Massive Irreparable Rotator Cuff Tears Research Articles

Indications, outcomes, and complications of tendon transfer for massive irreparable rotator cuff tears

Indications, outcomes, and complications of tendon transfer for massive irreparable rotator cuff tears

Arthroscopic Medialization Partial Repair with Biologic Interposition Tuberoplasty for Large to Massive Irreparable Rotator Cuff Tear.

An irreparable rotator cuff tear is a challenging condition to treat, and various treatment modalities are being introduced. Medialization in the partial repair method has the limitation of exposing the tuberosity, while tension-free biologic interposition tuberoplasty using acellular dermal matrix has the limitation of exposing the humeral head. The authors believe that by combining these two techniques, it is possible to complement each other's limitations. Therefore, they propose a surgical method that combines medialization and biologic interposition tuberoplasty for addressing these constraints.

Improving shoulder function and pain in a paraplegic patient with massive irreparable rotator cuff tear using a subacromial balloon spacer.

The subacromial balloon spacer is a promising treatment option for alleviating symptoms in patients with massive irreparable rotator cuff tears (MIRCTs). The balloon provides faster pain relief and easier rehabilitation than other options (such as arthroscopic partial rotator cuff repair). For a paraplegic MIRCT patient, the need for speedy recovery and rehabilitation is crucial, as these patients rely on their upper limbs for daily life activities and independence. In this report, we present a 60-year-old male paraplegic patient who presented to the clinic with an MIRCT of the right shoulder. After a holistic investigation and assessment of the patient, a subacromial balloon spacer with an upper border subscapularis repair was chosen as the treatment of choice. The patient had an uneventful recovery, and at the 1-year mark, had forward elevation of 170°, an American Shoulder and Elbow Surgeons score of 95, and a visual analogue scale pain score of 0.

Fascia Lata Autografts Achieve Interface Healing With the Supraspinatus Muscle Histologically and Mechanically in a Rat Supraspinatus Tendon Reconstruction Model for Massive Irreparable Rotator Cuff Tears

PurposeTo evaluate the histologic healing process and mechanical characteristics of the interface between a fascia lata autograft and supraspinatus muscle by establishing a supraspinatus tendon reconstruction model for chronic massive, irreparable rotator cuff tears (MIRCTs). MethodsA total of 40 rats were studied. Eight rats were sacrificed to establish an intact control group, and the other rats were first established as the chronic MIRCTs model and then developed as the supraspinatus tendon reconstruction model. Histology, fatty infiltration, mechanics and the open field test for the interface between the fascia lata autograft and muscle were assessed at 2, 4, 8 and 16 weeks postoperatively. ResultsHistologically, the interface between the fascia lata autograft and muscle gradually regenerated structural similarities to the normal muscle-tendon interface by 16 weeks postoperatively. The amounts of collagen I and III were both increased significantly during the healing time and stabilized at 8 weeks postoperatively. Fatty infiltration was obvious in the supraspinatus muscle 4 weeks after the MIRCTs model. However, the degree of fatty infiltration in the supraspinatus muscle gradually decreased after supraspinatus tendon reconstruction and stabilized at 8 weeks postoperatively. The ultimate failure force and the ultimate stress gradually increased from 2 to 16 weeks and reached the level of the intact control tendon at 16 weeks postoperatively (P=0.086). The movability of the forepaw returned to normal in the open field test (P=0.907). ConclusionsIn this rat supraspinatus tendon reconstruction model, fascia lata autografts showed good interface healing with the supraspinatus muscle, and fatty infiltration in the supraspinatus muscle was histologically decreased. The interface between the fascia lata autograft and muscle can sustain mechanical strength similar to the anatomical muscle–tendon interface. Clinical RelevanceThe supraspinatus tendon reconstruction technique using fascia lata autografts might be a good histological and biomechanical option for treating MIRCTs.

Surgical Management of Massive Irreparable Cuff Tears: Superior Capsule Reconstruction and Rotator Cable Reconstruction.

Massive irreparable rotator cuff tears (MIRCTs) present treatment challenges. Recently, superior capsule reconstruction (SCR) and anterior cable reconstruction have emerged as surgical options, but no single approach is superior. This review provides an overview of SCR and cable reconstruction techniques, including biomechanical studies, clinical outcomes, and surgical considerations. Biomechanical studies show SCR with autografts or allografts improves glenohumeral stability and mechanics. Clinical outcomes of SCR demonstrate improved range of motion, function scores, and pain relief in short-term studies. Anterior cable reconstruction reduces superior humeral head translation and subacromial pressures in biomechanical models. Early clinical studies report improved rotator cuff healing and outcomes for cable reconstruction in specific irreparable tear patterns. SCR and cable reconstruction are viable surgical options for MIRCTs based on early encouraging results. However, higher-level comparative studies with long-term follow-up are still needed. Careful consideration of tear pattern, patient factors, and surgical goals is required to optimize treatment of MIRCTs. Further research is necessary to determine the optimal role for these procedures.

The Insertion of a Subacromial Balloon Spacer Can Provide Symptom Relief and Functional Improvement at a Minimum 5-Year Follow-Up in Patients With Massive Irreparable Rotator Cuff Tears

To examine long-term patient-reported outcomes and range of motion in patients with massive irreparable rotator cuff tears (MIRCTs) who underwent subacromial balloon spacer implantation. A retrospective review of all patients who underwent subacromial balloon placement procedure for MIRCTs at our institution was conducted. Patients with adequate preoperative and postoperative data, with at least 5 years of follow-up, were included in our study. Outcome measures were range of motion (forward elevation), American Shoulder and Elbow Surgeon (ASES) score, and visual analog scale (VAS) score. Independent t test was conducted to check for statistically significant differences between preoperative and postoperative outcome scores, with P < .05 deemed significant. Ten patients were identified: 4were lost to follow-up beyond 2 years and were excluded. One was converted to an arthroplasty at the 1-year mark and was then lost to follow-up (conversion rate: 16.6%). Five patients had at least 5 years of follow-up after the balloon procedure and were involved in our case series analysis. Mean age was 63.1 years, and mean follow-up was 5.8 years (range, 5-7 years). Preoperatively, mean forward elevation was 110 degrees, mean ASES score was 40.68, and mean VAS score was 6.2. On follow-up, mean forward elevation was 163 degrees (P= .007), mean ASES score was 90.97 (P= .001), and mean VAS score was 0.9 (P= .004). All patients showed significant improvements in all outcome measures, and none had any significant complications. In this study, we found that the use of a subacromial balloon spacer can lead to good outcomes at a minimum 5-year follow-up in patients with MIRCTs. Level IV, therapeutic case series.

Margin convergence vs. superior capsular reconstruction for massive irreparable rotator cuff tears: outcomes are equivalent unless there is preoperative pseudoparesis

Margin convergence (MC) and superior capsular reconstruction (SCR) are common treatment options for irreparable rotator cuff tears in younger patients, although they differ in associated costs and operative times. The purpose of this study was to compare range of motion, patient-reported outcomes (PROs), and reoperation rates following MC and SCR. We hypothesized superior outcomes after SCR relative to MC regarding functional outcomes, subjective measures, and reoperation rates. This was a multicenter retrospective review of 59 patients from 3 surgeons treating irreparable rotator cuff tears with either MC (n=28) or SCR (n=31) and minimum 1-year follow-up from 2014-2019. Visual analog scale (VAS) for pain, Subjective Shoulder Value (SSV), active forward flexion (FF), external rotation (ER), retear rate, and conversion rate to reverse shoulder arthroplasty were evaluated. t tests and χ2 tests were used for continuous and categorical variables, respectively (P<.05). Baseline demographics, range of motion, and magnetic resonance imaging findings were similar between groups. Average follow-up was 31.5 months and 17.8 months for the MC and SCR groups, respectively (P<.001). The MC and SCR groups had similar postoperative FF (151°±26° vs. 142°±38°; P=.325) and ER (48°±12° vs. 46°±11°; P=.284), with both groups not improving significantly from their preoperative baselines. However, both cohorts demonstrated significant improvements in VAS score (MC: 7.3 to 2.5; SCR: 6.4 to 1.0) and SSV (MC: 54% to 82%; SCR: 38% to 87%). There were no significant differences in postoperative VAS scores, SSV, and rates of retear or rates of conversion to arthroplasty between the MC and SCR groups. In patients with preoperative pseudoparesis (FF<90°), SCR (n=9) resulted in greater postoperative FF than MC (n=5) (141°±38° vs. 67°±24°; P=.002). Both MC and SCR demonstrated excellent postoperative outcomes in the setting of massive irreparable rotator cuff tear, with significant improvements in PROs and no significant differences in range of motion. Specifically for patients with preoperative pseudoparesis, SCR was more effective in restoring forward elevation. Further long-term studies are needed to compare outcomes and establish appropriate indications.

Mixed-reality improves execution of templated glenoid component positioning in shoulder arthroplasty: a CT imaging analysis

Glenoid placement is critical for successful outcomes in total shoulder arthroplasty (TSA). Preoperative templating with three-dimensional imaging has improved implant positioning, but deviations from the planned inclination and version still occur. Mixed-Reality (MR) is a novel technology that allows surgeons intra-operative access to three-dimensional imaging and templates, capable of overlaying the surgical field to help guide component positioning. The purpose of this study was to compare the execution of preoperative templates using MR vs.standard instruments (SIs). Retrospective review of 97 total shoulder arthroplasties (18 anatomic, 79 reverse) from a single high-volume shoulder surgeon between January 2021 and February 2023, including only primary diagnoses of osteoarthritis, rotator cuff arthropathy, or a massive irreparable rotator cuff tear. To be included, patients needed a templated preoperative plan and then a postoperative computed tomography scan. Allocation to MR vs. SI was based on availability of the MR headset, industry technical personnel, and the templated preoperative plan loaded into the software, but preoperative or intraoperative patient factors did not contribute to the allocation decision. Postoperative inclination and version were measured by two independent, blinded physicians and compared to the preoperative template. From these measurements, we calculated the mean difference, standard deviation (SD), and variance to compare MR and SI. Comparing 25MR to 72 SI cases, MR significantly improved both inclination (P<.001) and version (P<.001). Specifically, MR improved the mean difference from preoperative templates (by 1.9° inclination, 2.4° version), narrowed the SD (by 1.7° inclination, 1.8° version), and decreased the variance (11.7-3.0 inclination, 14.9-4.3 version). A scatterplot of the data demonstrates a concentration of MR cases within 5° of plan relative to SI cases typically within 10° of plan. There was no difference in operative time. MR improved the accuracy and precision of glenoid positioning. Although it is unlikely that 2° makes a detectable clinical difference, our results demonstrate the potential ability for technology like MR to narrow the bell curve and decrease the outliers in glenoid placement. This will be particularly relevant as MR and other similar technologies continue to evolve into more effective methods in guiding surgical execution.

Comparison of Multiple Surgical Treatments for Massive Irreparable Rotator Cuff Tears in Patients Younger Than 70 Years of Age: A Systematic Review and Network Meta-analysis.

Massive irreparable rotator cuff tears (MIRCTs) remain a challenging treatment paradigm, particularly for nonelderly patients without pseudoparalysis or arthritis. To use a network meta-analysis to analyze comparative studies of surgical treatment options for MIRCTs in patients <70 years of age for several patient-reported outcomes, range of motion (ROM), and acromiohumeral distance (AHD). Network meta-analysis of comparative studies; Level of evidence, 3. A systematic review of the literature, using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, of the MEDLINE, Embase, and Cochrane Library databases was conducted from 2017 to 2022. Inclusion criteria were (1) clinical comparative studies of MIRCTs (with several study-specific criteria); (2) ≥1 outcome of interest reported on, with standard deviations; (3) minimum 1-year follow-up; and (4) mean age of <70 years for both cohorts, without arthritis or pseudoparalysis. There were 8 treatment arms compared. Outcomes of interest were the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, visual analog scale for pain, AHD, and forward flexion and external rotation ROM. A frequentist approach to network meta-analysis with a random-effects model was performed using the netmeta package Version 0.9-6 in R. A total of 23 studies met the inclusion criteria, with 1178 patients included in the network meta-analysis. There was a mean weighted age of 62.8 years, 568 (48.2%) men, with a mean follow-up of 28.9 months. There were no significant differences between groups in regard to sex (P = .732) or age (P = .469). For the ASES score, InSpace balloon arthroplasty (mean difference [MD], 12.34; 95% CI, 2.18 to 22.50; P = .017), arthroscopic bridging graft (aBG) (MD, 7.07; 95% CI, 0.28 to 13.85; P = .041), and long head of biceps augmented superior capsular reconstruction (BSCR) (MD, 5.16; 95% CI, 1.10 to 9.22; P = .013) resulted in the highest P-scores. For the Constant-Murley score, debridement (MD, 21.03; 95% CI, 8.98 to 33.08; P < .001) and aBG (MD, 6.97; 95% CI, 1.88 to 12.05; P = .007) resulted in the highest P-scores. For AHD, BSCR resulted in the highest P-score (MD, 1.46; 95% CI, 0.45 to 2.48; P = .005). For forward flexion ROM, debridement (MD, 45.77; 95% CI, 25.41 to 66.13; P < .001) resulted in the highest P-score, while RSA resulted in the lowest P-score (MD, -16.70; 95% CI, -31.20 to -2.20; P = .024). For patients <70 years with MIRCT without significant arthritis or pseudoparalysis, it appears that graft interposition repair techniques, superior capsular reconstruction using the long head of the biceps tendon, arthroscopic debridement, and balloon arthroplasty provide superiority in various outcome domains, while RSA provides the least benefit in forward flexion.

Acellular Human Dermal Allograft Tuberoplasty Improved the Biomechanics in Mid-Range and Higher Abduction Angles in a Cadaveric Model of Massive Irreparable Rotator Cuff Tears

PurposeTo evaluate the biomechanical effects of Acellular Human Dermal Allograft Tuberoplasty (AHDAT) in a cadaveric model of an irreparable supraspinatus + anterior ½ infraspinatus (Stage III) rotator cuff tear . MethodsEight cadaveric shoulders were tested at 20°, 40°, and 60° glenohumeral abduction (AB) and 0°, 30°, 60°, and 90° external rotation (ER). Superior humeral translation, acromiohumeral distance, and subacromial contact were quantified for four conditions: 1) intact, 2) stage III tear (entire supraspinatus and anterior one-half infraspinatus), 3) single-layer AHDAT, and 4) double-layer AHDAT. ResultsStage III tear significantly increased superior translation at 20° and 40°AB and all ER angles and at 60° AB/60° ER (P ≤ 0.045 vs. intact). Compared to the stage III tear, the single-layer AHDAT significantly decreased superior translation at 60° AB/60° ER (P = 0.003); whereas, the double-layer AHDAT significantly decreased superior translation at 40° and 60° AB at all ER angles except 60° AB/0° ER (P ≤ 0.028). The stage III tear significantly decreased acromiohumeral distance at 20° AB (P ≤ 0.003); both grafts increased acromiohumeral distance to intact levels(P ≥ 0.055 vs. intact). Stage III tear increased subacromial contact pressure at 20° and 40° AB/ 0° and 30° ER and at 60° AB/30° and 60° ER (P ≤ 0.034). Both AHDAT groups decreased contact pressure at 40° AB/30° and 60° ER back to intact; whereas the double-layer AHDAT also decreased contact pressure at 20° AB/0° and 60° ER and 60° AB/30° ER (P ≥ 0.051 vs. intact). ConclusionBoth single- and double- layer grafts for AHDAT, improved superior translation, subacromial contact characteristics and acromiohumeral distance after a stage III rotator cuff tear, with varying effectiveness due to the position-dependent nature of greater tuberosity-to-acromial contact with abduction.

Preoperative Diagnosis and Rotator Cuff Status Impact Functional Internal Rotation Following Reverse Shoulder Arthroplasty

PurposeThis study aimed to evaluate whether functional internal rotation (fIR) following reverse shoulder arthroplasty (RSA) differs based on diagnosis of either: primary osteoarthritis (OA) with intact rotator cuff, massive irreparable rotator cuff tear (MICT) or cuff tear arthropathy (CTA). MethodsA retrospective review was performed on RSAs performed by a single surgeon with the same implant over a five year period. Minimum two year follow-up was available in 235 patients; 139 (59.1%) were females, and the mean patient age was 72±8 years. Additional clinical evaluation included the simple shoulder value (SSV) and Constant score. Postoperative internal rotation was categorized as type I: hand to the buttock or hip, type II: to the lower lumbar region, or type III smooth motion to at least the upper lumber region. Type I was considered “non-functional” internal rotation and type II or III were fIR. . ResultsPreoperatively, internal rotation was classified as type I in 60 (25.5%) patients, type II in 114 (48.5%), and type III in 62 (26%). Postoperatively internal rotation was classified as type I in 70 (30%) patients, type II in 86 (36%), and type III in 79 (34%). Compared to preoperative status, fIR improved significantly in OA patients (p<0.001), with 49 (52.6%) classified as type II or III postoperatively. In CTA patients, there was no significant change (p=0.352). In patients with MICTs, there was significant loss in fIR postoperatively (p=0.003), with 25 (30.8%) patients deteriorating to type I after having either type II or III preoperatively, and only five (6.1%) patients improving to either type II or III. ConclusionsPatients who undergo RSA for primary OA have a better chance of postoperative fIR improvement. A decrease in fIR is common after RSA for MICTs.

[Early effectiveness of arthroscopic superior fulcrum reconstruction in treatment of irreparable massive rotator cuff tear].

To investigate early effectiveness of arthroscopic superior fulcrum reconstruction in the treatment of irreparable massive rotator cuff tear (IMRCT). A retrospective analysis was conducted on the clinical data of 24 patients with IMRCT who met the inclusion criteria between January 2020 and April 2022. Among them, there were 11 males and 13 females with an average age of 56.2 years (range, 42-68 years). There were 12 cases of falling injuries, 3 cases of traction injuries, and the other 9 cases had no obvious causes. The disease duration ranged from 1 to 25 months (median, 6 months). The rotator cuff tears were classified as Hamada grade 2 in 18 cases and grade 3 in 6 cases, and Goutallier grade 1 in 3 cases, grade 2 in 20 cases, and grade 3 in 1 case. All patients were treated with arthroscopic superior fulcrum reconstruction. Visual analogue scale (VAS) score, Constant-Murley score, the University of California at Los Angeles (UCLA) score, and the American Shoulder and Elbow Surgeons (ASES) score were recorded before operation and at 1, 3, 6, and 12 months after operation. The operations were all successfully completed. The incisions healed by first intention and no related complications occurred. All patients were followed up 12-33 months (mean, 24.6 months). The VAS, Constant-Murley, UCLA, and ASES scores at different time points after operation were superior to those before operation ( P<0.05). All of the above indicators further improved with time. Except for no significant difference in VAS and Constant-Murley scores between 6 and 12 months ( P>0.05), the differences between the other time points were significant ( P<0.05). At 12 months after operation, according to UCLA scoring standard, shoulder joint function was rated as excellent in 4 cases, good in 19 cases, and poor in 1 case, with an excellent and good rate of 96.0%. MRI showed that there was no graft re-tear and the transplanted tendon and bone tunnel healed. The arthroscopic superior fulcrum reconstruction for IMRCT can effectively relieve the pain, improve the shoulder range of motion, and restore good shoulder function.

Subacromial Balloon Spacer in Massive Irreparable Rotator Cuff Tears – What Does the Evidence Say?

The rupture of the rotator cuff is a common condition in Orthopedics, with massive and irreparable tears posing a challenge for Orthopedic surgeons. There are multiple techniques described for its treatment, with one of the most recent being the implantation of a subacromial balloon. This technically simple technique has shown good biomechanical results in the literature but controversial clinical outcomes. Most of the existing literature is of low scientific evidence. Studies with higher evidence are starting to emerge, but there is still no clear definition of the role of subacromial balloons.

Effect of subscapularis repair on joint contact forces based on degree of posterior-superior rotator cuff tear severity in reverse shoulder arthroplasty.

Massive irreparable rotator cuff tears (RCTs) affect the clinical outcomes of reverse shoulder arthroplasty (RSA). However, the effects of subscapularis repair on the outcomes of RSA, based on the degree of posterior-superior RCTs, are unclear. This study aimed to examine the effect of subscapularis repair on three-dimensional joint contact forces (JCFs) based on the degree of posterior-superior RCT severity in RSA. Ten human in vivo experimental data were used as input to the musculoskeletal model. A six-degrees-of-freedom (DOF) anatomical shoulder model was developed and validated against three-dimensional JCFs. The 6-DOF musculoskeletal shoulder model of RSA was then developed by importing the reverse shoulder implant into the validated anatomical shoulder model. Based on the various types of posterior-superior RCT severity, inverse dynamic simulations of subscapularis-torn and subscapularis-repaired models of RSA were performed: from isolated supraspinatus tears to partial or massive tears of the infraspinatus and teres minor. The intact rotator cuff model of RSA was also simulated for comparison with the different types of models. Our results showed that the more posterior-superior RCTs progressed in RSA, the more superior JCFs were observed at 90°, 105°, and 120° abduction in the subscapularis-torn model. However, subscapularis repair decreased the superior JCF at those angles sufficiently. In addition, the teres minor muscle-tendon force increased as infraspinatus bundle tears progressed in both the subscapularis-torn and -repaired models, in order to compensate for the reduced force during abduction. However, the teres minor muscle-tendon force was not as high as that of the infraspinatus muscle-tendon, which could result in muscle force imbalance between repaired subscapularis and teres minor. Therefore, our results suggest that repairing the subscapularis and the repairable infraspinatus during RSA can improve glenohumeral joint stability in the superior-inferior direction by restoring muscle force balance between the anterior cuff (i.e., subscapularis) and posterior cuff (i.e., infraspinatus and teres minor). The findings of this study can help clinician decide whether to repair the rotator cuff during RSA to enhance joint stability.

Bridging repair reinforced with artificial ligament as an internal brace for irreparable massive rotator cuff tears

BackgroundThe irreparable massive rotator cuff tear (IMRCT) is challenging to manage. Although various surgical options have been proposed to treat IMRCTs, the optimal surgical technique remains controversial. Arthroscopic bridging patch repair is clinically used for treating IMRCTs，but the healing rate of the patch graft is negatively affected by superior shift of the humeral head. This study aimed to evaluate the clinical efficacy of artificial ligament as an internal brace (IB) reinforcing fascia lata autograft bridging repair (ABR) in the treatment of IMRCTs. MethodsThe data of 50 patients with IMRCTs who underwent ABR reinforced with artificial ligament as an IB (ABR + IB) (internal brace group) or ABR alone (control group) were retrospectively evaluated preoperatively and at 2-year follow-up. Clinical outcomes were assessed based on the shoulder activity, of which the strength was measured using a 0-10 points manual muscle test scale, American Shoulder and Elbow Surgeons (ASES) Score, and visual analog scale (VAS) for pain. Imaging outcomes were evaluated based on acromiohumeral distance (AHD), Hamada grade, Goutallier grade, and the status of fascia lata grafts according to radiographs or magnetic resonance imaging findings. ResultsBoth groups showed significantly better results in shoulder activity, ASES score, VAS, and AHD at 2-year follow-up compared with preoperative levels (P < 0.001). Compared with the control group (n = 24), the internal brace group (n = 26) had better mean AHD (7.0 ± 1.4 mm versus 5.9 ± 1.0 mm, P = 0.002), mean improvement in AHD (3.3 ± 1.5 mm versus 2.0 ± 0.6 mm, P < 0.001), healing rate of autografts (92.3% versus 54.2%, P = 0.002), and improvement rate of Hamada grade (73.1% versus 41.7%, P = 0.025) at 2-year follow-up. No significant differences were found in active elevation, active external rotation, active internal rotation, abduction strength, external rotation strength, internal rotation strength, ASES score, or VAS between the two groups at 2-year follow-up ConclusionBoth the ABR + IB and ABR improved the postoperative short-term clinical and imaging outcomes in managing IMRCTs, the ABR + IB is statistically superior to ABR alone in terms of healing rate of the bridging graft, AHD, and Hamada grade at 2-year follow-up, while further clinical investigations with larger sample size and longer follow-ups are required to validate the clinical significance of this novel technique for IMRCTs.

Subacromial Balloon Spacer: When to Use This?

The subacromial balloon spacer is a novel treatment option for the management of massive irreparable rotator cuff tears. This device is introduced into the glenohumeral joint and acts to alleviate the acromiohumeral impingement, caused by the massive irreparable rotator cuff tear. The device also redistributes the tension around the adjacent muscles in the joint, allowing them to compensate for the torn rotator cuff tendons. By doing so, the balloon can act as a "rehabilitation accelerator", ultimately resulting in improved shoulder pain and function. Adherence to balloon indications when selecting the appropriate patient is necessary, and these include an irreparable posterosuperior rotator cuff tear, with preserved subscapularis function, minimal to no osteoarthritis, and the ability to forward flex to 90 degrees. Clinical studies have demonstrated promising potential regarding the benefit of the balloon, with numerous studies demonstrating great outcomes after its implantation. Nevertheless, future research remains necessary to render the evidence behind its utility unequivocal.

Arthroscopic Rotator Cuff Repair With Superior Fulcrum Reconstruction Using Autologous Ipsilateral Peroneus Longus Tendon for Irreparable Massive Rotator Cuff Tears

Rotator cuff tears are still among the serious challenges encountered by sports medicine surgeons. With the development of arthroscopic technology, the treatment options for irreparable massive rotator cuff tears (IMRCTs) have gradually increased, but postoperatively, these options are prone to graft retears, reoperations, infections, revision surgical procedures, and so on. On the basis of studies on the balance of the force couples of the rotator cuff, more scholars believe that when addressing IMRCTs, attention should be paid to the reconstruction of the force couples of the rotator cuff; hence, we developed the superior fulcrum reconstruction technique. This article describes an alternative approach to IMRCT repair with superior fulcrum reconstruction using autologous ipsilateral peroneus longus tendon.

Reverse total shoulder arthroplasty with combined latissimus dorsi and teres major transfer in massive irreparable rotator cuff tear with loss of active external rotation: circumferential suturing technique

BackgroundElderly patients with a massive irreparable rotator cuff tear suitable for reverse total shoulder arthroplasty (rTSA), combined with additional loss of active external rotation (ER), experience distress after rTSA alone due to the inability to perform daily tasks that require spatial control of the arm’s position. We hypothesized that performing a combined transfer of Latissimus dorsi (LD) and Teres major (TM) along with rTSA in such patients could lead to improved outcomes after surgery, including those requiring active ER. MethodsThis is a retrospective review of 17 patients with a massive irreparable rotator cuff tear and loss of active ER, managed with rTSA and combined LD and TM transfer using a novel circumferential suturing technique. Eleven patients were female, and 6 were male, with a mean age of 73.2 years (ranging from 60 to 82 years). The mean follow-up was 60.5 months. Preoperative and final follow-up clinical and radiological findings were assessed and compared for all patients. ResultsThe mean forward flexion (FF) increased from 92° to 137° (P = .001). The mean abduction improved from 94° to 106° (P = .025). The mean ER improved from −14° to 8° (P < .001). The mean range of internal rotation decreased from 4.9 to 4.3 points (thoracolumbar junction to L2) (P = .065). The mean improvement of strength expressed as a percentage of the opposite side was significant for FF, abduction, and ER (P < .001). The mean visual analog scale score for pain improved from 5.5 to 1.7 point (P < .001). The mean University of California at Los Angeles shoulder score increased from 12.6 to 26.7 points (P < .001). The mean Constant Murley shoulder score improved from 40.6 to 75.7 (P < .001). The mean activities of daily living score, which requires active ER, increased from 4.5 to 22.3 points (P < .001). There was a reversal of loss of active ER in 15/17 (88.2%) patients. No perioperative complications related to the tendon transfer and fixation were observed. ConclusionThe combination of rTSA with LD and TM transfer leads to gains in FF and ER, improving clinical outcomes, including those requiring active ER. Circumferential suturing of LD and TM transfer avoids problems with suture anchors, interference screws, or bone tunnels. The posterodistal attachment site opposite to the original LD insertion is endorsed to mitigate the loss of internal rotation.

Arthroscopic superior capsular reconstruction versus reverse shoulder arthroplasty in patients with massive irreparable rotator cuff tears: A comparative clinical study.

This study aimed to compare the clinical and functional outcomes of reverse shoulder arthroplasty versus arthroscopic supe- rior capsular reconstruction in the treatment of patients with massive irreparable rotator cuff tears and Hamada grade 1-2 glenohumeral arthritis. It is a retrospective case-control study comparing the prospective results of 2 different treatment methods. This retrospective comparison of groups was conducted between May 2016 and May 2020. The study included 40 people with massive irreparable rotator cuff tear and Hamada grade 1-2 arthropathy who had arthroscopic superior capsular reconstruction with tensor fascia latae autograft or reverse shoulder arthroplasty surgery. Patients were divided into 2 groups according to treatment. Clinical outcome measures included shoulder range of motion, pain, and functional scores (Constant-Murley, American Shoulder and Elbow Surgeons). The mean age was 61.85 ± 7.56 and 71.10 ± 6.42 years, respectively, for group I [superior capsular reconstruction (n=20)] and group II [superior capsular reconstruction (n=20)]. The mean follow-up was 22.30 ± 8.4 and 32.50 ± 8.11 months, respectively. In the postoperative data, flexion degrees and Constant scores were significantly higher in the superior capsular reconstruction group (P=.007, P = .043). No significant difference was found between the 2 groups in all parameters (P > .05) except abduction. The increase in abduction value in the reverse shoulder arthroplasty group was significantly higher than in the superior capsular reconstruction group (P = .003). In addition, postoperative data in all parameters in both groups showed significant changes compared to preoperatively. This study has shown that superior capsular reconstruction with tensor fascia latae autograft can provide clinical and func- tional improvement similar to the reverse shoulder arthroplasty procedure in treating massive irreparable rotator cuff tears with Hamada grade 1-2 arthropathy. Level III, Therapeutic Study.

Ultrasound-Guided Deflation and Arthroscopic Removal of a Migrated Subacromial Balloon Spacer

Full-thickness massive irreparable rotator cuff tears present a demanding challenge for the surgeon. The subacromial balloon spacer is a novel biodegradable implant used to treat massive, irreparable rotator cuff tears. There have, however, been several isolated reports of balloon migration. This Technical Note describes ultrasound-assisted balloon deflation followed by arthroscopic removal of a symptomatic dislodged balloon.