Treatment of Massive Rotator Cuff Tears with Reverse Shoulder Arthroplasty

Kobayashi, Evangeline F.; Oak, Sameer R.; Miller, Bruce S.; Bedi, Asheesh

doi:10.1016/j.csm.2022.08.007

Cited by 4 publications

(3 citation statements)

References 46 publications

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“…TSA consistently improves pain, range of motion, and function in patients with massive irreparable cuff tear as well as those with cuff tear arthropathy. 65…”

Section: Tendon Transfersmentioning

confidence: 99%

My Approach to Failed Rotator Cuff Repair

Chan,

Remedios,

Wong

2023

Sports Medicine and Arthroscopy Review

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Failed rotator cuff repairs pose several challenges due to the high incidence rate, complexity, and range of symptoms. We propose an overview for assessing and treating failed rotator cuff repairs. For active young patients, attempt revision repair with patch augmentation if possible. When anatomic revision is not viable, but muscle is retained, consider partial repair with interposition bridging. Isolated, irreparable supraspinatus tears may benefit from superior capsule reconstruction. Tendon transfer is suitable for patients with significant atrophy and multiple irreparable cuff tears. Low-demand elderly patients or those with substantial glenohumeral arthritis may consider reverse total shoulder arthroplasty if conservative management fails. There are a variety of reported outcomes in the literature but long-term studies with larger cohorts are needed to improve the management of failed rotator cuff repair.

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“…TSA consistently improves pain, range of motion, and function in patients with massive irreparable cuff tear as well as those with cuff tear arthropathy. 65…”

Section: Tendon Transfersmentioning

confidence: 99%

My Approach to Failed Rotator Cuff Repair

Chan,

Remedios,

Wong

2023

Sports Medicine and Arthroscopy Review

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“…Irreparable massive rotator cuff tear (RCT) is a challenging pathology in shoulder surgery, and up to 30% of RCTs are reported as irreparable due to the massive tear size and severe muscle fatty infiltration [10, 34]. Several surgical options have been reported for irreparable massive RCTs, such as debridement with or without subacromial decompression, partial repair, patch augmentation/interposition, biodegradable spacer, tendon transfer, superior capsular reconstruction (SCR), and reverse total shoulder arthroplasty [19, 20, 22, 28, 36, 41, 54]. Among these, SCR was proposed as a joint‐preserving solution for relatively younger patients with irreparable massive RCTs [31, 33]; graft healing to the bone is important for successful SCR [6].…”

Section: Introductionmentioning

confidence: 99%

Superior capsular reconstruction using hybrid graft for irreparable massive rotator cuff tear

Yoon

Kim

Yoon

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate the clinical and radiological outcomes of arthroscopic superior capsular reconstruction (SCR) using hybrid grafts composed of tensor fascia lata autografts and human dermal allografts. Methods This study included 30 patients with chronic irreparable posterosuperior rotator cuf tears (RCTs) who underwent arthroscopic SCR using a hybrid graft composed of tensor fascia lata autograft and human dermal allograft. Clinical outcomes were evaluated using the pain visual analogue scale score, shoulder range of motion, American Shoulder and Elbow Surgeons score, constant score, University of California-Los Angeles score, and simple shoulder test score preoperatively and at least 2 years after surgery. Radiographic analysis included the Hamada classiication grade, acromiohumeral distance (AHD), and graft integrity at 2 years after surgery. Results All patients exhibited signiicant clinical improvement in all functional outcome measurements, except external rotation (all P < 0.05). The number of patients who exhibited pseudoparalysis decreased from 7 (23.3%) to 2 (6.7%) postoperatively. Complications were not observed. Radiologically, the mean postoperative AHD increased signiicantly from 6.9 ± 1.6 cm to 8.8 ± 2.1 cm at 2 years postoperatively (P < 0.001). Twenty ive out of the 30 (83.3%) patients showed successful graft healing, and all healing failures occurred on the humeral side. The diferences between the healed-graft and failed-graft groups were signiicantly lower graft thickness (P = 0.001) and smaller AHD (P < 0.001) in the failed-graft group. Every functional outcome scores were not statistically diferent between healed-graft and failed-graft groups. Conclusions An arthroscopic SCR technique using a hybrid graft consisting of a tensor fascia lata autograft and human dermal allograft showed satisfactory clinical outcomes in patients with irreparable RCTs. Level of evidence IV. KeywordsSuperior capsular reconstruction • Hybrid graft • Tensor fascia lata • Human dermal allograft • Irreparable massive rotator cuf tear * Seok Won Chung

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“…These pathologies in isolation have reliable treatment algorithms, but together they prove challenging to treat without clear consensus for surgical intervention. While reverse shoulder arthroplasty (RSA) is the treatment of choice for severe cuff tear arthropathy 6-8 , it is historically contraindicated in the setting of deltoid compromise because of untenably poor outcomes including joint instability and limited range of motion 9,10 . In this report, we present the successful surgical management and return to activity of a 60-year-old patient with an irreparable cuff tear, glenohumeral osteoarthritis, and axillary nerve palsy through a staged approach with radial-to-axillary reverse end-to-side (RETS) “supercharging” 11 nerve transfer followed by RSA 12,13 .…”

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confidence: 99%

Reverse Shoulder Arthroplasty for Irreparable Rotator Cuff Tear After Radial to Axillary End-to-Side Transfer

Protzuk,

Schmidt,

Craig

et al. 2024

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Case: A 60-year-old man sustained a massive irreparable rotator cuff tear and axillary nerve palsy with deltoid dysfunction after an anterior shoulder dislocation. He underwent staged reverse end-to-side radial-to-axillary nerve transfer with return of deltoid function allowing for subsequent reverse shoulder arthroplasty. At 1 year postoperatively, he returned to full activity. Conclusion: Irreparable rotator cuff tears complicated by axillary nerve palsy can be effectively treated with a staged approach of nerve transfer followed by reverse shoulder arthroplasty.

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Treatment of Massive Rotator Cuff Tears with Reverse Shoulder Arthroplasty

Cited by 4 publications

References 46 publications

My Approach to Failed Rotator Cuff Repair

My Approach to Failed Rotator Cuff Repair

Superior capsular reconstruction using hybrid graft for irreparable massive rotator cuff tear

Reverse Shoulder Arthroplasty for Irreparable Rotator Cuff Tear After Radial to Axillary End-to-Side Transfer

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