Dermal Tissue Allograft for the Repair of Massive Irreparable Rotator Cuff Tears

114

102

Massive irreparable rotator cuff tears in young patients are a particular challenge for the orthopaedic surgeon. Surgical treatment options include debridement, partial rotator cuff repair, patch-augmented rotator cuff repair, bridging rotator cuff reconstruction with graft interposition, tendon transfer, and reverse total shoulder arthroplasty. Recently, reconstruction of the superior glenohumeral capsule using a fascia lata autograft has been suggested to reduce superior glenohumeral translation and restore superior stability. Promising clinical results have been reported in 1 case series of 23 patients, indicating that superior capsular reconstruction may be a promising tool to manage massive irreparable rotator cuff tears. This article describes our preferred technique for arthroscopic superior capsule reconstruction.

Section: Discussionmentioning

confidence: 99%

Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears

Petri

Greenspoon

Millett

2015

114

102

“…Lee et al 11 presented satisfactory results with good preservation of the preoperative and postoperative acromiohumeral interval and continuity in the inferior scapulohumeral line, diminishing pain, and improvement of active forward elevation in 36 patients with irreparable, massive rotator cuff tears who were followed up for at least 3 years after arthroscopic tuberoplasty with concomitant acromioplasty, as well as treatment of the biceps tendon when indicated. Gupta et al 12 described a prospective ob- E. SAVARESE AND R. ROMEO servational study of 24 patients who underwent interposition repair of massive rotator cuff tears with human dermal allograft; all patients showed a significant improvement in pain, range of motion, and strength, with ultrasonography-confirmed "fully intact" repairs in 76% of patients who were followed up for a 3-year period on average. Glanzmann et al 13 performed retrospective assessment of 31 deltoid flap transfers for massive posterosuperior rotator cuff tears at midterm and long-term follow-up examinations (mean, 53 and 175 months, respectively).…”

Section: Discussionmentioning

confidence: 99%

New Solution for Massive, Irreparable Rotator Cuff Tears: The Subacromial “Biodegradable Spacer”

Savarese

Romeo

2012

160

121

Massive, irreparable rotator cuff tears are a source of pain and disability. Although most rotator cuff tears can be completely repaired, a significant number are considered massive and irreparable. Numerous operative techniques have been described for the treatment of these kinds of tears including arthroscopic debridement, biceps tenotomy, tendon transfer, grafting, and reverse arthroplasty. We describe a surgical technique using a biodegradable subacromial balloon spacer (InSpace; OrthoSpace, Kfar Saba, Israel) implanted between the humeral head and acromion that permits smooth, frictionless gliding, restoring the shoulder biomechanics. The technique is easy to perform and is less invasive than the conventional surgical techniques available, and it may potentially serve as a bridging option in patients with massive, irreparable tears who are normally candidates for reverse arthroplasty.

“…6 In massive cuff tears, biologic augmentation of the repair may be helpful by strengthening the repair, adding collagen to the construct, and providing for a more anatomic repair. [3][4][5]7 Advantages of this all-arthroscopic technique include less potential for arthrofibrosis, lower rates of infection, and decreased damage to the deltoid. In addition, no special equipment is required to perform this technique.…”

Section: Discussionmentioning

confidence: 99%

“…Although previous authors have described successful results for bridging a gap between a medially retracted rotator cuff tear and the tuberosity with a patch, this use is considered offlabel by the US Food and Drug Administration. 4,5 The arthroscopic technique described in this article is used to augment reparable tears, 3 not to bridge irreparable tears. The tuberosity is prepared with a shaver and burr while care is taken not to violate the cortex.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Patch augmentation has been described as a technique to augment the biology of rotator cuff repair (RCR), with promising shortterm results. [3][4][5] Arthroscopic RCR with patch augmentation is best used in situations involving poor tissue quality with massive rotator cuff tears, tears of 2 or more tendons, and failed primary repair and/or revision rotator cuff surgery ( Table 1). The purpose of this article is to provide our preferred surgical technique for arthroscopic RCR with patch augmentation.…”

mentioning

confidence: 99%

See 1 more Smart Citation

All-Arthroscopic Patch Augmentation of a Massive Rotator Cuff Tear: Surgical Technique

Chalmers

Frank

Gupta

et al. 2013

Self Cite

Surgical management of massive rotator cuff tears remains challenging, with failure rates ranging from 20% to 90%. Multiple different arthroscopic and open techniques have been described, but there is no current gold standard. Failure after rotator cuff repair is typically multifactorial; however, failure of tendon-footprint healing is often implicated. Patch augmentation has been described as a possible technique to augment the biology of rotator cuff repair in situations of compromised tendon quality and has shown promising short-term results. The purpose of this article is to describe our preferred surgical technique for arthroscopic rotator cuff repair with patch augmentation.