Failed Dermal Allograft Procedures for Irreparable Rotator Cuff Tears Can Still Improve Pain and Function: The “Biologic Tuberoplasty Effect”

Mirzayan, Raffy; Stone, Michael A.; Batech, Michael; Acevedo, Daniel Camilo Aguirre; Singh, Anshuman

doi:10.1177/2325967119863432

Cited by 53 publications

(57 citation statements)

References 31 publications

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“…The interposition effect of the graft in the setting of an SCR was examined by Mirzayan et al. 31 who coined the term “biological tuberosity effect.” In their article, procedures in which the graft remained attached to the tuberosity had a significantly better outcome than those in which the tuberosity was uncovered. 31 …”

Section: Discussionmentioning

confidence: 99%

Bursal Acromial Reconstruction (BAR) Using an Acellular Dermal Allograft as a Surgical Solution for the Treatment of Massive Irreparable Rotator Cuff Tears

Ravenscroft

Barnes

Muench

et al. 2021

Arthroscopy Techniques

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Massive, irreparable rotator cuff tears in patients without severe signs of osteoarthritis remains a major challenge for orthopaedic surgeons. These can be a source of significant pain and functional loss occurring most commonly in a relatively frail, elderly patient population. A plethora of surgical techniques covering minimally invasive, arthroscopic techniques and open, salvage procedures have been described for this challenging patient cohort. Continuous evolvement of arthroscopic techniques has led to all-arthroscopic superior capsular reconstruction techniques using allografts, thereby reducing donor side morbidity along with decreased soft tissue dissection. However, conventional superior capsular reconstruction is noted to be a technically complex, time-consuming, and high-cost surgery, which may put this technique beyond the confidence of many shoulder surgeons. The subacromial balloon spacer has emerged as a potential solution in these patients, providing interposition between the humeral head and acromion. However, the subacromial balloon biodegrades rapidly and its effect is only temporary. Thus this technique article presents using an acellular human dermal allograft to reconstruct the bursal layer, which is normally interposed between the humeral head and the acromion. The proposed technique provides a permanent interposition graft preventing humeral acromial contact, which does not undergo rapid biodegradation. The surgical technique is technically feasible, both minimizing surgical time and therefore operative risk to the patient.

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Section: Discussionmentioning

confidence: 99%

Bursal Acromial Reconstruction (BAR) Using an Acellular Dermal Allograft as a Surgical Solution for the Treatment of Massive Irreparable Rotator Cuff Tears

Ravenscroft

Barnes

Muench

et al. 2021

Arthroscopy Techniques

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“…The improvement in pain was observed in patients with massive rotator cuff repair after a failed dermal allograft procedure because the tuberosity is covered by the graft to prevent bone-to-bone contact with the acromion. 41 SCR is still evolving from a surgical technique standpoint, with a wide variety of procedures being reported. 2,5,16,19,28,42,53 To date, debate exists about whether a side-to-side graft repair to the adjacent remaining rotator cuff is necessary.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Failure Rate After Superior Capsular Reconstruction With Achilles Tendon–Bone Allograft for Irreparable Rotator Cuff Tears

Kholinne

Sun

Kwak

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Superior capsular reconstruction (SCR) is an alternative to reverse shoulder arthroplasty for irreparable rotator cuff tears (IRCTs). The reconstructed capsule acts as a static restraint to prevent superior migration of the humeral head. Traditional SCR uses a fascia lata autograft, which has shown failure at the greater tuberosity. An Achilles tendon–bone allograft has been proposed to improve the failure rate. Purpose: To evaluate the surgical outcomes of SCR using an Achilles tendon–bone allograft for the treatment of IRCTs. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively evaluated 6 patients with massive IRCTs who underwent SCR using an Achilles tendon–bone allograft between January 2017 and January 2018. Clinical outcomes were assessed using range of motion, the American Shoulder and Elbow Surgeons score, and the visual analog scale for pain. The acromiohumeral distance and the status of graft integrity were evaluated using serial magnetic resonance imaging. Second-look arthroscopy surgery was performed to evaluate graft integrity at the mean of 7.5 months postoperative. Results: The mean ± SD clinical follow-up period was 14.5 months (range, 12-17 months). The American Shoulder and Elbow Surgeons and visual analog scale scores improved from 42.8 ± 11.9 and 4.0 ± 1.2 to 62.1 ± 14.7 and 2.8 ± 1.4, respectively. Forward flexion and external rotation improved from 98° ± 36° and 58° ± 4° to 123° ± 20° and 39° ± 8°, respectively. The acromiohumeral distance improved from 3.9 ± 0.8 mm to 6.4 ± 2.2 mm at final follow-up. However, second-look arthroscopy at a mean of 7.6 months postoperatively confirmed a graft failure rate of 83.3%. Conclusion: SCR using an Achilles tendon–bone allograft for the treatment of IRCTs had a high graft failure rate among patients in this case series.

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“…There were two kinds of tuberoplasty, non-prosthesis tuberoplasty and prosthesis tuberoplasty. Arthroscopic non-prosthesis tuberoplasty was a relatively mini-invasive and effective way among these procedures, which takes little harm to patients [19][20][21][22] . But the problem is that there was not a standard procedure for tuberoplasty, and surgeons had performed this surgery by intuition.…”

Section: Discussionmentioning

confidence: 99%

How Great is Greater Tuberosity? – A Analysis by CT Multiplanar Reconstruction

Yin

et al. 2021

Preprint

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Objective: This study was designed to explore the precise size of the greater tuberosity of humerus in Chinese population.Methods: The radiologic study was performed on 66 CTs of shoulder from the hospital’s CT scan database of out-patient department from December 2018 to February 2020. This study designed a method to measure the size of the greater tuberosity (GT). The width, height and thickness of the greater tuberosity were measured on CT image multiplanar reconstructions (MPR), which was independently conducted by two observers.Results: 66 intact shoulders CT scans were analyzed, including 26 women and 40 men with a mean age of 36.79 ± 9.17 years, with 41 right and 25 left shoulders. There were no significant differences in GT width, GT height, GT thickness and PH thickness between two observers. The ICC for the GT width measurements taken by CT was 0.872. The ICC for the GT height was 0.810. The ICC for the GT thickness was 0.777. The ICC for the PH thickness was 0.971. For male cases, the total PH thickness was 51.06±2.30 (45.70-55.20) mm for female cases, the total PH thickness was 45.79±2.57 (41.40-51.25) mm. Gender have a significant impact on the results, man had a larger GT than woman.Conclusions: The method was an applicable way the measure the size of greater tuberosity, it showed good reliability. The size of GT in male cases was larger than female. These data provides important information for further research and clinical practice.

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Failed Dermal Allograft Procedures for Irreparable Rotator Cuff Tears Can Still Improve Pain and Function: The “Biologic Tuberoplasty Effect”

Cited by 53 publications

References 31 publications

Bursal Acromial Reconstruction (BAR) Using an Acellular Dermal Allograft as a Surgical Solution for the Treatment of Massive Irreparable Rotator Cuff Tears

Bursal Acromial Reconstruction (BAR) Using an Acellular Dermal Allograft as a Surgical Solution for the Treatment of Massive Irreparable Rotator Cuff Tears

Failure Rate After Superior Capsular Reconstruction With Achilles Tendon–Bone Allograft for Irreparable Rotator Cuff Tears

How Great is Greater Tuberosity? – A Analysis by CT Multiplanar Reconstruction

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