Therapeutic outcomes of muscular advancement by an arthroscopic-assisted modified Debeyre-Patte procedure for irreparable large and massive rotator cuff tears

Morihara, Toru; Kida, Yoshikazu; Furukawa, Ryo; Sukenari, Tsuyoshi; Kabuto, Yukichi; Kurokawa, Mineo; Fujiwara, Hiroyoshi; Kubo, Toshikazu

doi:10.1016/j.jos.2018.01.009

Cited by 18 publications

(26 citation statements)

References 25 publications

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“…Suture bridge method has been reported to provide excellent rigidity compared with the single-row or double-row methods, because the contact area and contact pressure are greater [2,[23][24][25][26][27]; therefore, the suture bridge method has been frequently employed as a xation technique for rotator cuff tear. However, the incidence of retear has been reported to be still high in cases of massive rotator cuff tear and severe fatty degeneration of the rotator cuff [15], and it remains controversial though several treatment methods were reported for irreparable rotator cuff tear by primary repair, such as partial repair [28], patch [12], musculotendon transfer [16], muscular advancement [19], and superior capsular reconstruction [18]. Delamination is often observed and tearing occurs in the posterior region in many cases [29].…”

Section: Discussionmentioning

confidence: 99%

“…The super cial and deep layers were xed by en bloc suturing using suture anchors in the EMSB group, the super cial and deep layers were individually xed by sutures similar to the method reported by Mochizuki et al in the DLSB group [11,14]. When the rotator cuff was unable to be covered up to the footprint even though it was su ciently mobilized, the modi ed DP procedure [19] was added for xation of the stump after DLSB following the method reported by Morihara et al, being designated as the DLSB + DP group. The EMSB group comprised 18 shoulders of 18 patients (12 males and 6 females at mean age of 69 years (range: 58-78 years)), the DLSB group comprised 24 shoulders of 23 patients (11 males and 12 females at mean age of 69.6 years (range: 49-87 years)), and the DLSB + DP group comprised 11 shoulders of 11 patients (4 males and 7 females at mean age of 72.9 years (range: 67-87 years)).…”

Section: Methodsmentioning

confidence: 99%

“…In DLSB, rst, the medial anchor thread was passed through the deep layer to x and suture by adding sliding knots and 2 half-hitches, as described by Mochizuki et al [25], then all threads were passed through the super cial layer without cutting the anchor thread and xed using the lateral anchor. In cases unable to be covered up to the footprint despite the rotator cuff being su ciently mobilized, an approximately 3-cm transverse skin incision was made outward from the medial border of the spine of the scapula following the method reported by Morihara et al [19]. The modi ed DP procedure was added dissecting the supraspinatus and infraspinatus muscles, while maintaining continuity to the fascia of the rhomboideus muscle.…”

Section: Surgical Procedurementioning

confidence: 99%

“…The tear size and fatty degeneration of the rotator cuff are considered risk factors for retear after arthroscopic rotator cuff repair (ARCR) [15], and several repair methods of large or massive tears, such as musculotendinous advancement, have been reported [12,[16][17][18][19]. The modi ed Debeyre-Patte (DP) procedure was also reported effective for large or massive tears of the rotator cuff to reduce the tension of the repaired rotator cuff, which was applied for tears unable to be covered to the footprint by torn stumps even though su ciently mobilized [19].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Outcomes of Arthroscopic Repair for Large or Massive Rotator Cuff Tear with Delamination: Comparison of Three Suture-Bridge Technique

Okubo¹,

Yotsumoto²,

Watanabe³

et al. 2021

Preprint

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Background: Rotator cuff tear with delamination is considered as a risk factor for postoperative retear after rotator cuff repair. The purpose of this study was to compare clinical outcomes between 3 repair procedures for large or massive rotator cuff tears with delamination: conventional en masse suture bridge (EMSB), double-layer suture bridge (DLSB), and combination of double-layer suture bridge and modified Debyere-Patte (DLSB+DP) methods.Methods: A total of 53 shoulders of 52 patients who had large or massive rotator cuff tears with delamination were included. The patients were categorized into 3 groups: EMSB group comprised 18 patients, DLSB group comprised 24 shoulders of 23 patients, and DLSB+DP group comprised 11 patients. DP was applied for cases in which the rotator cuff was unable to be covered up to the footprint even though it was sufficiently mobilized. The mean postoperative follow-up period was 34.6 months (range, 24-72 months). Pre- and postoperative evaluations included the Constant scores and range of motion (ROM). Tendon integrity according to Sugaya classification, and fatty degeneration were also evaluated by magnetic resonance images (MRI).Results: The ROM significantly improved after the operation in all groups. Mean constant scores significantly improved (from 45.5±14.3 to 77.4±13.6, in the EMSB, from 45.5±11.6 to 87.6±11.4 in the DLSB, and from 46.3±11.2 to , and 88.0±10.5 in the DLSB+DP). Significant differences were noted in the postoperative Constant score (p<0.05: DLSB vs. EMSB , and p<0.05: DLSB+DP vs. EMSB)． The Constant pain score was better in the DLSB+DP than in the EMSB group. The mean pre-operative global fatty degeneration index was 1.52 in the EMSB group, 1.80 in the DLSB group, and 2.28 in the DLSB+DP group. Retear occurred in 27.8% in the EMSB group, 12.5% in the DLSB group, and 9.1% in the DLSB+DP group. Conclusions: Comparison of 3 groups demonstrated that DLSB and DLSB+DP achieved better clinical outcome than EMSB. DLSB+DP is useful for large or massive rotator cuff tears with severe fatty degeneration or for cases where presence of excessive tension is anticipated when repairing the torn cuff.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Surgical Procedurementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical Outcomes of Arthroscopic Repair for Large or Massive Rotator Cuff Tear with Delamination: Comparison of Three Suture-Bridge Technique

Okubo¹,

Yotsumoto²,

Watanabe³

et al. 2021

Preprint

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“…Hence, we reported on a technique of ARCR combined with “living” SSP and ISP muscle advancement for mRCTs for which it has been difficult to achieve primary repair, and we showed that the failure rate can be significantly reduced. 47 Debeyre et al 9 first reported open muscle advancement with acromio-osteotomy, and Morihara et al 29 modified this procedure arthroscopically without acromio-osteotomy. Morihara et al performed the procedures while maintaining medial fascial continuity and added arthroscopic SSN to prevent the postoperative SSN palsy described by Warner et al 46 We also performed muscle advancement with arthroscopic SSN release to avoid postoperative SSN palsy and without medial fascial continuity to extract the torn cuff tendon more laterally.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Rotator Cuff Repair With Muscle Advancement and Artificial Biodegradable Sheet Reinforcement for Massive Rotator Cuff Tears

Yokoya

Harada

Negi

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Because high failure rates have frequently been reported after arthroscopic rotator cuff repair (ARCR) of massive rotator cuff tears (mRCTs), we introduced the technique of ARCR with supraspinatus and infraspinatus muscle advancement (MA). However, for cases where the original footprint cannot be completely covered, additional surgery using an approved artificial biomaterial is performed. Purpose: To investigate the postoperative clinical outcomes and failure rate after MA-ARCR, with and without our reinforcement technique. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 74 patients (mean ± SD age, 68.7 ± 7.7 years) diagnosed with mRCT with a minimum postoperative follow-up of 2 years were included in the current study. Of these patients, 47 underwent MA-ARCR with polyglycolic acid (PGA) sheet reinforcement (study group), and 27 patients underwent MA-ARCR alone (control group). PGA reinforcement was performed when full coverage of the footprint could not be achieved by MA alone, but where the latter was possible, reinforcement was not required. Thus, the study group had significantly worse muscle quality than the control group ( P < .05). The pre- and postoperative range of motion (ROM), isometric muscle strength, acromiohumeral interval, and clinical outcomes were evaluated and compared between these 2 groups. Cuff integrity during the last follow-up period was assessed with magnetic resonance imaging, and the failure rate was calculated. In addition, the postoperative foreign body reaction was investigated in the study group. Results: In both groups, significant postoperative improvements were seen in acromiohumeral interval, clinical scores, ROM in anterior flexion, and isometric muscle strength in abduction, external rotation, and internal rotation ( P < .001 for all). The failure rate of the study group was 12.8% (6 patients) and that of the control group was 25.9% (7 patients). No significant differences were noted between the 2 groups on any of the data findings, even regarding the failure rate. Foreign body reactions in the early period were found in 3 patients, although these spontaneously disappeared within 3 months. Conclusion: Patients who underwent PGA patch reinforcement for MA-ARCR when the footprint could not be completely covered had clinical results similar to isolated MA-ARCR when the footprint could be covered. Both procedures resulted in significant improvement in symptoms and function compared with preoperatively.

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Low level of evidence for all treatment modalities for irreparable posterosuperior rotator cuff tears

Kooistra

Gurnani

Weening

et al. 2019

Knee Surg Sports Traumatol Arthrosc

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Purpose This systematic review assesses evidence for improvements in outcome for all reported types of treatment modalities [physical therapy, tenotomy or tenodesis of the long head of the biceps, debridement, partial repair, subacromial spacer, deltoid lap, muscle transfer, rotator cuf advancement, graft interposition, superior capsular reconstruction (SCR), and reversed shoulder arthroplasty (RSA)] used for irreparable posterosuperior rotator cuf tears without glenohumeral osteoarthritis. The primary aim was to be able to inform patients about expectations of the amount of clinical improvement after these treatments. Methods A systematic search was conducted in MEDLINE, EMBASE, CINAHL, and Cochrane databases for studies on irreparable posterosuperior rotator cuf lesions without glenohumeral osteoarthritis, published from January 2007 until January 2019, with minimum 2-year follow-up. Studies with pre-operative and/or intra-operative determination of cuf tear irreparability were included. We deined the non-adjusted Constant Score as the primary outcome. Results Sixty studies (2000 patients) were included with a fair mean quality score, according to the Modiied Coleman Methodology Score. The employed deinitions of 'irreparable' were mainly based on MRI criteria and were highly variable among studies. The smallest weighted mean preoperative to post-operative improvements in Constant Score were reported for biceps tenotomy/tenodesis (10.7 points) and physical therapy (13.0). These were followed by debridement (21.8) and muscle transfer (27.8), whereas the largest increases were reported for partial repair (32.0), subacromial spacer (32.5), rotator cuf advancement (33.2), RSA (34.4), graft reconstruction (35.0), deltoid lap (39.8), and SCR (47.4). Treatment using deltoid lap showed highest mean weighted improvement in Constant Score among studies with available medium-term (4-5-year) follow-up. Treatments deltoid lap, muscle transfer, and debridement were the only treatments with available long-term (8-10-year) follow-up and showed similar improvements in Constant Score at this time point. ConclusionThe variability in patient characteristics, co-interventions, outcome reporting, and length of follow-up in studies on irreparable rotator cuf tears without osteoarthritis complicates sound comparison of treatments. Clinically important treatment efects were seen for all 11 diferent treatment modalities. Level of evidence IV.

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Therapeutic outcomes of muscular advancement by an arthroscopic-assisted modified Debeyre-Patte procedure for irreparable large and massive rotator cuff tears

Cited by 18 publications

References 25 publications

Clinical Outcomes of Arthroscopic Repair for Large or Massive Rotator Cuff Tear with Delamination: Comparison of Three Suture-Bridge Technique

Clinical Outcomes of Arthroscopic Repair for Large or Massive Rotator Cuff Tear with Delamination: Comparison of Three Suture-Bridge Technique

Arthroscopic Rotator Cuff Repair With Muscle Advancement and Artificial Biodegradable Sheet Reinforcement for Massive Rotator Cuff Tears

Low level of evidence for all treatment modalities for irreparable posterosuperior rotator cuff tears

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