Outcomes of arthroscopic tuberoplasty for symptomatic irreparable rotator cuff tendon tear without pseudoparalysis

Pines, Yaniv; Magone, Kevin M.; Ben-Ari, Erel; Gordon, Dan; Rokito, Andrew S.; Virk, Mandeep S.; Kwon, Young W.

doi:10.1016/j.jseint.2022.06.007

Cited by 5 publications

(5 citation statements)

References 26 publications

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“…Given the efficacy of unsecured grafts, the next step is to explore how this biomechanical success translates to improved clinical outcomes. 39 As with any biological graft, long-term biological limitations need to be considered. While there is a possibility for the graft to resorb, these grafts will probably behave similarly to grafts in SCR or rotator cuff repair, preserving their overall structure and incorporating with surrounding structures.…”

Section: Discussionmentioning

confidence: 99%

“…Given the efficacy of unsecured grafts, the next step is to explore how this biomechanical success translates to improved clinical outcomes. 39…”

Section: Discussionmentioning

confidence: 99%

“…Designed to help treat pain and loss of function, 4,11 allograft spacer procedures utilize a graft to act as a spacer in the subacromial space, decreasing pain from impingement of the greater tuberosity on the acromion at the extremes of overhead motion. 32,39 Techniques are still evolving, 7,46 with the aim of decreasing procedural costs and increasing the ease of spacer insertion. With these goals in mind, this study looked to evaluate the biomechanical characteristics of secured versus unsecured tensor fascia lata allografts used in an allograft spacer procedure.…”

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confidence: 99%

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A Biological Spacer to Treat Irreparable Rotator Cuff Tears: A Biomechanical Study Utilizing a Secured Versus Unsecured Tensor Fascia Lata Graft

Malige,

Tibone,

Hui

et al. 2024

Am J Sports Med

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Background: Designed to help treat pain and loss of function after rotator cuff repair, allograft spacer procedures utilize a graft to act as a spacer in the subacromial space, decreasing pain from impingement of the greater tuberosity on the acromion at the extremes of overhead motion. Purpose: To evaluate the biomechanical characteristics of secured versus unsecured tensor fascia lata allografts used in an allograft spacer procedure. Study Design: Controlled laboratory study. Methods: A total of 8 fresh-frozen cadaveric shoulder specimens were used. There were 4 conditions tested: (1) intact rotator cuff, (2) stage III rotator cuff tear (complete supraspinatus tendon and superior one-half of the infraspinatus tendon), (3) unsecured tensor fascia lata graft, and (4) secured tensor fascia lata graft. Both superior and posterior translation of the humeral head were calculated in each condition. A 4-cm × 5-cm × 6-mm tensor fascia lata graft was used in the subacromial space to act as a spacer. Grafts were secured at the lateral edge of the native rotator cuff footprint with 2 knotless anchors. Results: With unbalanced loading, both secured and unsecured grafts varied in their ability to limit superior and posterior translation at various rotation angles back to levels seen with intact rotator cuffs at 0° and 20° of abduction. During balanced loading, both unsecured and secured grafts limited superior and posterior translation more than those seen in the rotator cuff–deficient condition ( P < .01) and similar to those seen in the intact condition ( P > .05). The secured and unsecured grafts allowed similar amounts of translation at every position with both unbalanced and balanced loading ( P > .05). Finally, total graft motion was <7 mm in all positions. Conclusion: Unsecured tensor fascia lata grafts were biomechanically equivalent to secured grafts when used during allograft spacer procedures. Clinical Relevance: While both grafts were successful at limiting superior and posterior translation of the humeral head during early range of motion, the unsecured graft represents a cheaper, easier option to utilize during allograft spacer procedures.

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Section: Discussionmentioning

confidence: 99%

“…Given the efficacy of unsecured grafts, the next step is to explore how this biomechanical success translates to improved clinical outcomes. 39…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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A Biological Spacer to Treat Irreparable Rotator Cuff Tears: A Biomechanical Study Utilizing a Secured Versus Unsecured Tensor Fascia Lata Graft

Malige,

Tibone,

Hui

et al. 2024

Am J Sports Med

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“…The basic objective of the tuberoplasty procedure is to relieve subacromial impingement by reshaping the GT to create a smooth articulation between the GT and the undersurface of the acromion during shoulder abduction [19]. By similar means, subacromial decompression and acromioplasty might also prevent future impingement of the rotator cuff [20].…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Clinical Outcomes in Rotator Cuff Re-Tear Patients Who Had Either an Arthroscopic Primary Repair or Arthroscopic Patch Augmentation for Large-to-Massive Rotator Cuff Tears

Kim

Cha

et al. 2023

Diagnostics

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Background and Purpose: Despite the prevalent incidence of re-tear following rotator cuff repair, there is a notable lack of comparative studies investigating the outcomes between patients with re-tear who underwent primary repair versus those who received patch augmentation for large-to-massive tears. We assessed clinical outcomes of these techniques through a retrospective, randomized controlled trial. Methods: 134 patients diagnosed with large-to-massive rotator cuff tears from 2018 to 2021 underwent surgery; 65 had primary repair and 69 had patch augmentation. A total of 31 patients with re-tears were included, split into two groups; Group A (primary repair, 12 patients) and Group B (patch augmentation, 19 patients). Outcomes were evaluated using several clinical scales and MRI imaging. Results: Most clinical scores improved postoperatively in both groups. No significant difference in clinical outcomes was observed between groups, except for pain visual analog scale (P-VAS) scores. P-VAS scores showed greater decrease in the patch-augmentation group, a statistically significant difference. Conclusions: for large-to-massive rotator cuff tears, patch augmentation led to greater decreases in pain than primary repair, despite similar radiographic and clinical results. Greater tuberosity coverage of the supraspinatus tendon footprint may impact P-VAS scores.

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“…Isolated tuberoplasty procedure, as initially described by Fenlin et al [21], was mini-open and consisted of rounding of the greater tuberosity to create a congruent acromiohumeral articulation, and it has been shown to have acceptable improvements in pain and function at a mean follow-up of 27 months. However, continuation of superior migration of the humeral head has been noted, and other long-term studies have shown borderline satisfactory outcomes [22][23][24][25]. Lee et al [23] reported on 32 patients who underwent arthroscopic tuberoplasty and were followed for a mean of 40 months.…”

Section: Discussionmentioning

confidence: 99%

Preliminary Outcomes of Arthroscopic Biologic Tuberoplasty in the Treatment of Massive Irreparable Rotator Cuff Tears

Mirzayan¹

2023

Cureus

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Introduction: Several treatment options exist for the treatment of massive, irreparable rotator cuff tears. A novel technique has been described whereby an acellular dermal allograft is secured to the greater tuberosity which acts as an interpositional tissue preventing bone-to-bone contact between the greater tuberosity and acromion. The preliminary results of this arthroscopic procedure are being presented. Methods: Patients who underwent a biologic tuberoplasty procedure between 2015 and 2022, by a single surgeon, were included in this study. Pre- and postoperative American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and visual analogue pain scores (VAS) were prospectively recorded and retrospectively reviewed. Postoperative MRI was obtained in some cases. Paired t-test was used to calculate significance set at <0.05. Results: Ten patients met the inclusion criteria. The mean age was 70.4+4.7 years (range 65-78). There were five males. The mean length of follow-up was 21+27 months (range six to 95 months). There was significant improvement in ASES (24.3+4 to 91.5+10.3, P<0.00001), SANE (22.5+10.3 to 88+11.6, P<0.00001), and VAS (8.8+0.6 to 1.1+2.5, P<0.00001). MRI was obtained in seven patients at a mean of 5.3+2.9 months and showed a healed graft to the tuberosity in all cases. Conclusion: Biologic tuberoplasty is an effective procedure in improving pain and functional outcomes in patients with massive, irreparable rotator cuff tears.

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Outcomes of arthroscopic tuberoplasty for symptomatic irreparable rotator cuff tendon tear without pseudoparalysis

Cited by 5 publications

References 26 publications

A Biological Spacer to Treat Irreparable Rotator Cuff Tears: A Biomechanical Study Utilizing a Secured Versus Unsecured Tensor Fascia Lata Graft

A Biological Spacer to Treat Irreparable Rotator Cuff Tears: A Biomechanical Study Utilizing a Secured Versus Unsecured Tensor Fascia Lata Graft

A Comparison of Clinical Outcomes in Rotator Cuff Re-Tear Patients Who Had Either an Arthroscopic Primary Repair or Arthroscopic Patch Augmentation for Large-to-Massive Rotator Cuff Tears

Preliminary Outcomes of Arthroscopic Biologic Tuberoplasty in the Treatment of Massive Irreparable Rotator Cuff Tears

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