Graft healing does not influence subjective outcomes and shoulder kinematics after superior capsule reconstruction: a prospective in vivo kinematic study

Hughes, Jonathan D.; Kane, Gillian; LeVasseur, Clarissa M.; Gabrielli, Alexandra S.; Popchak, Adam; Anderst, William; Lin, Albert

doi:10.1016/j.jse.2021.02.026

Cited by 12 publications

(11 citation statements)

References 34 publications

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“…The mean intraoperative lengths of the grafts were 25.0 ± 4.8 mm (range, 15-31 mm) for the anterior region and 22.2 ± 4.7 mm (range, 10-25 mm) for the posterior region of the graft. Graft healing was previously reported in Hughes et al, 8 but briefly, the posterior region was more likely to not heal than the anterior region: 5 of the 10 participants had full healing at the posterior anchors, whereas 7 had full healing at the anterior anchors (Table 1).…”

Section: Resultsmentioning

confidence: 52%

“…Inclusion and exclusion criteria, surgical parameters, and physical therapy protocols have all been previously reported. 8,10 The procedure was performed while the patient was in the beach-chair position. A measuring guide was used intraoperatively, before graft implantation, to measure the distance between the 2 anterior anchor locations, the 2 posterior anchor locations, the glenoid anchors, and the medial row anchors on the humerus.…”

Section: Methodsmentioning

confidence: 99%

“…as either healed or not healed. 8 Anterior and posterior regions of the graft were then classified as healed if the graft was healed at both anchor locations, or not healed if the graft was not healed at 1 or both anchor locations. Three-dimensional models of the humerus and scapula, as well as the position of the anchors relative to the humerus and scapula, were created from manual segmentation of the MRI.…”

Section: Methodsmentioning

confidence: 99%

“…Given that the scapulohumeral rhythm in this cohort was previously reported as 1.4, 60° to 65° of glenohumeral abduction corresponded to approximately 90° of humerothoracic abduction, or the arm horizontal. 8…”

Section: Methodsmentioning

confidence: 99%

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In Vivo Graft Elongation After Arthroscopic Dermal Superior Capsular Reconstruction

et al. 2023

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Background: Superior capsular reconstruction (SCR) is a procedure purported to restore stability of the glenohumeral joint after an irreparable rotator cuff tear, but the in vivo behavior of the graft is unknown. Previous work has not evaluated the relationship between graft deformation, kinematics, and healing. Purpose: To (1) determine regional graft elongation after SCR, (2) determine if graft elongation is related to graft healing, and (3) identify associations between graft elongation and changes in kinematics from presurgery to postsurgery. Study Design: Case series; Level of evidence, 4. Methods: Ten patients who underwent SCR performed abduction and shoulder rotation with the arm at 90° of humerothoracic abduction before and 1 year after surgery while biplane radiographs were collected at 50 images per second. Kinematics was determined with submillimeter accuracy by matching patient-specific digitally reconstructed radiographs of the humerus and scapula to the biplane radiographs using a validated volumetric tracking technique. Graft elongation was calculated using motion of the graft anchors that were identified on postoperative magnetic resonance imaging. Differences in elongation between anterior and posterior regions of the graft, as well as associations between graft elongation, graft healing, and kinematics, were analyzed. Results: Peak graft elongation ranged from a 3% decrease in the anterior region during rotation to up to a 171% increase in the anterior region during abduction and the posterior region during rotation. Grafts that were healed at both anterior anchors reached the intraoperative length at lower abduction angles (60°) than grafts that were not healed at 1 or both of the anterior anchors (87°) ( P = .005). The posterior anchor graft origin to insertion distances were 2.1 mm farther apart after surgery compared with before surgery during both abduction and rotation. Conclusion: SCR dermal allografts are stretched well beyond their intraoperative length in vivo. Graft healing appears to be associated with less graft elongation. The posterior portion of the SCR graft does not appear to improve glenohumeral joint stability 1 year after surgery. Improved clinical outcomes after dermal allograft SCR may be because of the spacer effect of the graft rather than improved glenohumeral joint stability 1 year after surgery.

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Section: Resultsmentioning

confidence: 52%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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In Vivo Graft Elongation After Arthroscopic Dermal Superior Capsular Reconstruction

et al. 2023

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“…Several studies have shown that clinical outcomes after SCR improve, regardless of the extent of graft healing detected by MRI. 12,15 To improve clinical results, SCR could be an effective salvage procedure for irreparable rotator cuff tears. However, long-term follow-up studies to evaluate the effect of failed graft integrity on clinical outcomes will be needed.…”

Section: Discussionmentioning

confidence: 99%

Effect of Fatty Infiltration of the Infraspinatus Muscle on Outcomes and Graft Failure After Arthroscopic Superior Capsule Reconstruction for Irreparable Posterosuperior Rotator Cuff Tears

et al. 2022

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Background: Superior capsule reconstruction (SCR) was developed as an alternative treatment for irreparable rotator cuff tears to restore superior stability of the glenohumeral joint. Although fatty infiltration (FI) of the rotator cuff muscles, especially the infraspinatus, has been implicated as a predictor of outcomes and graft integrity after rotator cuff repair, it has not been fully investigated in cases of SCR. Purpose: To evaluate the effect of FI of the infraspinatus muscle on clinical and radiological outcomes after SCR. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 55 consecutive patients with irreparable posterosuperior rotator cuff tears who underwent SCR between January 2013 and August 2020 were included retrospectively. Preoperative and postoperative clinical and radiological findings (median follow-up of >2 years), including magnetic resonance imaging results, were thoroughly reviewed. The patients were divided into 2 groups: group 1 with mild FI of the infraspinatus (Goutallier grades 0-2) and group 2 with severe FI of the infraspinatus (Goutallier grades 3-4). The American Shoulder and Elbow Surgeons score, Constant score, visual analog scale score for pain, and range of motion were evaluated. Acromiohumeral distance and rotator cuff tear arthropathy using the Hamada classification were assessed on plain radiography. Postoperative graft integrity was evaluated by magnetic resonance imaging. Graft failure was defined as complete discontinuity. Univariate and multivariable logistic regression analyses were performed to evaluate clinical and radiological findings that might be associated with successful SCR. Results: Clinical and radiological outcomes significantly improved after SCR. Graft failure was noted in 15 (27.3%) patients and was more frequent in group 2 than in group 1 (50.0% vs 14.3%, respectively; P = .004). Univariate analysis indicated a significant association between severe FI in the infraspinatus (group 2) and graft failure after SCR (odds ratio, 6.00 [95% CI, 1.65-21.80]; P = .006). Multivariable analysis indicated that FI of the infraspinatus was the only factor associated with graft failure (odds ratio, 6.37 [95% CI, 1.63-24.90]; P = .008). Conclusion: Severe FI of the infraspinatus muscle was a factor indicating a poor prognosis for graft integrity after SCR. Preoperative evaluation of FI in the rotator cuff muscles can help predict postoperative outcomes and may help guide therapeutic options.

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Improved Outcomes Following Arthroscopic Superior Capsular Reconstruction May Not Be Associated With Changes in Shoulder Kinematics: An In Vivo Study

Kane

LeVasseur

Hughes

et al. 2022

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Graft healing does not influence subjective outcomes and shoulder kinematics after superior capsule reconstruction: a prospective in vivo kinematic study

Cited by 12 publications

References 34 publications

In Vivo Graft Elongation After Arthroscopic Dermal Superior Capsular Reconstruction

In Vivo Graft Elongation After Arthroscopic Dermal Superior Capsular Reconstruction

Effect of Fatty Infiltration of the Infraspinatus Muscle on Outcomes and Graft Failure After Arthroscopic Superior Capsule Reconstruction for Irreparable Posterosuperior Rotator Cuff Tears

Improved Outcomes Following Arthroscopic Superior Capsular Reconstruction May Not Be Associated With Changes in Shoulder Kinematics: An In Vivo Study

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