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superior capsular reconstruction

William T Pennington, Brian A Bartz, Joann M Pauli, Carol E Walker, William Schmidt
PURPOSE: This outcome analysis presents 88 consecutive shoulders presenting with irreparable rotator cuff tears that we treated with arthroscopic superior capsular reconstruction (SCR) using an acellular dermal allograft. We also present the concept of superior capsular distance to quantitatively measure the decreased distance present upon restoration of superior capsular integrity. METHODS: A retrospective review was conducted of patients treated with arthroscopic SCR with a minimum 12-month follow-up...
February 15, 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Kazuhisa Hatayama, Masanori Terauchi, Kenichi Saito, Jun Aoki, Satoshi Nonaka, Hiroshi Higuchi
PURPOSE: To prospectively evaluate the sensitivity and specificity of magnetic resonance imaging (MRI) for diagnosing ramp lesions, to compare them between 1.5- and 3-T MRI, and to evaluate whether bone contusion of the posterior lip of the medial tibial plateau was associated with ramp lesions. METHODS: For 155 knees that underwent primary ACL reconstruction, we prospectively examined for ramp lesions and medial meniscal body tears on MRI. MRI diagnosis of ramp lesions required high signal irregularity of the capsular margin or separation in the meniscocapsular junction of the medial meniscus posterior horn on sagittal images...
February 15, 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
George Sanchez, Jorge Chahla, Gilbert Moatshe, Márcio B Ferrari, Nicholas I Kennedy, Matthew T Provencher
Massive rotator cuff tears are particularly challenging to treat and severely limit the function of the shoulder. Compared with a small rotator cuff tear, massive tears are more unpredictable and usually present with low tendon quality. When performing an anatomical repair of the rotator cuff, the surgical treatment is often associated with failure of the construct. An alternative procedure that can be performed in the setting of a massive tear is superior capsular reconstruction (SCR), using an autograft or allograft...
October 2017: Arthroscopy Techniques
P Valenti
An irreparable cuff tear is defined as the inability to achieve direct repair of native tendon to the great tuberosity despite intra- and extra-articular release of the remaining tissue. Three distinct anatomic patterns are identified: posterosuperior cuff tears which involve the supraspinatus, infraspinatus and teres minor; anterosuperior tears which involve the supraspinatus and subscapularis; and global tears which comprise both. Subacromial debridement and tenotomy or tenodesis of the long head of the biceps are proposed for older patients with a functional but very painful shoulder...
January 29, 2018: Der Orthopäde
Susan C Lee, Danielle Williams, Yoshimi Endo
PURPOSE OF REVIEW: The purposes of this review were to provide an overview of the current practice of evaluating the postoperative rotator cuff on imaging and to review the salient imaging findings of the normal and abnormal postoperative rotator cuff, as well as of postoperative complications. RECENT FINDINGS: The repaired rotator cuff frequently appears abnormal on magnetic resonance imaging (MRI) and ultrasound (US). Recent studies have shown that while the tendons typically normalize, they can demonstrate clinically insignificant abnormal imaging appearances for longer than 6 months...
March 2018: Current Reviews in Musculoskeletal Medicine
Achilleas Boutsiadis, Shiyi Chen, Chunyan Jiang, Hubert Lenoir, Philippe Delsol, Johannes Barth
Massive irreparable rotator cuff tears remain a challenging condition during daily clinical practice. Irreversible fatty infiltration of muscles and excessive chronic retraction of tendons predispose to high failure rates of their surgical treatment. Superior capsular reconstruction with either fascia lata autograft or a dermal allograft patch is a newly described solution that could prevent superior humeral head migration and restore the anteroposterior shoulder muscle force couples. The purpose of this article is to propose a technical modification of superior capsular reconstruction using long head of the biceps tendon autograft...
October 2017: Arthroscopy Techniques
Jason P Rogers, Adam Kwapisz, John M Tokish
A subscapularis complete tear presents its own challenges in management. The glenohumeral biomechanics and force couple are reliant on a competent and functioning subscapularis muscle. An irreparable subscapularis makes those same challenges even more difficult to address. Traditionally, this problem has been addressed with tendon transfers, including pectoralis major or latissimus dorsi. These techniques can alter the ideal biomechanics of the shoulder and have high rates or failure. Iliotibial autograft or tibialis anterior have also been wrought with high failure rates...
December 2017: Arthroscopy Techniques
John M Tokish, Amit Momaya, Troy Roberson
CASE: Chronic massive irreparable rotator cuff tears remain challenging to treat. We present the case of a 70-year-old active and healthy woman who presented with 6 months of worsening shoulder pain and function; she had experienced considerable deterioration over the past 2 months. Nonoperative management of the massive rotator cuff tear was not successful. Superior capsule reconstruction (SCR) was performed with a partial rotator cuff repair. CONCLUSION: SCR is an exciting advancement for the chronic massive irreparable rotator cuff tear, one of the more challenging problems encountered by shoulder surgeons...
January 10, 2018: JBJS Case Connector
Jonas Pogorzelski, Kyle J Muckenhirn, Justin J Mitchell, J Christoph Katthagen, Jason M Schon, Kimi D Dahl, Alan M Hirahara, Joshua S Dines, Christopher R Adams, Thomas Dooney, Patrick J Denard, Travis Lee Turnbull, Peter J Millett
BACKGROUND: Superior capsular reconstruction (SCR) was recently introduced as a treatment for irreparable superior rotator cuff tears in younger patients. Purpose/Hypothesis: The purpose was to assess the biomechanical strength of 3 methods for fixation of the graft to the glenoid for SCR. It was hypothesized that a 4-anchor technique would provide greater load to failure than 3-anchor techniques. STUDY DESIGN: Controlled laboratory study. METHODS: Thirty-six cadaveric specimens were randomized into 3 groups of previously established glenoid-side graft fixation techniques: (1) three 3...
December 1, 2017: American Journal of Sports Medicine
Tengteng Tang, Peter A Cripton, Pierre Guy, Heather A McKay, Rizhi Wang
Hip fractures pose a major health problem throughout the world due to their devastating impact. Current theories for why these injuries are so prevalent in the elderly point to an increased propensity to fall and decreases in bone mass with ageing. However, the fracture mechanisms, particularly the stress and strain conditions leading to bone failure at the hip remain unclear. Here, we directly examined the cortical bone from clinical intra-capsular hip fractures at a microscopic level, and found strong evidence of compression induced failure in the superior cortex...
December 22, 2017: Bone
Kalpit N Shah, Steven F DeFroda, James Kristopher Ware, Sarath C Koruprolu, Brett D Owens
Background: Medial instability of the patellofemoral joint is a rare but known phenomenon that may result from an incompetent lateral patellofemoral ligament (LPFL). Surgical reconstruction of the LPFL has been described. However, anatomic details of the ligament have not been the subject of scrutiny. Purpose: To describe the anatomic origin and insertion of the LPFL. Study Design: Descriptive laboratory study. Methods: Ten fresh-frozen, unpaired human cadaveric knees (mean age, 57 years) were dissected to identify the LPFL...
December 2017: Orthopaedic Journal of Sports Medicine
Robert D Graham
Non-arthroplasty treatment options for pseudoparalysis of the shoulder are preferable in the younger patient population. Although there are differing philosophies among shoulder surgeons, many prefer to avoid reversed total shoulder arthroplasty for patients under age 60 years. Arthroscopically assisted latissimus dorsi transfer may be a good alternative for these patients, but how the results compare with arthroscopic superior capsular reconstruction is the question.
December 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
Robert U Hartzler, Stephen S Burkhart
Superior capsular reconstruction (SCR) of the shoulder has recently gained popularity as an option for joint-preserving shoulder surgery for patients with an irreparable rotator cuff tear. In the absence of glenohumeral arthritis, rotator cuff tear irreparability should only be diagnosed for most patients after a careful diagnostic arthroscopy. Superior capsular reconstruction adds biological, passive, superior constraint to the glenohumeral joint, thereby optimizing the rotator cuff force couples and improving joint kinematics...
October 1, 2017: Orthopedics
Michal Brichacek, Kimberly Dalke, Edward Buchel, Thomas E J Hayakawa
This study evaluates a novel limited submuscular direct-to-implant technique utilizing AlloMax where only the upper few centimeters of the implant is covered by the pectoralis, whereas the majority of the implant including the middle and lower poles are covered by acellular dermal matrix. METHODS: The pectoralis muscle is released off its inferior and inferior-medial origins and allowed to retract superiorly. Two sheets of AlloMax (6 × 16 cm) are sutured together and secured to the inframammary fold, serratus fascia, and the superiorly retracted pectoralis...
July 2017: Plastic and Reconstructive Surgery. Global Open
J Zerr, J D McDermott, N M Beckmann, R K Fullick, A Chhabra
Superior capsular reconstruction (SCR) is a novel technique for treating irreparable rotator cuff tears in younger patients in whom a reverse total shoulder arthroplasty is not the optimal treatment choice. This case study describes a middle-aged male with a recurrent, massive, irreparable rotator cuff tear treated with SCR that subsequently failed at the glenoid attachment. The patient underwent successful arthroscopic revision of the SCR. The case illustrates the MRI and arthroscopic correlations of the failed dermal allograft reconstruction, which to our knowledge has not been previously shown in the radiology literature...
November 2017: Skeletal Radiology
E Grant Sutter, Jonathan A Godin, Grant E Garrigues
Massive irreparable rotator cuff tears are difficult to treat. Although several treatment options exist, none provides superior long-term results. There is no consensus on optimal surgical technique. Superior capsular reconstruction is an operative treatment option aimed at restoring native biomechanics of the glenohumeral joint by providing a restraint to superior subluxation. Partial rotator cuff repair for massive tears has also been shown to improve shoulder kinematics and can be performed in conjunction with superior capsule reconstruction...
July 1, 2017: Orthopedics
A Ali Narvani, Paolo Consigliere, Ioannis Polyzois, Tanaya Sarkhel, Rohit Gupta, Ofer Levy
The management of irreparable rotator cuff tears is a difficult problem to deal with. The options include nonoperative route with anterior deltoid exercises, debridement with or without long head of biceps tenotomy, partial rotator cuff repair, tuberoplasty, muscle transfer, patch augmentation, biodegradable spacers, and reverse shoulder arthroplasty. None of these options are without their limitations. In recent years, arthroscopic superior capsular reconstruction has gained popularity as an alternative technique to address irreparable rotator cuff tears...
December 2016: Arthroscopy Techniques
Raffaele Garofalo, Enrico Ceccarelli, Alessandro Castagna, Vittorio Calvisi, Brody Flanagin, Marco Conti, Sumant G Krishnan
PURPOSE: Appropriate surgical management for type V complete acromioclavicular (AC) joint dislocation remains controversial. The purpose of this paper is to retrospectively report the clinical and radiographic outcomes of an open surgical technique consisting for AC joint ligamentous and capsular reconstruction using autologous hamstring tendon grafts and semi-permanent sutures. METHODS: Between January 2005 and December 2011, 32 consecutive patients with symptomatic type V complete AC joint dislocation underwent surgical treatment using the same technique...
July 2017: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Daniel S Roh, Matthew D Treiser, Emily H Lafleur, Yoon S Chun
BACKGROUND: Bilateral breast reconstruction in the setting of unilateral postmastectomy radiation therapy (PMRT) remains one of the most difficult reconstructive challenges due to significant radiation-induced asymmetry from capsular contracture and superior migration of the irradiated reconstructed breast. We describe a novel and straightforward intraoperative technique for creating compensatory asymmetry to maximize postradiation symmetry in immediate bilateral tissue expander (TE) and acellular dermal matrix (ADM) reconstruction requiring unilateral PMRT...
April 2017: Annals of Plastic Surgery
Lene Nyhøj Heidemann, Gudjon Leifur Gunnarsson, Camilla Bille, Jens Ahm Sørensen, Jørn Bo Thomsen
The demand for reconstructive surgery after therapeutic and prophylactic mastectomy is increasing. The hammock technique for breast reconstruction was introduced in 2001 and provides support for the implant using either biologically derived or synthetic mesh. The material is formed as a hammock in the lower pole of the reconstructed breast, and due to its supportive capabilities it has been found to shorten the time needed for reconstruction, decrease the risk of capsular contracture and leave a superior aesthetic result...
March 6, 2017: Ugeskrift for Laeger
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