Tendon transfer for irreparable rotator cuff tears: indications and surgical rationale

Merolla, Giovanni; Chillemi, Claudio; Franceschini, Vincenzo; Cerciello, Simone; Ippolito, Giorgio; Paladini, Paolo; Porcellini, Giuseppe

doi:10.32098/mltj.04.2014.06

Cited by 30 publications

(16 citation statements)

References 48 publications

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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 . A recent systematic review identified that 42% of RCT can be classified as irreparable tears 5 .…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Alike

Hou

Tang

et al. 2020

Orthopaedic Surgery

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“…In the setting of a massive irreparable posterosuperior rotator cuff tear, the force couples are often imbalanced and patients present with not only lack of function, but also significant pain and debility [ 14 ]. A lower trapezius tendon transfer in this setting aims to primarily relieve pain, but also to provide strength and function.…”

Section: Indicationsmentioning

confidence: 99%

“…Although reverse total shoulder arthroplasty results in effective pain relief, this option is often reserved for patients with degenerative changes and a less active lifestyle [ 17 ]. Tendon transfer surgery has become a more accepted treatment option for irreparable rotator cuff tears in patients desiring greater postoperative function, particularly strength and range of motion [ 8 , 10 , 13 , 14 ]. Specifically, the lower trapezius tendon transfer with Achilles tendon allograft augmentation is indicated for massive irreparable posterosuperior rotator cuff tears in patients with limited degenerative changes as well as in patients with paralytic shoulders following nerve injuries.…”

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confidence: 99%

Lower trapezius transfer with Achilles tendon augmentation: indication and clinical results

Aibinder

Elhassan

2018

Obere Extremität

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Lower trapezius tendon transfer with Achilles tendon allograft augmentation may be used to treat patients with lack of active external rotation following shoulder paralysis or massive irreparable posterosuperior rotator cuff tears. In the setting of shoulder paralysis, the integrity of the ipsilateral lower trapezius may be compromised. In this instance, the contralateral lower trapezius may be used with reasonable results. In the setting of irreparable rotator cuff tears, the procedure may be performed through an open or arthroscopically assisted technique. The latter avoids the need for an acromial osteotomy and risk of nonunion associated with repair of the osteotomy. Both are effective in reversing pseudoparesis or pseudoparalysis. Advanced degenerative changes have an effect on outcomes, resulting in less pain improvement, decreased range of motion, and greater need for reoperation with conversion to reverse total shoulder arthroplasty. Nonetheless, the lower trapezius tendon transfer is an effective option for restoring active external rotation with relatively consistent results.

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“…The management of large and massive RoCTs in shoulders with minimal arthritis remains a dilemma for shoulder surgeons [15,16] . There are many options available, including specialised rehabilitation, simple arthroscopic surgery including debridement [17][18][19][20], long head of biceps tenotomy, bursectomy [21,22], various tendon transfers [23,24] through to formal repair of the tendon. This may be in the form of partial repair or complete repair where achievable.…”

Section: Introductionmentioning

confidence: 99%

The use of a synthetic shoulder patch for large and massive rotator cuff tears – a feasibility study

Cowling

Hackney

Dube

et al. 2020

BMC Musculoskelet Disord

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Background: The aim of this study was to explore the feasibility of using a non-absorbable biocompatible polyester patch to augment open repair of massive rotator cuff tears (Patch group) and compare outcomes with other treatment options (Non-patch group). Methods: Participants referred to orthopaedic clinics for rotator cuff surgery were recruited. Choice of intervention (Patch or Non-patch) was based on patient preference and intra-operative findings. Oxford Shoulder Score (OSS), Shoulder Pain and Disability Index (SPADI), and Constant score were completed at baseline and 6 months. Shoulder MRI was performed at baseline and 6 months to assess fat fraction and Goutallier classification pre-and post-treatment. Feasibility outcomes (including retention, consent and missing data) were assessed. Results: Sixty-eight participants (29 in the Patch group, 39 in Non-patch group) were included (mean age 65.3 years). Conversion to consent (92.6%), missing data (0% at baseline), and attrition rate (16%) were deemed successful feasibility endpoints. There was significant improvement in the Patch group compared to Non-patch at 6 months in OSS (difference in medians 9.76 (95% CI 2.25, 17.29) and SPADI: 22.97 (95% CI 3.02, 42.92), with no substantive differences in Constant score. The patch group had a higher proportion of participants improving greater than MCID for OSS (78% vs 62%) and SPADI (63% vs 50%) respectively. Analysis of the 48 paired MRIs demonstrated a slight increase in the fat fraction for supraspinatus (53 to 55%), and infraspinatus (26 to 29%) at 6 months. These differences were similar and in the same direction when the participants were analysed by treatment group. The Goutallier score remained the same or worsened one grade in both groups equally. Conclusions: This study indicates that a definitive clinical trial investigating the use of a non-absorbable patch to augment repair of massive rotator cuff tears is feasible. In such patients, the patch has the potential to improve shoulder symptoms at 6 months. Trial registration: ISRCTN, ISRCTN79844053, Registered 15th October 2014 (retrospectively registered).

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Tendon transfer for irreparable rotator cuff tears: indications and surgical rationale

Cited by 30 publications

References 48 publications

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

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

Lower trapezius transfer with Achilles tendon augmentation: indication and clinical results

The use of a synthetic shoulder patch for large and massive rotator cuff tears – a feasibility study

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