Cargando…

Superior Capsule Reconstruction for Reinforcement Before Arthroscopic Rotator Cuff Repair Improves Cuff Integrity

OBJECTIVES: We developed the superior capsule reconstruction (SCR) technique for surgical treatment of irreparable rotator cuff tears. In these patients, SCR restores shoulder stability and muscle balance, consequently improving shoulder function and relieving pain. In this study, we evaluated wheth...

Descripción completa

Detalles Bibliográficos
Autores principales: Mihata, Teruhisa, Lee, Thay Q., Fukunishi, Kunimoto, Kawakami, Takeshi, Fujisawa, Yukitaka, Itami, Yasuo, Ohue, Mutsumi, Neo, Masashi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5882000/
http://dx.doi.org/10.1177/2325967118S00007
_version_ 1783311395545153536
author Mihata, Teruhisa
Lee, Thay Q.
Fukunishi, Kunimoto
Kawakami, Takeshi
Fujisawa, Yukitaka
Itami, Yasuo
Ohue, Mutsumi
Neo, Masashi
author_facet Mihata, Teruhisa
Lee, Thay Q.
Fukunishi, Kunimoto
Kawakami, Takeshi
Fujisawa, Yukitaka
Itami, Yasuo
Ohue, Mutsumi
Neo, Masashi
author_sort Mihata, Teruhisa
collection PubMed
description OBJECTIVES: We developed the superior capsule reconstruction (SCR) technique for surgical treatment of irreparable rotator cuff tears. In these patients, SCR restores shoulder stability and muscle balance, consequently improving shoulder function and relieving pain. In this study, we evaluated whether SCR for reinforcement before arthroscopic rotator cuff repair (ARCR) improves cuff integrity, especially in the case of severely degenerated supraspinatus tendon. METHODS: A series of 32 consecutive patients (mean age, 69.0 years) with severely degenerated but reparable rotator cuff tears (medium size: 1-3 cm, and large size: 3-5 cm) underwent SCR using fascia lata autografts for reinforcement before ARCR. To determine the indications for SCR for reinforcement, the severity of degeneration in the torn supraspinatus tendon was assessed. We evaluated fatty degeneration in the muscle by using the Goutallier grade; we also scored retraction of the torn tendon (grade 0: no retraction; grade 1: torn edge on the greater tuberosity; grade 2: torn edge on the lateral half of the humeral head; grade 3: torn edge on the medial half of the humeral head; grade 4: torn edge on the glenoid) and tendon quality (grade 0: normal; grade 1: slightly thin, or slight fatty degeneration in the tendon part; grade 2: severely thin, or severe fatty degeneration in the tendon part; grade 3: severely thin, and severe fatty degeneration in the tendon part; grade 4: no tendon). In patients classified with grade 3 or 4 in at least two of these three categories, arthroscopic SCR was performed for reinforcement, after which the torn tendon was repaired over the fascia lata graft. To assess the benefit of SCR for reinforcement, the results from these 32 patients were compared with those after ARCR alone in 91 consecutive patients with medium (1-3 cm) to large (3-5 cm) rotator cuff tears (mean age, 66.7 years). Torn tendons were repaired by using double-row suture-bridges with and without SCR for reinforcement. By using t- and chi-square tests, we compared the American Shoulder and Elbow Surgeons (ASES) score, active shoulder range of motion (ROM), and cuff integrity (Sugaya MRI classification) between ARCR with and without SCR as well as between before surgery and at final follow-up (mean, 19 months; 12 to 40 months). A significant difference was defined as P < 0.05. RESULTS: All 32 patients who underwent SCR before ARCR had no postoperative re-tear and demonstrated type I cuff integrity (sufficient thickness with homogeneously low intensity), whereas those treated with ARCR without SCR had a 5.5% incidence (5/91 all patients) of postoperative re-tear, and 22.1% (19/86 healed patients) had type II (partial high-intensity area) or III (insufficient thickness) cuff integrity. ASES score, active elevation, active external rotation, and active internal rotation increased significantly after ARCR both with and without SCR (P < 0.001) (Table). Postoperative ASES score and active ROM did not differ significantly between ARCR with and without SCR, but the Goutallier grade of the supraspinatus was significantly higher for ARCR with SCR (mean, 2.8) than for ARCR alone (mean, 2.1) (P < 0.0001). CONCLUSION: SCR for reinforcement prevented postoperative re-tear after ARCR and improved the quality of the repaired tendon on MRI. Furthermore, postoperative functional outcomes were similar in patients who underwent ARCR alone and those who also underwent SCR, even though degeneration of the torn tendons was greater in the latter group.
format Online
Article
Text
id pubmed-5882000
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-58820002018-04-05 Superior Capsule Reconstruction for Reinforcement Before Arthroscopic Rotator Cuff Repair Improves Cuff Integrity Mihata, Teruhisa Lee, Thay Q. Fukunishi, Kunimoto Kawakami, Takeshi Fujisawa, Yukitaka Itami, Yasuo Ohue, Mutsumi Neo, Masashi Orthop J Sports Med Article OBJECTIVES: We developed the superior capsule reconstruction (SCR) technique for surgical treatment of irreparable rotator cuff tears. In these patients, SCR restores shoulder stability and muscle balance, consequently improving shoulder function and relieving pain. In this study, we evaluated whether SCR for reinforcement before arthroscopic rotator cuff repair (ARCR) improves cuff integrity, especially in the case of severely degenerated supraspinatus tendon. METHODS: A series of 32 consecutive patients (mean age, 69.0 years) with severely degenerated but reparable rotator cuff tears (medium size: 1-3 cm, and large size: 3-5 cm) underwent SCR using fascia lata autografts for reinforcement before ARCR. To determine the indications for SCR for reinforcement, the severity of degeneration in the torn supraspinatus tendon was assessed. We evaluated fatty degeneration in the muscle by using the Goutallier grade; we also scored retraction of the torn tendon (grade 0: no retraction; grade 1: torn edge on the greater tuberosity; grade 2: torn edge on the lateral half of the humeral head; grade 3: torn edge on the medial half of the humeral head; grade 4: torn edge on the glenoid) and tendon quality (grade 0: normal; grade 1: slightly thin, or slight fatty degeneration in the tendon part; grade 2: severely thin, or severe fatty degeneration in the tendon part; grade 3: severely thin, and severe fatty degeneration in the tendon part; grade 4: no tendon). In patients classified with grade 3 or 4 in at least two of these three categories, arthroscopic SCR was performed for reinforcement, after which the torn tendon was repaired over the fascia lata graft. To assess the benefit of SCR for reinforcement, the results from these 32 patients were compared with those after ARCR alone in 91 consecutive patients with medium (1-3 cm) to large (3-5 cm) rotator cuff tears (mean age, 66.7 years). Torn tendons were repaired by using double-row suture-bridges with and without SCR for reinforcement. By using t- and chi-square tests, we compared the American Shoulder and Elbow Surgeons (ASES) score, active shoulder range of motion (ROM), and cuff integrity (Sugaya MRI classification) between ARCR with and without SCR as well as between before surgery and at final follow-up (mean, 19 months; 12 to 40 months). A significant difference was defined as P < 0.05. RESULTS: All 32 patients who underwent SCR before ARCR had no postoperative re-tear and demonstrated type I cuff integrity (sufficient thickness with homogeneously low intensity), whereas those treated with ARCR without SCR had a 5.5% incidence (5/91 all patients) of postoperative re-tear, and 22.1% (19/86 healed patients) had type II (partial high-intensity area) or III (insufficient thickness) cuff integrity. ASES score, active elevation, active external rotation, and active internal rotation increased significantly after ARCR both with and without SCR (P < 0.001) (Table). Postoperative ASES score and active ROM did not differ significantly between ARCR with and without SCR, but the Goutallier grade of the supraspinatus was significantly higher for ARCR with SCR (mean, 2.8) than for ARCR alone (mean, 2.1) (P < 0.0001). CONCLUSION: SCR for reinforcement prevented postoperative re-tear after ARCR and improved the quality of the repaired tendon on MRI. Furthermore, postoperative functional outcomes were similar in patients who underwent ARCR alone and those who also underwent SCR, even though degeneration of the torn tendons was greater in the latter group. SAGE Publications 2018-03-29 /pmc/articles/PMC5882000/ http://dx.doi.org/10.1177/2325967118S00007 Text en © The Author(s) 2018 http://creativecommons.org/licenses/by-nc-nd/4.0/ This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For reprints and permission queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.
spellingShingle Article
Mihata, Teruhisa
Lee, Thay Q.
Fukunishi, Kunimoto
Kawakami, Takeshi
Fujisawa, Yukitaka
Itami, Yasuo
Ohue, Mutsumi
Neo, Masashi
Superior Capsule Reconstruction for Reinforcement Before Arthroscopic Rotator Cuff Repair Improves Cuff Integrity
title Superior Capsule Reconstruction for Reinforcement Before Arthroscopic Rotator Cuff Repair Improves Cuff Integrity
title_full Superior Capsule Reconstruction for Reinforcement Before Arthroscopic Rotator Cuff Repair Improves Cuff Integrity
title_fullStr Superior Capsule Reconstruction for Reinforcement Before Arthroscopic Rotator Cuff Repair Improves Cuff Integrity
title_full_unstemmed Superior Capsule Reconstruction for Reinforcement Before Arthroscopic Rotator Cuff Repair Improves Cuff Integrity
title_short Superior Capsule Reconstruction for Reinforcement Before Arthroscopic Rotator Cuff Repair Improves Cuff Integrity
title_sort superior capsule reconstruction for reinforcement before arthroscopic rotator cuff repair improves cuff integrity
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5882000/
http://dx.doi.org/10.1177/2325967118S00007
work_keys_str_mv AT mihatateruhisa superiorcapsulereconstructionforreinforcementbeforearthroscopicrotatorcuffrepairimprovescuffintegrity
AT leethayq superiorcapsulereconstructionforreinforcementbeforearthroscopicrotatorcuffrepairimprovescuffintegrity
AT fukunishikunimoto superiorcapsulereconstructionforreinforcementbeforearthroscopicrotatorcuffrepairimprovescuffintegrity
AT kawakamitakeshi superiorcapsulereconstructionforreinforcementbeforearthroscopicrotatorcuffrepairimprovescuffintegrity
AT fujisawayukitaka superiorcapsulereconstructionforreinforcementbeforearthroscopicrotatorcuffrepairimprovescuffintegrity
AT itamiyasuo superiorcapsulereconstructionforreinforcementbeforearthroscopicrotatorcuffrepairimprovescuffintegrity
AT ohuemutsumi superiorcapsulereconstructionforreinforcementbeforearthroscopicrotatorcuffrepairimprovescuffintegrity
AT neomasashi superiorcapsulereconstructionforreinforcementbeforearthroscopicrotatorcuffrepairimprovescuffintegrity