because clinical outcomes after SCR are correlated with graft healing, which is affected by the surgeon's skill. In cases in which the graft does heal, active shoulder elevation increases after SCR even in patients with pseudoparalysis before surgery. These patients can elevate the arm using the deltoid muscle when superior shoulder stability is restored after SCR. When patients whose grafts have healed cannot elevate the arm even after SCR, they may have concomitant cervical radiculopathy, which causes real paralysis.

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Pseudoparalysis From a Massive Rotator Cuff Tear Is Reliably Reversed With an Arthroscopic Rotator Cuff Repair in Patients Without Preoperative Glenohumeral Arthritis

Abstract: ARCR can lead to reversal of preoperative pseudoparalysis in patients with minimal preoperative glenohumeral arthritis. ARCR is a viable first line of treatment for patients with pseudoparalysis in the absence of advanced glenohumeral arthritis.

Cited by 79 publications

References 33 publications

Subacromial spacer implantation for massive rotator cuff tears

Subacromial spacer implantation for massive rotator cuff tears

Arthroscopic Superior Capsular Reconstruction for Massive Irreparable Rotator Cuff Repair

Editorial Commentary: Superior Capsular Reconstruction—Improved Superior Stability and Functional Deltoid Reverse Pseudoparalysis in Patients With Irreparable Rotator Cuff Tears

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