Superior Capsular Reconstruction With a Long Head of the Biceps Tendon Autograft: A Cadaveric Study

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Abstract

Background:

Several procedures have been proposed to address irreparable rotator cuff (RC) tears with pseudoparalysis. One recently proposed procedure is superior capsular reconstruction (SCR) using a tensor fasciae latae (TFL) autograft.

Hypothesis:

SCR with a locally available long head of the biceps tendon (LHB) autograft is biomechanically equivalent to SCR using TFL autograft for preventing superior humeral migration and the development of RC arthropathy in patients with irreparable RC tears.

Study Design:

Controlled laboratory study.

Methods:

Ten cadaveric shoulders (5 matched pairs) were tested. One shoulder from each pair was randomly assigned to the LHB reconstruction group using our novel technique, while the contralateral side was assigned to the TFL reconstruction group. SCR with a TFL autograft was performed based on previously described techniques. Massive RC tears were created by detachment of the supraspinatus and infraspinatus footprints from the greater tuberosity. The force required to superiorly translate the humerus 1.5 cm was then tested and recorded using a servohydraulic testing machine under 2 conditions: (1) after a massive RC tear and (2) after SCR with either a TFL autograft or an LHB autograft.

Results:

SCR with an LHB autograft required 393.2% ± 87.9% ( P = .029) of the force needed for superior humeral migration in the massive RC tear condition, while SCR with a TFL autograft required 194.0% ± 21.8% ( P = .0125). The LHB reconstruction group trended toward a stronger reconstruction when normalized to the torn condition ( P = .059).

Conclusion:

SCR with an LHB autograft is a feasible procedure that is shown to be biomechanically equivalent and potentially even stronger than SCR with a TFL autograft in the prevention of superior humeral migration.

Clinical Relevance:

This new technique may help to prevent superior humeral migration and the development of RC arthropathy in patients with irreparable RC tears.

Related collections

Most cited references 18

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Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears.

Teruhisa Mihata, Thay Lee, Chisato Watanabe … (2013)

The objective of this study was to investigate the clinical outcome and radiographic findings after arthroscopic superior capsule reconstruction (ASCR) for symptomatic irreparable rotator cuff tears.

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Reverse total shoulder arthroplasty: a review of results according to etiology.

Bryan Wall, Laurent Nové-Josserand, Daniel P O'Connor … (2007)

Reverse total shoulder arthroplasty provides a surgical alternative to standard total shoulder arthroplasty for the treatment of selected complex shoulder problems. The purpose of the present study was to evaluate the effects of etiology on the results of reverse total shoulder arthroplasty. Between May 1995 and June 2003, 240 consecutive reverse total shoulder arthroplasties were performed in 232 patients with an average age of 72.7 years. Patients were grouped according to etiology, and the clinical and radiographic outcomes for each group were measured and compared. One hundred and eighty-six patients with 191 retained reverse total shoulder arthroplasty prostheses were followed for an average of 39.9 months. Overall, the average Constant score improved from 23 points before surgery to 60 points at the time of follow-up and 173 of the 186 patients were satisfied or very satisfied with the result. Although substantial clinical and functional improvement was observed in all etiology groups, patients with primary rotator cuff tear arthropathy, primary osteoarthritis with a rotator cuff tear, and a massive rotator cuff tear had better outcomes, on average, than patients who had posttraumatic arthritis and those managed with revision arthroplasty. Dislocation (fifteen cases) and infection (eight cases) were the most common complications among the 199 shoulders that were followed for two years or were revised prior to the minimum two-year follow-up. Patients who received the reverse prosthesis at the time of a revision arthroplasty had a higher complication rate than did those who received the reverse prosthesis at the time of a primary arthroplasty. The reverse total shoulder arthroplasty prosthesis can produce good results when used for the treatment of a number of other complex shoulder problems in addition to cuff tear arthropathy. Patients with posttraumatic arthritis and those undergoing revision arthroplasty may have less improvement and higher complication rates in comparison with patients with other etiologies. The advanced age of the patients in the present series and the relatively short duration of follow-up suggest that the prosthesis should continue to be used judiciously.

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Cuff-tear arthropathy.

Lorraine Craig, David Fukuda, Charles Neer (1983)

In this report we describe the clinical and pathological findings of cuff-tear arthropathy in twenty-six patients and discuss the differential diagnosis and a hypothesis on the pathomechanics that lead to its development. This lesion is thought to be peculiar to the glenohumeral joint because of the unique anatomy of the rotator cuff. Following a massive tear of the rotator cuff there is inactivity and disuse of the shoulder, leaking of the synovial fluid, and instability of the humeral head. These events in turn result in both nutritional and mechanical factors that cause atrophy of the glenohumeral articular cartilage and osteoporosis of the subchondral bone of the humeral head. A massive tear also allows the humeral head to be displaced upward, causing subacromial impingement that in time erodes the anterior portion of the acromion and the acromioclavicular joint. Eventually the soft, atrophic head collapses, producing the complete syndrome of cuff-tear arthropathy. The incongruous head may eventually erode the glenoid so deeply that the coracoid becomes eroded as well. Although treatment of cuff-tear arthropathy is extremely difficult, the preferred method appears to be a resurfacing total shoulder replacement with rotator-cuff reconstruction and special rehabilitation. We think that it is important to recognize cuff-tear arthropathy as a distinct pathological entity, as such recognition enhances our understanding of the more common impingement lesions. Cuff-tear arthropathy is especially difficult to treat, and although many tears of the rotator cuff do not enlarge sufficiently to allow this condition to develop, it is a factor to consider when deciding whether or not a documented tear of the rotator cuff should be surgically repaired.

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Author and article information

Journal

Journal ID (nlm-ta): Orthop J Sports Med

Journal ID (iso-abbrev): Orthop J Sports Med

Journal ID (publisher-id): OJS

Journal ID (hwp): spojs

Title: Orthopaedic Journal of Sports Medicine

Publisher: SAGE Publications (Sage CA: Los Angeles, CA )

ISSN (Electronic): 2325-9671

Publication date (Electronic): 19 July 2018

Publication date Collection: July 2018

Volume: 6

Issue: 7

Electronic Location Identifier: 2325967118785365

Affiliations

[* ]Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York, USA.

[2-2325967118785365] Investigation performed at the Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York, USA

Author notes

[*] [† ]Ilya Voloshin, MD, Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14625, USA (email: ilya_voloshin@ 123456urmc.rochester.edu ).

Article

Publisher ID: 10.1177_2325967118785365

DOI: 10.1177/2325967118785365

PMC ID: 6053870

PubMed ID: 30038920

SO-VID: 7475658b-4dd1-470c-addf-d85b531c9460

License:

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License ( http://www.creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

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Keywords: superior capsular reconstruction,rotator cuff arthropathy,irreparable rotator cuff,biceps tendon autograft,biomechanical,superior humeral migration

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Keywords: superior capsular reconstruction, rotator cuff arthropathy, irreparable rotator cuff, biceps tendon autograft, biomechanical, superior humeral migration

Superior Capsular Reconstruction With a Long Head of the Biceps Tendon Autograft: A Cadaveric Study

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Abstract

Background:

Hypothesis:

Study Design:

Methods:

Results:

Conclusion:

Clinical Relevance:

Related collections

NTT Journal for Theology and the Study of Religion

Most cited references 18

Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears.

Reverse total shoulder arthroplasty: a review of results according to etiology.

Cuff-tear arthropathy.

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