Clinical and Imaging Outcomes After Arthroscopic Superior Capsule Reconstruction With Human Dermal Allograft for Irreparable Posterosuperior Rotator Cuff Tears: A Minimum 2-Year Follow-Up

Lacheta, Lucca; Horan, Marilee P.; Schairer, William W.; Goldenberg, Brandon T.; Dornan, Grant J.; Pogorzelski, Jonas

doi:10.1016/j.arthro.2019.12.024

Cited by 75 publications

(99 citation statements)

References 26 publications

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“…They should be used in situations where native tendon is compromised and additional mechanical augmentation is needed. Early studies from SCR report a wide range of healing rates (45-95%), [63][64][65][66] despite increases in clinical outcomes. Stem cells have been the least studied to date and there is insufficient evidence to give a recommendation for their use at this time.…”

Section: Dovepressmentioning

confidence: 99%

“…No significant differences in clinical outcome scores (P > 0.930) were found in patients with intact grafts versus those with torn grafts. 65 Denard et al showed a 45% healing rate at 1 year postoperative MRI and 18.6% of patients underwent a revision procedure. 66 In 86 patients, Pennington et al used 3 mm thick grafts and reported an increase in ASES score from 52 to 82, and an increase in mean acromiohumeral distance of 7.1 mm to 9.7 mm postoperatively.…”

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confidence: 97%

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<p>Biologics to Improve Healing in Large and Massive Rotator Cuff Tears: A Critical Review</p>

Goldenberg

Lacheta

Dekker

et al. 2020

ORR

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Large and massive rotator cuff tears have the highest risk of retear. Common biologic modalities that can potentially reduce the retear rate and improve healing include platelet-rich plasma (PRP), scaffolds, and mesenchymal stem cells (MSCs). PRP has been studied for its role in improving rotator cuff healing and results of randomized controlled trials and meta-analyses show mixed results. Most studies in large and massivge tears show that PRP decreases the retear rate, but the connection between structural integrity and clinical outcomes is still unknown. Extracellular matrix (ECM) and synthetic scaffolds can increase healing in augmentation and bridging repair. Acellular dermal allografts have shown better healing rates and outcomes than xenografts in meta-analyses. Synthetic scaffolds augmented with bone marrow-derived stem cells have only been studied in vitro but are promising for the combination of mechanical stability and induction of a biological response. Superior capsule reconstruction is an exciting type of interposition graft reconstruction that has shown favorable early clinical outcomes for large and massive tears. Bone marrow-derived stem cells and adipose-derived stem cells improve the biomechanical characteristics of tendon repair and enhance the histological findings of the healing process in animal studies. However, evidence from human studies is lacking, especially in patients with large and massive tears. In summary, there are many biological options to augment rotator cuff repair in patients with large and massive tears. Due to mixed results and a lack of standardization in high-quality studies, we cannot recommend PRP at this time as an adjunct to rotator cuff repair. Both ECM and synthetic scaffolds, as well as SCR, can be used, especially in situations where native tendon is compromised, and additional mechanical augmentation is needed. Stem cells have been the least studied to date, so it is difficult to give recommendations for or against their use at this time.

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Section: Dovepressmentioning

confidence: 99%

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confidence: 97%

<p>Biologics to Improve Healing in Large and Massive Rotator Cuff Tears: A Critical Review</p>

Goldenberg

Lacheta

Dekker

et al. 2020

ORR

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“…Moreover, while functional outcomes have been encouraging, healing of dermal allograft has been variable. [7][8][9][10] Another alternative is the use of the long head of the biceps tendon (LHBT). The LHBT has a history of use in augmentation of rotator cuff repairs 11 and recently has been described for SCR.…”

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confidence: 99%

Biceps Box Configuration for Superior Capsule Reconstruction of the Glenohumeral Joint Decreases Superior Translation but Not to Native Levels in a Biomechanical Study

Denard

Chae

Chalmers

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To quantitatively biomechanically assess superior stability, subacromial contact pressures, and glenohumeral kinematics of an in situ biceps tenodesis and a box-shaped long head of the biceps tendon (LHBT) superior capsule reconstruction (SCR) in a superior massive rotator cuff tear (MCT) model. Methods: Eight cadaveric shoulders (mean age, 62 years; range, 46-70 years) were tested with a custom testing system used to evaluate range of motion, superior translation, and subacromial contact pressure at 0 , 20 , and 40 of abduction. Conditions tested included native state, MCT (complete supraspinatus and one-half of the infraspinatus), a box-shaped LHBT SCR, and an in situ biceps tenodesis. The box-shaped SCR was performed by maintaining the biceps origin, securing 2 corners to the greater tuberosity, and one corner to the posterior glenoid. The in situ tenodesis was performed anatomically at the top of the articular margin in the same shoulder after take-down of the box SCR. Results: Range of motion was not impaired with either repair construct (P > .05). The box SCR decreased superior translation by approximately 2 mm compared with the MCT at 0 , but translation remained greater compared with the intact state in nearly every testing position. The in situ tenodesis had no effect on superior translation. Peak subacromial contact pressure was increased in the MCT at 0 and 20 abduction compared with the native state but not different between the native and box SCR at the same positions. Conclusions: A box-shaped SCR using the native biceps tendon partially restores increased superior translation and peak subacromial contact pressure due to MCT. The technique may have a role in augmentation of an irreparable MCT. Clinical Relevance: The box-shaped LHBT SCR technique may have a role in augmentation of an irreparable MCT.T he superior capsule of the glenohumeral joint is a distinct anatomical structure that plays a vital biomechanical role in the shoulder. 1,2 In the setting of a massive irreparable rotator cuff repair, stability of the glenohumeral joint is disrupted. An absent superior capsule allows for passive superior translation and hence an impaired fulcrum for glenohumeral abduction. Superior capsule reconstruction (SCR) has been shown biomechanically to restore superior stability and is supported with clinical outcomes up to 5 years after surgery. 3,4 A variety of graft sources have been proposed for SCR. Initially, Mihata et al. 5 reported the use of tensor

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“…24 After Mihata et al 22 reported the clinical outcomes of 23 patients who underwent superior capsular reconstruction (SCR) using a fascia lata autograft, some authors reported favorable clinical outcomes of SCR. 1,6,12,16,17,21 In biomechanical studies, Mihata et al 23,25 also showed that SCR decreased superior migration of the humerus. Although cadaveric studies have demonstrated superior stability of the humerus, it remains unclear whether the humerus migrates superiorly after SCR in vivo.…”

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confidence: 99%

Comparison of Dynamic In Vivo Shoulder Kinematics Before and After Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears

Lee

Min

Chung

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Superior capsular reconstruction (SCR) is an alternative surgical option for young active patients with irreparable rotator cuff tears without arthritis. Although cadaveric studies have shown superior stability of the humerus, it remains unclear whether the humerus migrates superiorly after SCR in vivo. Purpose: To analyze the change in glenohumeral translation in patients before and after SCR. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 patients who underwent SCR by a single surgeon for irreparable rotator cuff tears were included. Among them, 14 patients had intact grafts, and 8 patients were diagnosed with retears on 1-year postoperative magnetic resonance imaging (MRI) scans. Fluoroscopy was performed in all patients preoperatively and at 3-month, 6-month, and 1-year follow-up. Moreover, 3-dimensional bone models from computed tomography, MRI, and fluoroscopic scans during scapular plane abduction of the shoulder joints were analyzed. Results: In the intact graft group, 3-dimensional dynamic shoulder kinematics at 6 months ( P = .026) and 1 year ( P = .032) postoperatively showed statistically significant decreases in humeral head superior translation compared with preoperatively. The ≥6-mm acromiohumeral distance (AHD) subgroup had a larger decrease in humeral head superior translation from preoperatively than did the <6-mm AHD subgroup (6 months: P = .026; 1 year: P = .032). The retear group had significantly greater humeral head superior translation at 1 year postoperatively than did the ≥6-mm and <6-mm AHD subgroups (post hoc test: P < .001; ≥6-mm AHD vs retear group: P = .001; <6-mm AHD vs retear group: P = .012). Conclusion: SCR with intact grafts resulted in decreased humeral head superior translation after 6 months. Patients with retears showed no improvement in humeral head superior translation. Patients with a preoperative AHD <6 mm had less improvement in humeral head superior translation than did those with a preoperative AHD ≥6 mm. Early surgical treatment before an excessive decrease in preoperative AHD could be helpful for postoperative humeral head translation recovery.

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Clinical and Imaging Outcomes After Arthroscopic Superior Capsule Reconstruction With Human Dermal Allograft for Irreparable Posterosuperior Rotator Cuff Tears: A Minimum 2-Year Follow-Up

Cited by 75 publications

References 26 publications

<p>Biologics to Improve Healing in Large and Massive Rotator Cuff Tears: A Critical Review</p>

<p>Biologics to Improve Healing in Large and Massive Rotator Cuff Tears: A Critical Review</p>

Biceps Box Configuration for Superior Capsule Reconstruction of the Glenohumeral Joint Decreases Superior Translation but Not to Native Levels in a Biomechanical Study

Comparison of Dynamic In Vivo Shoulder Kinematics Before and After Superior Capsular Reconstruction for Irreparable Rotator Cuff Tears

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