Supraspinatus Rotator Cuff Repair: A Mouse Model and Technique.
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ABSTRACT:
SUBMITTER: Miller M
PROVIDER: S-EPMC8355505 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Failure of rotator cuff repair can be a disastrous clinical outcome. Although failure is a multifactorial issue, recent interest has piqued in understanding the biology of the insertional components of the supraspinatus and infraspinatus at the footprint. When the torn tendon is of poor quality, especially if it is diminutive or thin, rotator cuff repair augmentation should be considered to aid in long-term healing. Various allograft options have been described in the past, and more recently, xenografts and synthetics have become more commonly used. The use of autografts in the treatment of insertional footprint deficiency has great potential; however, few grafts have been described. This study describes the surgical technique for footprint augmentation in arthroscopic supraspinatus repair using harvested autologous coracoacromial ligament tissue.
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Project description:An all-arthroscopic rotator cuff repair demands a high level of technical skill and is associated with a steep learning curve. It is well accepted that small rotator cuff tears or partial tears can be more difficult than large or even massive tears to repair. Part of the reason is the difficulty in visualizing the tear, as well as important surrounding structures, during repair. To improve visibility during the repair process, we have introduced a second arthroscopic camera. Two cameras allow the surgeon to observe the rotator cuff from both the articular and bursal sides. We find this technique has merit in small or partial-thickness rotator cuff tears; however, there may be other applications.
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Project description:The concept of margin convergence for side-to-side strain reduction in massive U-type rotator cuff tears has been used to protect the free margin repair to bone. Data in the literature show favorable outcomes for this method of repair. However, one of the challenges when performing side-to-side repair has been the dog-ear deformity that forms at both the convergence split and marginal ends. We present a method of single-suture convergence using a "shoelace" weaving technique, which seems to decrease the incidence of dog-ear deformity, decreases margin strain, and can be incorporated into current transosseous-equivalent rotator cuff repair configurations. The technique is simple and reproducible for large or massive tear patterns.
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Project description:Various surgical techniques exist for rotator cuff repair that provide a suitable environment for tendon-bone healing. Arthroscopic recreation of transosseous repairs, which had previously been performed by open or miniopen techniques, can now be performed; however, arthroscopic, transosseous passage of suture material can be challenging technically. There are potential biologic and cost-saving advantages of arthroscopic transosseous rotator cuff repair that make an efficient and reproducible technique desirable for arthroscopists. The technique for arthroscopic transosseous rotator cuff repair using a knotless anchor-based system is demonstrated in the current Technical Note. Potential advantages of this construct include excellent biomechanics, enhanced footprint vascularization, and utility in poor bone quality while using minimal anchor numbers. Further studies will be needed to elucidate healing rates and clinical outcomes.
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Project description:The double-row suture technique and the suture-bridge technique have been used for rotator cuff repair to decrease the occurrence of retears. However, when only the degenerated tendon end is sutured, the risk of retear remains. The augmentation suture technique is a new procedure that connects the intact medial tendon to the lateral greater tuberosity, and this approach may protect the initial repair site. The procedures for this technique are as follows: 2 sutures are placed through the medial intact tendon, the cuff tear is repaired by the single-row technique, 2 sutures are pulled laterally over the single-row repair site, and 2 sutures are fixed at the lateral greater tuberosity with a push-in-type anchor. This technique is simple and easy and does not require special equipment. Moreover, this approach can augment the single-row repair technique without creating high tension at the cuff end.
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Project description:The transosseous-equivalent Speedbridge™ technique is commonly used during rotator cuff repair; however, the soft bone of the lateral humerus may result in toggling of the lateral row anchors with subsequent de-tensioning of the repair. The technique presented here uses an additional third-row anchor, in a tripod fashion, that reduces the forces on the lateral humerus anchors and protects the repair. Technique Video Video 1 Intraoperative video demonstrating the tripod technique to augment transosseous equivalent rotator cuff repair. This is performed on the patient’s left shoulder, and the patient is in the lateral decubitus position.
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Project description:Rotator cuff tear is a muscle-tendinous injury representative of various musculoskeletal disorders. In general, rotator cuff tear occurs in the tendon, but it causes unloading of the muscle resulting in muscle degeneration including fatty infiltration. These muscle degenerations lead to muscle weakness, pain, and loss of shoulder function and are well known as important factors for poor functional outcome after rotator cuff repair. Given that rotator cuff tear in various animal species results in similar pathological changes seen in humans, the animal model can be considered a good approach to understand the many aspects of the molecular changes in injured muscle. To comprehensively analyze changes in gene expression with time following a rotator cuff tear, we established a rotator cuff tear in mouse supraspinatus tendon of shoulder. At weeks 1 and 4 after the tear, the injured muscles were harvested for RNA isolation, and microarray analysis was performed. Expression patterns of genes belonging to 10 muscle physiology-related categories, including aging, apoptosis, atrophy, and fatty acid transport, were analyzed and further validated using real-time PCR. A total of 39,429 genes were analyzed, and significant changes in expression were observed for 12,178 genes at 1 week and 2,370 genes at 4 weeks after the tear. From the list of top 10 significantly up- and downregulated genes at the 2 time periods and the network evaluation of relevant genes according to the 10 categories, several important genes in each category were observed. In this study, we found that various genes are significantly altered after rotator cuff tear, and these genes may play key roles in controlling muscle degeneration after a rotator cuff tear.
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Project description:Transosseous repair of a supraspinatus tendon (SSP) defect (Patte size II) can be difficult if the tendon is retracted and the muscle atrophied. In this situation alternatives are margin convergence techniques, local tendon transfers or distant tendon transfers in massive tears. The object of this study was to compare two local tendon transfers in terms of the feasibility of the shift, the area covered by the shift and the force needed to accomplish the shift. Thirteen fresh-frozen cadaver shoulders were used. First a supraspinatus defect extending to the apex of the humeral head (Patte size II) was created. Transosseous repair was attempted with the infraspintus (ISP) and with the subscapularis (SCP) in all cases; repair was successful in all ISP cases, while use of the SCP resulted in a successful repair in only 8 of the 13 (61.5%). A significantly (P=0.012) larger defect area was covered by the ISP transfer than by the SCP shift: 89.7+/-8.5% versus 31.2+/-31.1% of the original defect, respectively. The tensile force needed to accomplish the shift was significantly (P=0.004) lower when the ISP was used (15+/-11 N) than with the SCP (37.1+/-15 N). In this cadaver model the ISP shift proved more favourable than the SCP shift for covering a Patte size II SSP defect.
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Project description:Understanding the pathophysiology of rotator cuff tears (RCTs) in animal models is of great importance, as it helps in the development of repair strategies and therapeutic treatments for rotator cuff diseases in humans. This Technical Note describes a comprehensive step-by-step description of an arthroscopic-assisted minimally invasive RCT model in rabbits. This technique is beneficial because the rabbit has rotator cuffs anatomically similar to those of humans, and it has been widely used as a preclinical animal model in the basic science literature. Compared with other small animals (e.g., mice and rats), the advantage of the rabbit model is that it can test the effectiveness and healing process of new surgical repair techniques that require relatively larger anatomical structures. Moreover, it is more cost-effective compared with larger animal models, such as sheep and canines. This arthroscopic-assisted mini-invasive technique to create an RCT model may have a better effect on simulating the degenerative and chronic RCT state in humans than the commonly used open surgery, along with an earlier return to activities, less scarring and tissue adhesion, fewer injuries to the deltoid, and fewer complications.
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