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Superior capsule reconstruction

Teruhisa Mihata, Thay Q Lee, Kunimoto Fukunishi, Yasuo Itami, Yukitaka Fujisawa, Takeshi Kawakami, Mutsumi Ohue, Masashi Neo
BACKGROUND: Although sports participation and heavy physical work can contribute to rotator cuff tears, many patients expect to return to these activities after surgery; however, irreparable rotator cuff tears can preclude this outcome. A new surgical treatment-arthroscopic superior capsule reconstruction (SCR)-restores shoulder stability and muscle balance in patients with irreparable rotator cuff tears; consequently, it improves shoulder function and relieves pain. PURPOSE: To evaluate the rates of return to sports and physical work among patients treated with arthroscopic SCR...
March 1, 2018: American Journal of Sports Medicine
Michael B Banffy, Carlos Uquillas, Julie A Neumann, Neal S ElAttrache
BACKGROUND: An anatomic double-tunnel (DT) reconstruction technique has been widely adopted to reconstruct the ruptured coracoclavicular (CC) ligaments seen with high-grade acromioclavicular (AC) joint injuries. However, the anatomic DT reconstruction has been associated with the risk of clavicle fractures, which may be problematic, particularly for contact athletes. Purpose/Hypothesis: The purpose was to compare a single-tunnel (ST) CC ligament reconstruction for AC joint injuries with the native state as well as with the more established anatomic DT CC ligament reconstruction...
February 1, 2018: American Journal of Sports Medicine
Varun R Kshettry, Gurston Nyquist, James J Evans
Surgery for craniopharyngiomas can be challenging due to the involvement of multiple critical neurovascular structures. The expanded endoscopic endonasal approach can provide superior access to suprasellar craniopharyngiomas, particularly with retrochiasmatic extension and significant hypothalamic involvement. We describe the surgical technique used to treat a 30-year-old patient who presented with 4 weeks of worsening vision, fatigue, and memory loss. His vision was counting fingers at 1 feet on the right and 20/800 on the left with a temporal hemianopsia...
February 2018: Journal of Neurological Surgery. Part B, Skull Base
Raffaele Dalla Valle, Matteo Rossini, Laura Lamecchi, Maurizio Iaria
Pancreatic fistula (PF) remains the Achilles' heel of pancreaticoduodenectomy (PD). Pancreaticogastrostomy (PG) appears to be associated with a lower risk of postoperative leak according to recent evidence. We started to fashion PG, especially in soft pancreas, modifying the original technique described by Bassi. At our institution, 105 PD procedures were carried out from January 2011 to December 2016; pancreatic-enteric continuity was restored by PG in 35 cases. Superior mesenteric/portal vein resection/reconstruction was necessary in three patients...
January 31, 2018: Updates in Surgery
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
Philipp R Heuberer, Leo Pauzenberger, Daniel Smolen, Roman C Ostermann, Werner Anderl
Rotator cuff repairs are the most common procedures in shoulder surgery, but still show long-term retear rates of up to 70%. Nonanatomic reconstruction is one possible cause of repair failure. The rotator cuff histologically consists of 5 separate layers of which 2 are macroscopically identifiable: the superior or tendinous layer and the inferior or capsule-ligamentous layer. In case of rotator cuff tears, these layers are often retracted to different degrees. The intraoperative detectable prevalence of rotator cuff delamination reaches up to 85%...
January 2018: Arthroscopy Techniques
George Sanchez, William H Rossy, Kyle P Lavery, Kevin J McHale, Marcio B Ferrari, Anthony Sanchez, Matthew T Provencher
Massive, irreparable rotator cuff tears are challenging to treat and associated with pain and severe limitation in shoulder elevation due to the proximal migration of the humeral head and, consequently, subacromial impingement. Furthermore, retraction of the tendons in combination with fat infiltration and muscular weakness results in unpredictable treatment outcomes. While conservative treatment may be warranted for low-demand patients, surgical treatment is often indicated for a successful return to activities of daily living as well as an improved quality of life...
August 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
Kevin C Wall, Alison P Toth, Grant E Garrigues
PURPOSE OF REVIEW: To introduce the challenges in addressing irreparable rotator cuff tears and examine the surgical options, specifically interposition grafting and superior capsule reconstruction. RECENT FINDINGS: Interposition grafting of rotator cuff tears shows promising results in reducing pain and improving function postoperatively and one study demonstrated that it performs significantly better than partial repair alone. Superior capsule reconstruction has become popular rapidly, but given the novelty of the procedure, there is currently a paucity of outcomes data to review...
March 2018: Current Reviews in Musculoskeletal Medicine
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
Timothy S Leroux
The young patient with a massive, irreparable rotator cuff tear is a challenging problem. Not only is this patient population demanding, but of the few surgical options that exist to manage this problem, each have their own unique limitations; as such, the orthopaedic community continues to search for a treatment that maximizes outcome and durability, while minimizing risk and preserving the native shoulder. Over the past few years, there has been considerable interest in a new surgical technique: the superior capsule reconstruction (SCR)...
January 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Teruhisa Mihata
In my experience, after superior capsule reconstruction for irreparable rotator cuff tears, if the graft heals, we can expect a successful outcome, such as an American Shoulder and Elbow Surgeons score of more than 90 points and a visual analog scale score of less than 1.0. To decrease the graft tear rate after surgery, I have found that a thicker, stiffer graft than can be achieved with a dermal allograft alone is required to restore superior stability in the glenohumeral joint. Furthermore, the graft size should be determined precisely from the size of the defect in the rotator cuff tendons...
January 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
François Vassal, Benjamin Pommier, Anna Sontheimer, Jean-Jacques Lemaire
PURPOSE: Precise knowledge of the structural connectivity of white matter fascicles could yield new insights into function and is important for neurosurgical planning. Therefore, we aimed to provide a detailed map of the cortical terminations of the inferior fronto-occipital fascicle (IFOF), with special emphasis on putative inter-individual variations and hemispheric asymmetries. METHODS: Deterministic diffusion tensor imaging-based tractography was used to perform virtual dissection of the IFOF in 20 healthy subjects...
December 28, 2017: Surgical and Radiologic Anatomy: SRA
Patrick J Denard, Paul C Brady, Christopher R Adams, John M Tokish, Stephen S Burkhart
PURPOSE: The purpose of this study was to evaluate the short-term outcomes of arthroscopic superior capsule reconstruction (SCR) with dermal allograft for the treatment of irreparable massive rotator cuff tears (MRCTs). METHODS: A multicenter study was performed on patients undergoing arthroscopic SCR for irreparable MRCTs. The minimum follow-up was 1 year. Range of motion and functional outcome according to visual analog scale (VAS) pain, American Shoulder and Elbow Surgeons (ASES) score, and subjective shoulder value (SSV) score were assessed preoperatively and at final follow-up...
November 13, 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
Teruhisa Mihata, Christopher N H Bui, Masaki Akeda, Matthew A Cavagnaro, Michael Kuenzler, Alexander B Peterson, Michelle H McGarry, Yasuo Itami, Orr Limpisvasti, Masashi Neo, Thay Q Lee
BACKGROUND: Biomechanical and clinical success of the superior capsule reconstruction (SCR) using fascia lata (FL) grafts has been reported. In the United States, human dermal (HD) allograft has been used successfully for SCRs; however, the biomechanical characteristics have not been reported. METHODS: Eight cadaveric shoulders were tested in 5 conditions: (1) intact; (2) irreparable supraspinatus tear; (3) SCR using FL allograft with anterior and posterior suturing; (4) SCR using HD allograft with anterior and posterior suturing; and (5) SCR using HD allograft with posterior suturing...
December 2017: Journal of Shoulder and Elbow Surgery
Paul Sethi, Wm Grant Franco
Massive, irreparable rotator cuff disease is a challenging problem to treat, especially in the younger active patient. This condition allows the deltoid to generate anterosuperior translation and shoulder dysfunction. Ideally, this dysfunction may be improved with rotator cuff repair. However, in the setting of irreparable rotator cuff disease, normal function is challenging to restore. Superior capsule reconstruction theoretically improves function by recentering the humeral head and improving glenohumeral kinematics...
January 2018: Orthopedic Clinics of North America
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
Peter J Millett, Zaamin B Hussain, Erik M Fritz, Ryan J Warth, J Christoph Katthagen, Jonas Pogorzelski
Although uncommon, rotator cuff tears that occur medially at the musculotendinous junction can result from acute trauma, anatomic force imbalance, or medial row cuff failure following a previous rotator cuff repair. The quality of the torn muscle and tendon along with the length of the remnant tendon stump should be considered before deciding on the most appropriate repair technique. When muscle and tendon quality are sufficient, the tear can often be repaired directly to the remnant tendon stump and compressed onto the greater tuberosity...
August 2017: Arthroscopy Techniques
Lu Zang, Junjun Ma, Minhua Zheng
Laparoscopic radical gastrectomy(LRG) has been popularized with the development of laparoscopic surgical techniques. As a result of the requirement of surgical skill of LRG, the evidence is always highly demanded. The surgical safety and radical resection of tumor is one of the most important principles. Based on published studies and authors' own experience, this article discusses the following topics on laparoscopic gastrectomy: (1)Indications of surgery: Laparoscopic gastrectomy for early gastric cancer is accepted all over the world...
August 25, 2017: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
J S Lin, R Chen, W Yan, D D Chen
Objective: To investigate the operative method and clinical application of the BARD(®) Mesh in enhancing joint stability and function of endoprosthetic reconstruction for bone tumors. Methods: From Jan 2013 to Jun 2015, the clinical data of 51 patients aged (44.75±23.18) years underwent wide resection of tumor and endoprosthetic reconstruction using the BARD(®) Mesh were collected. Among them, 27 were male and 24 were female. The surgical treatments received by these patients included 5 shoulder arthroplasties, 12 elbow replacements, 12 hip replacements and 32 knee replacements (including 24 femoral tumors and 8 tibial tumors)...
July 23, 2017: Zhonghua Zhong Liu za Zhi [Chinese Journal of Oncology]
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