The Subacromial Balloon Spacer Versus Superior Capsular Reconstruction in the Treatment of Irreparable Rotator Cuff Tears: A Biomechanical Assessment

Singh, Supriya; Reeves, Jacob M.; Langohr, G. Daniel G.; Johnson, James A.; Athwal, George S.

doi:10.1016/j.arthro.2018.09.016

Cited by 80 publications

(68 citation statements)

References 12 publications

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“…45 However, at higher abduction angles, the resultant force vector from the deltoid may be directed more horizontally into the glenoid, providing a concavity compression force and preventing superior head migration. 44 As a result, the graft may be superfluous at higher abduction angles and thus may contribute only as a subacromial spacer. 44 In the present study, the nontensioned graft did not increase maximum abduction angle, nor did it reduce acquired deltoid force compared with the torn condition.…”

Section: Discussionmentioning

confidence: 99%

“…16,17 Thus, superior capsular reconstruction (SCR) has emerged as an increasingly popular procedure with initial promising biomechanical results in restoring glenohumeral kinematics. 6,[33][34][35]45 As originally described by Mihata et al 35 in 2012, SCR involved using a fascia lata autograft rigidly fixed between the greater tuberosity and superior glenoid rim. Since then, the technique has been further evolved, with promising biomechanical and clinical results, as a potential alternative for young patients in the presence of massive, irreparable rotator cuff tears without osteoarthritis.…”

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confidence: 99%

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Graft Tensioning in Superior Capsular Reconstruction Improves Glenohumeral Joint Kinematics in Massive Irreparable Rotator Cuff Tears: A Biomechanical Study of the Influence of Superior Capsular Reconstruction on Dynamic Shoulder Abduction

Dyrna

Berthold

Muench

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Superior capsular reconstruction (SCR) for massive, irreparable rotator cuff tears has become more widely used recently; however, ideal tensioning of the graft and the influence on joint kinematics remain unknown. Purpose/Hypothesis: The purpose of this study was to assess the effects of graft tensioning on glenohumeral joint kinematics after SCR using a dermal allograft. The hypothesis was that a graft fixed under tension would result in increased glenohumeral abduction motion and decreased cumulative deltoid forces compared with a nontensioned graft. Study Design: Controlled laboratory study. Methods: A total of 10 fresh-frozen cadaveric shoulders were tested using a dynamic shoulder simulator. Each shoulder underwent the following 4 conditions: (1) native, (2) simulated irreparable supraspinatus (SSP) tear, (3) SCR using a nontensioned acellular dermal allograft, and (4) SCR using a graft tensioned with 30 to 35 N. Mean values for maximum glenohumeral abduction and cumulative deltoid forces were recorded. The critical shoulder angle (CSA) was also assessed. Results: Native shoulders required a mean (±SE) deltoid force of 193.2 ± 45.1 N to achieve maximum glenohumeral abduction (79.8° ± 5.8°). Compared with native shoulders, abduction decreased after SSP tears by 32% (54.3° ± 13.7°; P = .04), whereas cumulative deltoid forces increased by 23% (252.1 ± 68.3 N; P = .04). The nontensioned SCR showed no significant difference in shoulder abduction (54.1° ± 16.1°) and required deltoid forces (277.8 ± 39.8 N) when compared with the SSP tear state. In contrast, a tensioned graft led to significantly improved shoulder abduction compared with the SSP tear state ( P = .04) although abduction and deltoid forces could not be restored to the native state ( P = .01). A positive correlation between CSA and maximum abduction was found for the tensioned-graft SCR state ( r = 0.685; P = .02). Conclusion: SCR using a graft fixed under tension demonstrated a significant increase in maximum shoulder abduction compared with a nontensioned graft; however, abduction remained significantly less than the intact state. The nontensioned SCR showed no significant improvement in glenohumeral kinematics compared with the SSP tear state. Clinical Relevance: Because significant improvement in shoulder function after SCR may be expected only when the graft is adequately tensioned, accurate graft measurement and adequate tension of at least 30 N should be considered during the surgical procedure. SCR with a tensioned graft may help maintain sufficient acromiohumeral distance, improve clinical outcomes, and reduce postoperative complications.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Graft Tensioning in Superior Capsular Reconstruction Improves Glenohumeral Joint Kinematics in Massive Irreparable Rotator Cuff Tears: A Biomechanical Study of the Influence of Superior Capsular Reconstruction on Dynamic Shoulder Abduction

Dyrna

Berthold

Muench

et al. 2020

Orthopaedic Journal of Sports Medicine

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“…Tanto el sistema InSpace como la reconstrucción capsular superior restauran la fuerza de abducción a un nivel que no fue estadísticamente significativo comparado con su estado intacto. 7 Se estudiaron 15 casos entre 2014 y 2016, de los cuales tres habían tenido reparaciones fallidas previas. Al aplicar el test de Constant no se encontraron diferencias significativas a 12 meses, ni en el test QuickDASH.…”

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Manejo artroscópico en rupturas masivas del manguito rotador con espaciador subacromial

Cázares¹,

Corona²,

Parás³

2020

Acta Médica Grupo Ángeles

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Con los avances en cirugía artroscópica se ha logrado actualmente el manejo de lesiones masivas, sean reparables o irreparables, ofreciendo una mejoría importante en el dolor y la funcionalidad, y en ocasiones la fuerza muscular. Para elegir el tipo de tratamiento más adecuado debe tenerse en cuenta el síntoma principal, la edad, el grado funcional, la anatomía de la lesión y síntomas asociados. Entre las opciones terapéuticas se encuentran la debridación, la reparación parcial del manguito, la aumentación con parche, la reparación capsular superior y recientemente, la colocación de espaciador subacromial biodegradable. Éste último dispositivo es una adición importante al manejo en pacientes con tejidos deficientes, así como en la protección de reparaciones parciales.

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“…Is the graft just a glorified spacer? Singh et al 5 performed a biomechanical study comparing SCR with a subacromial balloon spacer. They concluded that both techniques decreased superior humeral head migration and restored more normal glenohumeral joint position and forces during abduction.…”

Section: See Related Article On Page 1243mentioning

confidence: 99%

Editorial Commentary: SCR: Substantial Confusion Remains

Favorito¹,

Stephens²

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The Subacromial Balloon Spacer Versus Superior Capsular Reconstruction in the Treatment of Irreparable Rotator Cuff Tears: A Biomechanical Assessment

Cited by 80 publications

References 12 publications

Graft Tensioning in Superior Capsular Reconstruction Improves Glenohumeral Joint Kinematics in Massive Irreparable Rotator Cuff Tears: A Biomechanical Study of the Influence of Superior Capsular Reconstruction on Dynamic Shoulder Abduction

Graft Tensioning in Superior Capsular Reconstruction Improves Glenohumeral Joint Kinematics in Massive Irreparable Rotator Cuff Tears: A Biomechanical Study of the Influence of Superior Capsular Reconstruction on Dynamic Shoulder Abduction

Manejo artroscópico en rupturas masivas del manguito rotador con espaciador subacromial

Editorial Commentary: SCR: Substantial Confusion Remains

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