Dataset Information

Repair of Rotator Cuff Tear With Delamination: Independent Repairs of the Infraspinatus and Articular Capsule.

ABSTRACT: We propose a technique to repair delamination, which often occurs during rotator cuff repair surgery. We have reported that the infraspinatus occupies most of the greater tuberosity with the articular capsule attached to a very wide area, and that the superficial layer is mainly composed of the infraspinatus, and the deep layer is mainly composed of the articular capsule. To repair such delamination with consideration of the detailed anatomy, we developed the following repair method with independent repair of the superficial layer (infraspinatus) and the deep layer (articular capsule): (1) the deep layer is pulled laterally and joined to the medial margin of the greater tuberosity using 4 simple sutures from 2 anchors; (2) the paired limbs (same color) of 4 knots are passed over the posterior leaf of the superficial layer at intervals; (3) a push-in anchor loaded with 1 thread each of 4 knots is placed on the anterolateral corner of the greater tuberosity to pull the superficial layer anterolaterally; (4) another push-in anchor (remaining threads) is pushed on the posterior corner of the greater tuberosity. We believe that this technique can recover the function of both the articular capsule and rotator cuff, thereby facilitating better treatment outcomes after surgery.

SUBMITTER: Mochizuki T

PROVIDER: S-EPMC5310146 | biostudies-literature | 2016 Oct

REPOSITORIES: biostudies-literature

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Repair of Rotator Cuff Tear With Delamination: Independent Repairs of the Infraspinatus and Articular Capsule.

Mochizuki Tomoyuki T Nimura Akimoto A Miyamoto Takashi T Koga Hideyuki H Akita Keiichi K Muneta Takeshi T

Arthroscopy techniques 20161003 5

We propose a technique to repair delamination, which often occurs during rotator cuff repair surgery. We have reported that the infraspinatus occupies most of the greater tuberosity with the articular capsule attached to a very wide area, and that the superficial layer is mainly composed of the infraspinatus, and the deep layer is mainly composed of the articular capsule. To repair such delamination with consideration of the detailed anatomy, we developed the following repair method with indepen ...[more]

PMID: 28224067

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Project description:Myosteatosis is the pathological accumulation of lipid that occurs in conjunction with atrophy and fibrosis following skeletal muscle injury or disease. Little is known about the mechanisms by which lipid accumulates in myosteatosis, but many studies have demonstrated the degree of lipid infiltration negatively correlates with muscle function and regeneration. Our goal was to identify biochemical pathways that lead to muscle dysfunction and lipid accumulation in injured rotator cuff muscles, a model that demonstrates severe myosteatosis. Adult rats were subjected to a massive tear to the rotator cuff musculature. After a period of either 0 (healthy control), 10, 30, or 60 days, muscles were prepared for RNA sequencing, shotgun lipidomics, metabolomics, biochemical measures, electron microscopy, and muscle fiber contractility. Following rotator cuff injury, there was a decrease in muscle fiber specific force production that was lowest at 30d. There was a dramatic time dependent increase in triacylglyceride content. Interestingly, genes related to not only triacylglyceride synthesis, but also lipid oxidation were largely downregulated over time. Using bioinformatics techniques, we identified that biochemical pathways related to mitochondrial dysfunction and reactive oxygen species were considerably increased in muscles with myosteatosis. Long chain acyl-carnitines and L-carnitine, precursors to beta-oxidation, were depleted following rotator cuff tear. Electron micrographs showed injured muscles displayed large lipid droplets within mitochondria at early time points, and an accumulation of peripheral segment mitochondria at all time points. Several markers of oxidative stress were elevated following rotator cuff tear. The results from this study suggest that the accumulation of lipid in myosteatosis is not a result of canonical lipid synthesis, but occurs due to decreased lipid oxidation in mitochondria. A failure in lipid utilization by mitochondria would ultimately cause an accumulation of lipid even in the absence of increased synthesis. Further study will identify whether this process is required for the onset of myosteatosis.

Project description:PurposeTo determine whether anterior cable tears could be identified at the time of arthroscopic rotator cuff repair and determine the characteristics of the anterior cable tears identified.MethodsFrom 2016 to 2017 all shoulder arthroscopies had data collected prospectively at the time of surgery, specifically including injury to the capsular and tendon zones of insertion on the greater tuberosity. Anterior cable position and degree of injury and medialization were recorded, as well as complete findings of the diagnostic arthroscopy. The inclusion criterion was primary shoulder arthroscopy. The exclusion criterion was any revision shoulder arthroscopy. All arthroscopic rotator cuff repairs (ARCR) were grouped together and all other nonarthroscopic rotator cuff repair surgeries (non-ARCR) were grouped together.ResultsIn total, 118 shoulder arthroscopies had data collected prospectively at the time of surgery: 90 primary shoulder arthroscopies met the inclusion criteria; 28 were excluded because they were revision surgeries. There were 42 patients in the ARCR group (Group 1). Six of these were partial tears, and 36 were full-thickness tears. There were 48 patients in the non-ARCR group (Group 2). The non-ARCR Group 2 served as an anatomic baseline for ARCR Group 1. In all 90 shoulders, the rotator cable and anterior cable were identified. Group 1 (ARCR) incidence of anterior cable tears with abnormal position was 71.4% compared to 2.1% in group 2 (non-ARCR) (P < .001) Group 1 (ARCR) incidence of anterior cable tears with normal anterior cable position (n = 12) was compared to abnormal anterior cable position (n = 30). Injury to the anterior footprint capsular and tendon zones were compared. Normal anterior cable position correlated with no or low-grade injury to anterior footprint capsular zone. (Nimura zone C1). Abnormal anterior cable displacement graded as moderate (n = 20) and severe (n = 10) were compared for injury to the anterior footprint. Moderate displacement correlated with complete or high grade injury to C1 in 85% and complete injury to R1 in 45% (P < .001 and .049). In severe displacement complete C1 injury was 100%, and complete R1 injury was 100% (P < .001 and .001).ConclusionsAnterior cable tears are universally identified in ARCR. Three patterns of medial displacement severity correlated with injury to a crucial insertion zone (C1) at the anterior footprint. The degree of anterior cable disruption at the anterior footprint and displacement was commonly disproportionately greater than the injury to the supraspinatus.Level of evidenceLevel III, diagnostic study.

Dataset Information

Repair of Rotator Cuff Tear With Delamination: Independent Repairs of the Infraspinatus and Articular Capsule.

Publications

Repair of Rotator Cuff Tear With Delamination: Independent Repairs of the Infraspinatus and Articular Capsule.

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