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massive rotator cuff

Kotaro Yamakado
An irreparable anterosuperior massive rotator cuff tear with an irreparable subscapularis tear is not common; however, once symptomatic, it would become a challenging situation. Tendon transfer is a choice and the pectoralis major is a commonly selected graft source. However, there are theoretical concerns over its use: high invasiveness and low reproducibility, different force vector from the subscapularis, unsuitability for the arthroscopic modification, and difficulty in conversion to the reverse shoulder arthroplasty due to adhesions and scar formation in the anterior shoulder...
March 2018: Arthroscopy Techniques
Nikhil Sharma, Ahmed El Refaiy, T F Sibly
We report outcomes of using GraftJacket to repair massive rotator-cuff-tears. Twenty patients with a mean age of 64.6y over 12-month duration were reviewed. Two patients had a single GraftJacket repair (group1), whilst 18 had the GraftJacket sheet doubled (group2). Pre and post oxford shoulder scores (OSS) and patient related outcome measures were evaluated. A statistically significant improvement of OSS was demonstrated in-group 2 from a mean of 22 to 45.5 (p < 0.00148) over a follow up of 18 months...
June 2018: Journal of Orthopaedics
Yu Sasaki, Nobuyasu Ochiai, Arata Nakajima, Takahisa Sasho, Tomonori Kenmoku, Takeshi Yamaguchi, Takehiro Kijima, Eiko Hashimoto, Yasuhito Sasaki, Seiji Ohtori
BACKGROUND: Rotator cuff tears are the most common shoulder injury, and little is known about the underlying etiology of fatty infiltration after rotator cuff tear. Previous studies speculated that rotator cuff tears lead to neural injury due to tethering of the suprascapular nerve at the notch. This study aimed to evaluate fatty infiltration after suprascapular nerve injury and rotator cuff tears. METHODS: Ninety adult male Sprague-Dawley rats were used and were divided into four groups: sham, tendon transection only, suprascapular nerve ligation, and tendon transection plus suprascapular nerve ligation...
June 5, 2018: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Jonas Pogorzelski, Marilee P Horan, Jonathan A Godin, Zaamin B Hussain, Erik M Fritz, Peter J Millett
INTRODUCTION: The purpose of this study was to investigate clinical outcomes following Achilles tendon allograft-augmented latissimus dorsi tendon transfer (LDTT) for the treatment of irreparable posterosuperior rotator cuff tears with a minimum of 2 years post-operative follow-up. We hypothesized that patients would show significant improvement in outcomes scores with a low failure rate. MATERIALS AND METHODS: Patients who were treated with Achilles tendon allograft-augmented LDTT for irreparable posterosuperior rotator cuff tears with a minimum follow-up of 2 years were included...
June 6, 2018: Archives of Orthopaedic and Trauma Surgery
Krzysztof Hermanowicz, Adrian Góralczyk, Konrad Malinowski, Piotr Jancewicz, Marcin E Domżalski
Despite the development in shoulder surgery, massive irreparable rotator cuff tears still remain challenging for orthopaedic surgeons. Many surgical methods are addressed to this kind of pathology, but each of them has its own limitations. We decided to fuse the ideas of superior capsular reconstruction, "GraftJacket" technique, and partial rotator cuff repair. In this way, the technique using the long head biceps tendon simultaneously as a vascularized bridge between rotator cuff remnants and greater tubercle and as a depressor for the humeral head was created...
May 2018: Arthroscopy Techniques
Stephen S Burkhart
Active patients with massive irreparable rotator cuff tears and no glenohumeral arthritis have long posed a dilemma for shoulder surgeons. Such high-demand patients do not do well with partial cuff repair, as their results tend to deteriorate over time. They are also not good candidates for reverse total shoulder arthroplasty due to high rates of complications and high revision rates. The early good results of superior capsular reconstruction for these challenging patients are very encouraging, and they highlight the potential for superior capsular reconstruction to be a reliable joint-preserving option with low morbidity...
June 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Hans Van der Bracht, Tom Van den Langenbergh, Marc Pouillon, Skrallan Verhasselt, Philippe Verniers, Danny Stoffelen
BACKGROUND: This study investigated the feasibility and safety of all-suture anchors in arthroscopic rotator cuff repair. METHODS: All patients were diagnosed with a rotator cuff tear by ultrasound or magnetic resonance imaging (MRI). Patients with partial tears, massive tears, subscapularis tears, or previous shoulder surgery, were excluded. MRI and clinical outcome were investigated in all patients at 1.58 years (range, 1.0-2.0 years) after rotator cuff repair with all-suture anchors (prospective case series)...
May 22, 2018: Journal of Shoulder and Elbow Surgery
Mohammad Samim, Pamela Walsh, Soterios Gyftopoulos, Robert Meislin, Luis S Beltran
OBJECTIVE: The aim of this article is to review the postoperative MRI appearances of irreparable massive rotator cuff tears (RCTs) after surgery was performed using newer techniques, including patch repair, muscle tendon transfer, superior capsular reconstruction, and subacromial balloon implantation. CONCLUSION: Newer surgical techniques are emerging for the management of massive RCTs. As radiologists become increasingly likely to encounter postoperative imaging studies of RCTs repaired using these techniques, familiarity with the normal postoperative appearances and complications associated with these techniques becomes important...
May 24, 2018: AJR. American Journal of Roentgenology
Michael W Hast, Elaine Schmidt, John D Kelly, Josh R Baxter
Superior capsular reconstruction has received increased attention as a surgical technique to address massive 'irreparable' rotator cuff tears; however, the functional limitations and surgical techniques associated with this repair have yet to be sufficiently explored. The goal of this study was to utilize a multidisciplinary approach to characterize the biomechanics of this repair by: 1) identifying activities of daily living that may overburden graft, and 2) optimizing surgical techniques used during implantation...
May 14, 2018: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Silvan Beeler, Anita Hasler, Jonas Getzmann, Lizzy Weigelt, Dominik C Meyer, Christian Gerber
BACKGROUND: There is evidence for differences of scapular shape between shoulders with rotator cuff tears (RCT) and osteoarthritic shoulders (OA). This study analyzed orientation and shape of the acromion in patients with massive RCT and concentric OA (COA) in a multiplanar computed tomography (CT) analysis. METHODS: CT scans of 70 shoulders with degenerative RCT and 45 shoulders with COA undergoing primary shoulder arthroplasty were analyzed. The 2 groups were compared in relation of (1) shape of the acromion, (2) its orientation in space, and (3) the anteroposterior glenoid coverage in relation to the scapular plane...
May 8, 2018: Journal of Shoulder and Elbow Surgery
Ana P Valencia, Jim K Lai, Shama R Iyer, Katherine L Mistretta, Espen E Spangenburg, Derik L Davis, Richard M Lovering, Mohit N Gilotra
BACKGROUND: Massive rotator cuff tears (RCTs) begin as primary tendon injuries and cause a myriad of changes in the muscle, including atrophy, fatty infiltration (FI), and fibrosis. However, it is unclear which changes are most closely associated with muscle function. PURPOSE: To determine if FI of the supraspinatus muscle after acute RCT relates to short-term changes in muscle function. STUDY DESIGN: Controlled laboratory study. METHODS: Unilateral RCTs were induced in female rabbits via tenotomy of the supraspinatus and infraspinatus...
May 1, 2018: American Journal of Sports Medicine
Felix Dyrna, Neil S Kumar, Elifho Obopilwe, Bastian Scheiderer, Brendan Comer, Michael Nowak, Anthony A Romeo, Augustus D Mazzocca, Knut Beitzel
BACKGROUND: Previous biomechanical studies regarding deltoid function during glenohumeral abduction have primarily used static testing protocols. HYPOTHESES: (1) Deltoid forces required for scapular plane abduction increase as simulated rotator cuff tears become larger, and (2) maximal abduction decreases despite increased deltoid forces. STUDY DESIGN: Controlled laboratory study. METHODS: Twelve fresh-frozen cadaveric shoulders with a mean age of 67 years (range, 64-74 years) were used...
May 1, 2018: American Journal of Sports Medicine
Jeung Yeol Jeong, Young Cheol Yoon, Sang Min Lee, Jae Chul Yoo
PURPOSE: The first aim of this study was to introduce the concept of hybrid repair (incomplete repair) for large to massive rotator cuff tears and to report clinical results and structural integrity of patients with a minimum 2-year follow-up. The second aim was to compare arthroscopic hybrid repair with partial repair for large to massive rotator cuff tears. METHODS: We retrospectively evaluated 65 patients who underwent arthroscopic incomplete (hybrid) repair (45 patients) or partial repair (20 patients) for large to massive cuff tears from March 2011 to January 2015...
May 2, 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Barak Haviv, Tal Frenkel Rutenberg, Shlomo Bronak, Mustafa Yassin
PURPOSE: To compare the outcome, recovery and surgical findings after shoulder arthroscopy of clinically defined traumatic and non-traumatic rotator cuff pathology in middle-aged patients. METHODS: Of the patients who underwent rotator cuff surgery, 37 patients who reported a preceding shoulder injury related to their shoulder symptoms (traumatic group) were compared to a control group of 58 patients without a preceding injury (non-traumatic group), matched by age, body mass index and comorbidities...
May 4, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Hyeon Jang Jeong, Sung Min Rhee, Joo Han Oh
BACKGROUND: The authors have sometimes encountered postoperative new-onset pseudoparalysis (PONP) after arthroscopic repair for large to massive rotator cuff tear (ARCR). As there are insufficient data regarding PONP, the authors aimed to determine whether such a condition is characterized by obvious risk factors, as well as to assess the conditions under which it can be reversed. PURPOSE: To evaluate the predictors of PONP development after ARCR and its reversal and to integrate these predictors into a scoring system that can be applied in clinical practice...
June 2018: American Journal of Sports Medicine
Giuseppe Milano
Biceps autograft can be a viable option for biological augmentation of massive rotator cuff repair, albeit results of this procedure might depend on the surgical technique. In the present qualitative systematic review, 8 case series were analyzed, in which biceps autograft was used as a scaffold or tissue bridge. Indeed, leaving the proximal portion intact and fixing it onto the greater tuberosity can simulate a superior capsule reconstruction, with potentially high biologic and mechanical advantages.
April 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
A Kolk, J F Henseler, F J Overes, J Nagels, R G H H Nelissen
Aims Since long-term outcome of teres major tendon transfer surgery for irreparable posterosuperior rotator cuff (RC) tears is largely unknown, the primary aim of this study was to evaluate the long-term outcome of the teres major transfer. We also aimed to report on the results of a cohort of patients with a similar indication for surgery that underwent a latissimus dorsi tendon transfer. Patients and Methods In this prospective cohort study, we reported on the long-term results of 20 consecutive patients with a teres major tendon transfer for irreparable massive posterosuperior RC tears...
March 1, 2018: Bone & Joint Journal
Carlo Bottegoni, Luca Farinelli, Alberto Aquili, Sandra Manzotti, Marco Baldini, Antonio Gigante
BACKGROUND: In the glenohumeral joint, the long head of biceps brachii (LHBB) is exposed to tension and compression loading. The short head of biceps brachii (SHBB) works only in tension. It is known that tendon under compression might develop fibrocartilaginous metaplasia that improves the resistance to compression but reduces the resistance to tension. This study evaluated the presence of cartilage in LHBB and SHBB samples, supporting its possible role in tendon tear. METHODS: Between 2014 and 2016, 13 samples of LHBB and SHBB were collected during surgery for shoulder instability, glenohumeral arthritis, and massive rotator cuff tears...
March 19, 2018: Journal of Shoulder and Elbow Surgery
Yong-Beom Lee, Cheol-Jung Yang, Cheng Zhen Li, Zhong Zhuan, Seung-Cheol Kwon, Kyu-Cheol Noh
Background: This study aimed to investigate whether fatty infiltration (FI) measured on a single sagittal magnetic resonance imaging (MRI) slice can represent FI of the whole supraspinatus muscle. Methods: This study retrospectively reviewed the MRIs of 106 patients (age 50-79 years) divided into three rotator cuff tear-size groups: medium, large, and massive. Fat mass and muscle mass on all T1-weighted sagittal MRI scans (FA and MA) were measured. Of the total MRI scans, the Y-view was defined as the most lateral image of the junction of the scapular spine with the scapular body on the oblique sagittal T1-weighted image...
March 2018: Clinics in Orthopedic Surgery
Lorenzo Merlini, Matthew Yalizis, Yannick Carrillon, Hugo Bothorel, Mo Saffarini, Arnaud Godenèche
BACKGROUND: A rare form of rotator cuff tear (RCT) is observed secondary to glenohumeral dislocation, followed by immediate repositioning, as well as formation of scar tissue between tendons and tuberosities. Radiographic diagnosis of such "degloving" tears is problematic because they are obscured by scar tissue. We aimed to describe characteristics of degloving tears and report outcomes following their arthroscopic repair. METHODS: Among 67 patients who underwent arthroscopic repair of RCTs secondary to shoulder dislocation, we identified 8 patients (12%) (7 anterior dislocations and 1 posterior dislocation), aged 54...
March 16, 2018: Journal of Shoulder and Elbow Surgery
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