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Arthroscopic Superior Capsule Reconstruction Using Three-Dimensional Preoperative Planning: Technique Description.

ABSTRACT: We describe a technique using a fascia lata autograft with 3-dimensional (3D) printing to reconstruct the rotator cuff. Prototyping constitutes the construction of physical prototypes with high complexity after virtual studies. Such models increase the knowledge of the characteristics and size of rotator cuff injuries, thus improving the accuracy of determining the correct size of the graft to be used in superior capsule reconstruction. We present a case of superior capsule reconstruction using 3D printing for enhancing the accuracy of fascia lata allograft size and tension determination; 3D reconstruction has never been described in the literature for rotator cuff injuries.

SUBMITTER: Stirma GA

PROVIDER: S-EPMC8252837 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears.

Project description:Massive irreparable rotator cuff tears in young patients are a particular challenge for the orthopaedic surgeon. Surgical treatment options include debridement, partial rotator cuff repair, patch-augmented rotator cuff repair, bridging rotator cuff reconstruction with graft interposition, tendon transfer, and reverse total shoulder arthroplasty. Recently, reconstruction of the superior glenohumeral capsule using a fascia lata autograft has been suggested to reduce superior glenohumeral translation and restore superior stability. Promising clinical results have been reported in 1 case series of 23 patients, indicating that superior capsular reconstruction may be a promising tool to manage massive irreparable rotator cuff tears. This article describes our preferred technique for arthroscopic superior capsule reconstruction.

| S-EPMC4886263 | biostudies-literature

Arthroscopic partial Superior Capsular Reconstruction using the Long Head of the Biceps Tendon-Technique Description.

Project description:Superior capsule reconstruction is a valuable intervention for some patients who present symptomatic irreparable posterosuperior rotator cuff tears. Superior capsule reconstruction techniques most commonly use either fascia lata autograft or dermal allograft. Both options have literature support but also present a few drawbacks such as donor site issues, potential allergic reactions, and high cost of the operation. The long head of biceps is a potential graft for rotator cuff tears and may be particularly useful in bridging the gap in irreparable massive rotator cuff tears, specifically as an alternative to more traditional superior capsular reconstruction. Long head of biceps transposition may offer unique and significant advantages over other techniques and can be an effective and valuable alternative in selected cases. The tendon's insertion into the glenoid is left intact, whereas laterally it is transferred to a more central humeral head position and sutured with anchors onto the footprint of the supraspinatus tendon acting as a superior static stabilizer of the shoulder joint. The purpose of this article is to propose a technical modification of superior capsular reconstruction using long head of the biceps tendon autograft.

| S-EPMC7953170 | biostudies-literature

Arthroscopic Superior Capsule Reconstruction With Doubled Autologous Semitendinosus Tendon Graft.

Project description:Massive and irreparable rotator cuff tears remain a difficult condition to treat. Fatty infiltration of the muscles and excessive retraction of the tendons predispose to high failure rates of arthroscopic repair techniques. In recent years, studies on the superior capsule have shown that it plays a key role in reducing superior humeral head translation and restoring balance to the force couples required for dynamic shoulder function. Superior capsule reconstruction has become common in clinical practice. Several techniques with different types of grafts have been described, such as fascia lata autograft, dermal allograft patch, and long head of the biceps tendon autograft. More recently, an open technique with semitendinosus tendon autograft has been proposed. Our aim is to describe an all-arthroscopic technique for superior capsule reconstruction using a doubled semitendinosus tendon autograft in a box-shaped configuration. We believe that the technique can combine the advantages of other techniques, such as graft availability, low harvest-site morbidity, limited cost, and mechanical strength.

| S-EPMC7695576 | biostudies-literature

Arthroscopic Superior Capsule Reconstruction Technique in the Setting of a Massive, Irreparable Rotator Cuff Tear.

Project description:Massive, irreparable rotator cuff tears are challenging to treat and associated with pain and severe limitation in shoulder elevation due to the proximal migration of the humeral head and, consequently, subacromial impingement. Furthermore, retraction of the tendons in combination with fat infiltration and muscular weakness results in unpredictable treatment outcomes. While conservative treatment may be warranted for low-demand patients, surgical treatment is often indicated for a successful return to activities of daily living as well as an improved quality of life. The reported failure rate of rotator cuff repair for the treatment of a massive rotator cuff tear varies. However, this failure is often found at the interface between the tendon and tendon footprint. Several techniques have been reported to address this pathology, including muscular transfer, arthroscopic debridement, augmentation procedures, and superior capsule reconstruction. In particular, superior capsule reconstruction has been reported as a safe and effective method to treat a massive, irreparable rotator cuff tear. The purpose of this Technical Note is to describe our preferred technique of a superior capsule reconstruction for the treatment of a massive, irreparable rotator cuff tear.

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Superior Capsule Reconstruction Technique Using an Acellular Dermal Allograft.

Project description:Chronic, massive, irreparable rotator cuff tears remain one of the most challenging pathologies in shoulder surgery to treat. Because of this, many treatment options exist for the management of chronic retracted rotator cuff tears. Superior capsule reconstruction is one option that provides the potential to restore and rebalance the force couples necessary for dynamic shoulder function. We describe an all-arthroscopic technique using an acellular dermal allograft for superior capsule reconstruction indicated for patients with a deficient superior rotator cuff. This technique provides an option for patients with an irreparable rotator cuff tear without compromising future treatment options. Although this is a relatively new and unproven method for treating chronic irreparable rotator cuff tears, our short-term results are promising. Nevertheless, larger studies with long-term follow-up are required to fully evaluate the success of this technique.

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The "Pull-Over" Technique for Arthroscopic Superior Capsular Reconstruction.

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.

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Arthroscopic Superior Capsular Reconstruction With Biceps Autograft: Snake Technique.

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

Technique for Double Row Superior Capsule Reconstruction with Dermal Allograft.

Project description:Superior capsular reconstruction (SCR) is increasingly being used as a procedure for addressing irreparable rotator cuff tears. The procedure was initially described for failed rotator cuff repairs where the retears are severely retracted and when grade 3-4 fatty infiltration and atrophy exist. The SCR procedure can also be considered for irreparable rotator cuff tears in patients that are either too young or too high demand to be appropriate candidates for arthroplasty. Early short and medium term follow up studies support SCR with favorable outcomes compared with other salvage procedures.

| S-EPMC6993533 | biostudies-literature

A Lasso-Loop Traction Technique for Arthroscopic Superior Capsular Reconstruction.

Project description:Irreparable rotator cuff tears (RCTs) cause shoulder pain and disfunction. Management of RCT patients has classically been difficult due to few treatment options. Since Mihata et al. in 2013 introduced the superior capsular reconstruction (SCR) technique as a treatment option, it has become widespread among surgeons, especially for young active patients in whom reverse shoulder arthroplasty is not recommended. With SCR, a reduced humeral head can be maintained and superior displacement is avoided, improving shoulder pain and restoring active shoulder motion. A variety of grafts may be used, but the surgery can be technically complicated. An arthroscopic lasso-loop traction technique for SCR is described here, which simplifies graft shoulder reduction by traction from the anteromedial and posteromedial portals.

| S-EPMC7528755 | biostudies-literature

Arthroscopic Superior Capsule Reconstruction with a Doubled-Over (6 mm) Dermal Allograft.

Project description:Superior capsule reconstruction has gained popularity as a treatment option for massive rotator cuff tears. The initial graft described was a tensor fascia lata. In the United States, acellular dermal matrix or dermal allograft has gained popularity. The results from published reports have been promising, but graft tear on postoperative imaging has been reported in several studies. Strives are being made to reduce the graft tear rate. One such way is to increase the thickness of the graft. Biomechanical studies have shown that thicker and stiffer grafts perform better in restoring superior stability. We present a technique of doubling a commercially available 3 mm dermal allograft and making it into a 6 mm graft for superior capsule reconstruction.

| S-EPMC7917301 | biostudies-literature

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