Arthroscopic Superior Capsule Reconstruction Using Autologous Fascia Lata and Biceps Tendon Augmentation.
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ABSTRACT:
SUBMITTER: Hsu CH
PROVIDER: S-EPMC8252841 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description: Not available
| S-EPMC10838020 | biostudies-literature
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
Project description:The proportion of postoperative retears after arthroscopic rotator cuff reconstruction remains constant despite advancement of suture techniques and improved anchor implants. The commonly degenerative nature of rotator cuff tears can carry the risk of compromised tissue. Several techniques have been developed to biologically enhance rotator cuff repair, and a considerable number of autologous, allogeneic, and xenogenous augmentation methods have been described. This article introduces the biceps smash technique, an arthroscopic augmentation procedure for posterosuperior rotator cuff reconstruction using an autograft patch of the long head of the biceps tendon.
| S-EPMC10066417 | biostudies-literature
Project description:Background:Painful dysfunctional shoulders with irreparable rotator cuff tears (IRCTs) in active patients are a challenge. Arthroscopic superior capsular reconstruction (ASCR) is a new treatment option originally described using a fascia lata autograft harvested through an open approach. However, concerns about donor site morbidity have discouraged surgeons from using this type of graft. Hypothesis:ASCR using a minimally invasive harvested fascia lata autograft produces good 6-month and 2-year shoulder outcomes in IRCTs, with low-impact thigh morbidity at 2 years. Study Design:Case series; Level of evidence, 4. Methods:From 2015 to 2016, a total of 22 consecutive patients (mean age, 64.8 ± 8.6 years) with chronic IRCTs (Hamada grade 1-2; Goutallier cumulative grade ?3; Patte stage 1: 2 patients; Patte stage 2: 6 patients; Patte stage 3: 14 patients) underwent ASCR using a minimally invasive harvested fascia lata autograft. All patients completed preoperative and 6-month evaluations consisting of the Simple Shoulder Test (SST), subjective shoulder value (SSV), Constant score (CS), range of motion (ROM), acromiohumeral interval (AHI), and magnetic resonance imaging. Twenty-one patients completed the 2-year shoulder and donor site morbidity assessments. Results:The mean active ROMs improved significantly (P < .001): elevation, from 74.8° ± 55.5° to 104.5° ± 41.9° (6 months) and 143.8° ± 31.7° (2 years); abduction, from 53.2° ± 43.3° to 86.6° ± 32.9° (6 months) and 120.7° ± 37.7° (2 years); external rotation, from 13.2° ± 18.4° to 27.0° ± 16.1° (6 months) and 35.6° ± 17.3° (2 years); and internal rotation, from 1.2 ± 1.5 points to 2.6 ± 1.5 points (6 months) and 3.8 ± 1.2 points (2 years). The mean functional shoulder scores improved significantly (P < .001): SST, from 2.1 ± 2.9 to 6.8 ± 3.5 (6 months) and 8.6 ± 3.5 (2 years); SSV, from 33.0% ± 17.4% to 55.7% ± 25.6% (6 months) and 70.0% ± 23.0% (2 years); CS, from 17.5 ± 13.4 to 42.5 ± 14.9 (6 months) and 64.9 ± 18.0 (2 years). The mean shoulder abduction strength improved significantly (P < .001) from 0.0 to 1.1 ± 1.4 kg (6 months) and 2.8 ± 2.6 kg (2 years). The mean AHI improved from 6.4 ± 3.3 mm to 8.0 ± 2.5 mm (6 months) and decreased to 7.1 ± 2.5 mm (2 years). This 0.7 ± 1.5-mm overall decrease was statistically significant (P = .042). At 6 months, 20 of 22 patients (90.9%) had no graft tears. At 2 years, 12 of 21 patients (57.1%) were bothered by their harvested thigh, 16 (76.2%) noticed donor site changes, 16 (76.2%) considered that the shoulder surgery's end result compensated for the thigh's changes, and 18 (85.7%) would undergo the same surgery again. Conclusion:ASCR using a minimally invasive harvested fascia lata autograft produced good 6-month and 2-year shoulder outcomes in IRCTs, with low-impact thigh morbidity at 2 years.
| S-EPMC6259077 | biostudies-literature
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
Project description:PurposeWe systematically reviewed the literature to compare the clinical and radiologic outcomes and retear rates of superior capsular reconstruction (SCR) using fascia lata autograft (FLA) versus human dermal allograft (HDA) in cases of massive irreparable rotator cuff tears.MethodsSearches of Pub Med and Cochrane Library identified clinical studies addressing SCR using FLA and HDA. Two reviewers independently screened the titles, abstracts and full texts to extract data from eligible studies. Reported outcome measures were descriptively analyzed.ResultsA total of 6 studies with 2 study groups satisfied the inclusion criteria. The number of shoulders in the HDA group was 155, and in the FLA group, the number was 140 shoulders. The mean age at time of surgery for the HDA group and the FLA group was 60.49 years and 65.8 years, respectively, and the mean follow-up was 15.2 months and 44.6 months, respectively. Active elevation improved from of 121°-130° to 158°-160° in the HDA group and from 74.8°-133° to 130.4°-146° in the FLA group. Active external rotation improved from 36°-45° in the HDA group and from 13°-28° to 30°-43° in the FLA group. The Visual Analog Scale for pain improved from 4-6.25 to 0.38-1.7 points in the HDA group, whereas in the FLA group, it improved from 6-2.5 points. In the HDA group, American Shoulder and Elbow Surgeons scores improved from 42-52 to 77.5-86.5, whereas in the FLA group scores improved from 35-54.4 to 73.7-94.3. The acromiohumeral distance improved in both groups. The retear rate was 3.4%-55% in the HDA group and 4.5%-29% % in the FLA group.ConclusionsArthroscopic SCR for massive, irreparable rotator cuff tears using both fascia lata allograft and human dermal allograft leads to improvement in clinical outcomes and radiologic outcomes. There is a lower retear rate in fascia lata allografts. The current literature is heterogeneous and has low levels of evidence.Level of evidenceLevel IV, systematic review of level IV studies.
| S-EPMC7451904 | biostudies-literature
Project description:Excellent clinical results of arthroscopic repair of rotator cuff tears have been reported. However, retears after surgical repair of large and massive rotator cuff tears are one of the most common complications. We present single-row repair with graft augmentation of the fascia lata for large and massive rotator cuff tears to reduce tension at the tendon-bone repair site, and this technique may prevent retears of the repaired rotator cuff. A candidate for this technique is a patient who has a large or massive rotator cuff tear in which the torn edge cannot reach the footprint after mobilization of the torn rotator cuff. This technique could provide an excellent option for irreparable large and massive rotator cuff tears.
| S-EPMC5262532 | biostudies-literature
Project description:Large to massive rotator cuff tears are challenging to repair, although there are several options for dealing with them. Among them, superior capsular reconstruction was recently introduced as an effective procedure for retaining the static stability of the shoulder joint and preventing the progression to cuff tear arthropathy. The purpose of this technique-based article is to describe a surgical option, called arthroscopic in situ superior capsular reconstruction, for large to massive rotator cuff tears using the long head of the biceps tendon.
| S-EPMC5850885 | biostudies-other
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:Superior capsule reconstruction (SCR) can be performed using fascia lata, dermal allograft, and long head of the biceps tendon (LHBT). We present a Technical Note combining dermal allograft and autologous LHBT, reconstructing the superior capsule's actual anatomical thickness and augmenting with single-stranded LHBT. The glenoid side consists of intact LHBT insertion and is covered with dermal allograft. The lateral side comprises posteriorly transpositioned LHBT, dermal allograft, and repairable remnant cuff. First, 1 suture-based anchor is used to fix the biceps 5 to 8 mm posterior to the bicipital groove, and tenotomy is done distal to it, while the glenoid side of the biceps is preserved. Second, 2 suture-based anchors are used to fix the dermal allograft at the glenoid side by 1 double-pulley and 2 mattress sutures. Third, 2 SwiveLock anchors are used to fix allograft's lateral side by 2 reverse mattress sutures. The tension and coverage of the graft can be determined by the position of the SwiveLock anchors. In this way, fewer anchors are needed than the conventional dermal allograft SCR and larger footprint coverage can be achieved than LHBT SCR. A better spacer effect may be achieved by combining both biological grafts' thickness, mimicking the intact shoulder's true anatomy.
| S-EPMC8556551 | biostudies-literature