Abstract
Background: Superior capsular reconstruction (SCR) has shown good results in the management of irreparable rotator cuff tears due to the depressive effect on the humeral head, but it is a technically demanding and expensive procedure.Purpose: We hypothesized that an intra-articular neoligament that prevents the superior translation of the humeral head could give similar results in terms of the superior translation of humerus (STH) and range of motion (ROM).Study Design: To compare our proposed technique and the SCR, we conducted a biomechanical study on 10 porcine shoulders in a custom shoulder testing system.Methods: STH and total rotational ROM were quantified in the following four scenarios: (1) when the rotator cuff was intact, (2) after cutting the supraspinatus tendon, (3) after the reconstruction of the superior capsule by long head of the biceps tendon (LHB), and (4) after an arthroscopic intra-articular stabilization by an intra-articular graft. Our proposed technique provides the creation of a humeral and glenoid tunnel, the passage of a graft through these tunnels under arthroscopic guidance, and the graft fixation in the two tunnels. We analyzed the STH and total ROM in each scenario.Results: With respect to the STH, we reported that the present proposed technique is characterized by a significant reduction of superior translation at 0 and 45° compared to scenario 2. In addition, the comparison between our proposed technique and SCR showed a significant difference of the STH at 0° of abduction. Total rotational ROMs of the two tenchinques were similar to scenario 2. Therefore, the use of an intra-articular ligament that prevents the STH can restore shoulder stability in irreparable rotator cuff injuries at both 0 and 45° of glenohumeral abduction without apparently limiting the total rotational ROM.Conclusion: Our proposed technique could be an important treatment option in irreparable rotator cuff tears, especially in patients under 65 years in whom reverse shoulder arthroplasty (RSA) has shown poor results and many complications.
Highlights
Massive rotator cuff tears could determine significant pain and disability of the shoulder [1]
The creation of a complete and irreparable lesion of the supraspinatus increases the superior translation of the humerus significantly by 2.5 mm at 0◦ of abduction (p < 0.001) and by 2.6 mm at 45◦ of abduction (p < 0.001)
Both the Arthroscopic Biceps Chillemi (ABC) and the AISS technique make the shoulder more stable compared to scenario 2
Summary
Massive rotator cuff tears could determine significant pain and disability of the shoulder [1]. Treatment options for massive and irreparable rotator cuff injuries depend on a multitude of factors including age of the patient, activity level and expectation, degree of joint arthropathy, and the extent of disability caused by the injury [8]. In these lesions, surgical options include arthroscopic debridement, biceps tenotomy/tenodesis, partial cuff repair, interposition grafts, subacromial balloon spacers, tendon transfers, superior capsular reconstruction (SCR), and reverse shoulder arthroplasty (RSA) [9, 10]. Purpose: We hypothesized that an intra-articular neoligament that prevents the superior translation of the humeral head could give similar results in terms of the superior translation of humerus (STH) and range of motion (ROM)
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