Pivot Superior Capsular Reconstruction of the Shoulder.
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ABSTRACT:
SUBMITTER: Bader DAL
PROVIDER: S-EPMC7301191 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Irreparable rotator cuff tears (IRCTs) in young and considerably active patients are difficult to treat because it is mostly associated with poor outcome which may lead to a painful and dysfunctional shoulder. Most of the IRCTs are encountered in massive size rotator cuff tears which associated with high failure rate following surgical repair. Thus, the IRCTs was considered challenging for its poor healing rate following repair which may induce the arthritic changes. Since the advent of arthroscopic superior capsular reconstruction (ASCR) of the shoulder in 2013, it has gained its popularity. The procedure has become the most popular option for joint-preserving shoulder surgery for patients with IRCTs. It works by providing a static restraint to the superior humeral head migration to optimize the rotator cuff force couples, hence improving joint kinematics. The acceptance of superior capsular reconstruction has made it rapidly evolving in terms of a wider variety of procedures and broader surgical indications. Despite the enthusiasm and widely acceptance towards the procedure, there are still many queries that exist regarding the best indications, surgical technique particularly graft of choice, the long-term outcome, and the complication and risk of the superior capsular reconstruction (SCR). This narrative review provide the current evidence of SCR in an attempt to provide a state-of-the-art knowledge.
| S-EPMC7940888 | biostudies-literature
Project description:The shoulder position during fixation of the graft may be a key factor impacting the outcome of arthroscopic superior capsular reconstruction (ASCR) in irreparable rotator cuff tears (IRCTs). However, biomechanical evidence regarding this effect is lacking. The aim of this study was to evaluate the influence of the shoulder position during fixation of the graft on shoulder stability and graft tear risk in ASCR. A 3-D musculoskeletal model of the upper limb was modified to account for the fixation of the graft in ASCR, assuming a full-thickness tear of the supraspinatus tendon. The concomitant tenotomy of the long head of the biceps (LHB) tendon was also studied. The biomechanical parameters evaluated included the strain of the graft and the glenohumeral joint reaction force (GH JRF), which were used to evaluate graft integrity and shoulder stability, respectively. Fixation of the graft considering abduction angles greater than 15° resulted in a high risk for graft tearing when the arm was adducted to the side of the trunk. For abduction angles below 15°, the mean shoulder stability improved significantly, ranging between 6% and 20% (p < 0.001), compared with that in the preoperative condition. The concomitant tenotomy of the LHB tendon resulted in loss of stability when compared to ASCR with an intact LHB tendon. The position of the shoulder during fixation of the graft has a significant effect on shoulder stability and graft tear risk after ASCR in IRCTs. This study provides new and important information regarding the role of shoulder positioning during fixation of the graft.
| S-EPMC8698921 | biostudies-literature
Project description:Superior capsular reconstruction is a common treatment option for irreparable rotator cuffs. Arthroscopic surgery procedures mostly use anchor-based methods. However, difficulty in preoperative graft measurement and intra-articular knot-tying present an obstacle for most sport surgeons. Complementing the known advantages of the transosseous technique in rotator cuff repair, a feasible, economical arthroscopic transosseous superior capsular reconstruction technique is described in this Technical Note. This procedure results not only in similar fixation strength and stability and greater bone stock but also in greater cost effectiveness due to using fewer anchors. This Technical Note describes the procedure in detail and compares it with conventional procedures. Technique Video Video 1 Patients undergo surgery in the beach-chair position. A standard posterior portal is created for arthroscopic visualization. Intra-articular management, including debridement or labral reattachment, is performed via the anterior portal. Then, the scope is shifted to the subacromial space from the posterior portal, and bursectomy is undertaken via the anterior portal. The irreparable cuff tear edge is debrided to approach the medial aspect of the superior labrum. Two inlets are created: one anterior inlet near the biceps groove and one 2-cm inlet posterior to the anterior tunnel inlet. The ETHIBOND 5-0 suture needle tip is visible through the posterior portal and is grasped using a curved needle holder introduced via the lateral portal. The needle tip is introduced into the medial row inlet with a needle holder, and the lateral humeral cortex is pierced. The scope is shifted to the subdeltoid space for retrieval of the needle tip using the curved needle holder through the lateral portal. The ETHIBOND suture is left in the tunnel for shuttle purposes. Next, 3.7-mm all-suture anchors are fixed at the superior glenoid. Single-limb sutures are retrieved from 2 anchors outside via the lateral portal, and the proximal allograft edge is pierced. The graft is delivered along two sutures of glenoid-fixed anchors using a knot pusher. Glenoid graft fixation is achieved by tying knots at each all-suture anchor. After corner knots are tied, an extra knot is tied at the center of the proximal graft edge using each of the corner sutures. Suture tunnel entry points are located using the scope to determine the following piercing site on the graft. The graft undergoes intra-articular piercing, and tunnel sutures are relayed on the proximal and distal row using a tissue penetrator and shuttle suture manipulation. Four sutures are passed through 2 suture tunnels, one of which crosses 2 tunnels in the proximal region to form a medial row of footprint sutures. The shoulder is placed in a neutral position to lessen suture tension. The lateral row is tied first on the lateral cortex, simultaneously applying tension to suture tunnel exits and the medial row. The superior limb of the posterior cross-link suture and the inferior limb of the anterior cross-link suture are retrieved and tied together. The inferior limb of the posterior cross-link suture and superior limb of the anterior cross-link suture are tied to finish the cross-link construction. The final “hourglass” shape construction is achieved after tuberosity fixation.
| S-EPMC10466137 | biostudies-literature
Project description:Reconstruction of the superior capsule is a valuable intervention for some patients in whom massive, irreparable posterosuperior rotator cuff tears are identified. Superior capsular reconstruction techniques most commonly use either tensor fascia lata autograft or dermal allograft. As an alternative to more traditional superior capsular reconstruction, we commonly transpose and incorporate the biceps tendon into the rotator cuff repair construct in such patients instead. This biological superior capsular reconstruction biceps transposition technique ("bio-SCR"), described herein, provides increased structural integrity and supplemental tendon graft using viable cells while potentially serving the role of the superior capsule. As such, transposition of the biceps tendon may offer unique and significant advantages over other techniques and can be an effective and valuable alternative in appropriate cases.
| S-EPMC7301374 | biostudies-literature
Project description:Irreparable rotator cuff tears are a complicated problem, and current treatment options include nonoperative rehabilitation, debridement with or without a biceps tenotomy, tuberoplasty, partial rotator cuff repair, patch augmentation, biodegradable spacers, tendon transfer, and reverse shoulder arthroplasty. Arthroscopic superior capsular reconstruction is a more recent technique that is gaining popularity for use in irreparable rotator cuff tears. However, this surgery can be technically complicated. The purpose of this technique is to increase reproducibility and simplify a complicated procedure by addressing the current challenges of previous techniques.
| S-EPMC6112060 | biostudies-literature
Project description:Superior capsular reconstruction (SCR) has become an increasingly popular choice in the treatment of massive, irreparable rotator cuff tears, pseudoparalysis, and in cases in which revision of previous rotator cuff repair is indicated. The SCR procedure is intended to restore the superior stabilizing forces of a deficient rotator cuff. This technique is accomplished by substituting an autograft or allograft between the superior glenoid and the greater tuberosity of the humerus, thus keeping the humeral head centered in the glenoid during shoulder forward flexion and abduction. Since its advent, numerous techniques have been described for this procedure. A fascia lata autograft was initially described; however, many surgeons in the United States have advocated for the use of a humeral dermal allograft. Yet, biomechanical studies have demonstrated elongation and thinning of this material. Thus, the Achilles tendon allograft may be an attractive choice for SCR, given its previous success with ligamentous and tendinous reconstructions. In this article, we present our technique of SCR using an Achilles tendon allograft.
| S-EPMC7189387 | biostudies-literature
Project description:The management of irreparable rotator cuff tears is a difficult problem to deal with. The options include nonoperative route with anterior deltoid exercises, debridement with or without long head of biceps tenotomy, partial rotator cuff repair, tuberoplasty, muscle transfer, patch augmentation, biodegradable spacers, and reverse shoulder arthroplasty. None of these options are without their limitations. In recent years, arthroscopic superior capsular reconstruction has gained popularity as an alternative technique to address irreparable rotator cuff tears. Arthroscopic superior capsular reconstruction, however, is technically difficult. The purpose of this technical note is to describe a simple and reproducible technique for this procedure that addresses some of the challenges involved.
| S-EPMC5439159 | biostudies-literature
Project description:Many options have been developed to treat irreparable massive cuff tears. Superior capsular reconstruction has been reported as one of the treatment options for relatively young patients with irreparable massive cuff tear. However, this original technique has a disadvantage of requiring a tensor facia lata autograft. It requires another incision at the lateral thigh and can be a cause of thigh pain. This article describes our modified technique for arthroscopic superior capsule reconstruction using the biceps autograft to preserve the long head of the biceps tendon anchors to the glenoid labrum (the snake technique).
| S-EPMC6948113 | biostudies-literature
Project description:PurposeThe purposes of this study were to investigate the difference in value (benefit to cost ratio) of dermal allograft superior capsular reconstruction (SCR) versus reverse total shoulder arthroplasty (rTSA) for the treatment of massive rotator cuff tears (MRCTs) without arthritis; to compare the patient populations selected for the operations and report pre- and postoperative functional data; and to understand other characteristics of the 2 operations, including operating time, use of institutional resources, and complications.MethodsA retrospective, single-institution analysis during the study period 2014-2019 with MRCT treated with SCR or rTSA by 2 surgeons with complete institutional cost data and minimum 1-year clinical follow-up with American Shoulder and Elbow Surgeons (ASES) score. Value was defined as ΔASES/(total direct costs/$10,000).ResultsThirty patients underwent rTSA and 126 patients SCR during the study period with significant differences noted in patient demographics and tear characteristics between the groups (patients who underwent rTSA were older, less male, had more pseudoparalysis, had greater Hamada and Goutallier scores, and had more proximal humeral migration). Value was 25 and 29 (ΔASES/$10,000) for rTSA and SCR, respectively (P = .7). The total costs of rTSA and SCR were $16,337 and $12,763, respectively (P = .7). Both groups experienced substantial improvements in ASES scores: 42 for rTSA vs 37 for SCR (P = .6). The operative time for SCR was much longer (204 vs 108 minutes, P < .001) but complication rate lower (3% vs 13%, P = .02) versus rTSA.ConclusionsIn a single institutional analysis of the treatment of MRCT without arthritis, rTSA and SCR demonstrated similar value; however, the value calculation is highly dependent on institution specific variables and duration of follow-up. The operating surgeons demonstrated different indications in selecting patients for each operation. rTSA had an advantage over SCR in shorter operative time, whereas SCR demonstrated a lower complication rate. Both SCR and rTSA are demonstrated to be effective treatments for MRCT at short-term follow-up.Level of evidenceIII, retrospective comparative study.
| S-EPMC9971871 | biostudies-literature
Project description:We have been performing arthroscopic superior capsular reconstruction (SCR) with acellular dermal allograft for almost 2 years. Our techniques are based on Mihata's original concept for SCR, in which he used fascia lata autograft. In this report, we describe our standard arthroscopic technique as well as 2 variations of a "zip-line" technique, which we have found particularly useful for large dermal allografts (grafts that are ≥40 mm in any dimension).
| S-EPMC5264010 | biostudies-literature