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

Abstract

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.

Arthroscopic Superior Capsular Reconstruction for Massive Irreparable Rotator Cuff Tears Results in Significant Improvements in Patient Reported Outcomes and Range of Motion: A Systematic Review

“…In addition, a previous cadaveric biomechanical study 47 has suggested that repair of the ASCR graft with posterior or anterior rotator cuff tissue could increase the AHD postoperatively by decreasing the glenohumeral superior translation. ( Fig 5 ) Furthermore, posterior or anterior margin convergence may increase the survival rate of graft by accelerating the vascularization, 51 which reinforced the structural strength of the graft as well.

Fig 5 Posterior margin convergence may increase the postoperative acromiohumeral distance (AHD) postoperatively by decreasing the glenohumeral superior translation.

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A method for the treatment of patients with massive tears of the rotator cuff: a clinical case

“…Авторы сообщали о благоприятных результатах, а именно о снижении болевого синдрома и увеличении объема движений поврежденного сустава, однако в 16,7% случаев были отмечены отрывы трансплантата, частота которых, по данным литературы, составляет от 10 до 12,9%. Описаны также случаи повторных проксимальных подвывихов головки плечевой кости в результате растяжения трансплантата и последующего его отрыва [5][6][7].…”

Allogeneic Tendon Transplantation for the Treatment of Pathological Patellar Ligament Defect in Children: Technical Note and 4‐Year Follow‐Up

“…Currently, the material selection of ligament reconstruction includes autografts, allografts, and synthetic materials 6 , 15 , 16 . Based on the fact that different grafts have their own advantages, the selection of grafts was mainly based on individual needs and surgeons' experience.…”