Clinical and structural outcomes after superior capsular reconstruction and augmentation for massive rotator cuff tears using the long head biceps tendon as a graft
ESSKA Academy. Llinas Hernandez P. 11/08/19; 285211; epESA-05 Topic: A10 - Head depressing procedures (open, e.g. balloon, superior capsule reconstruction, etc.)
Prof. Dr. Paulo Jose Llinas Hernandez
Prof. Dr. Paulo Jose Llinas Hernandez
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We describe a surgical technique in which augmentation of arthroscopic repair of the rotator cuff tear (RCT) and reconstruction of the superior capsule is performed, using the proximal portion of the long head of the biceps tendon (BT) in 34 patients with reparable massive rupture of the rotator cuff at risk of re-tear (RCRT) or healing failure.
We present functional postoperative results at a minimum of 24 months, evaluated with VAS and ASES score, as well as healing assessed by magnetic resonance imaging.
During surgery, a distal tenotomy of the long head of the BT is made at its entrance in the bicipital groove, leaving its insertion in the glenoid tubercle intact, and then fixing the distal portion of the proximal stump on the greater tuberosity of the humerus, thus reconstructing the superior capsule. Then, the RCT is sutured, incorporating the tenodesed BT, therefore achieving a biological augmentation.
Using our technique we operated 34 patients (22 women and 12 men) with repairable massive ruptures of the rotator cuff. Mean age at surgery was 66 years (range, 58-72 years) with an average follow-up of 24 months (range, 22 - 30 months). All patients underwent MRI at 24 months to assess tendon integrity. On average, flexion improved from 80 degrees (range, 40 - 100 degrees) to 130 degrees (range, 100 - 160 degrees) and external rotation improved from 25 degrees (range, 10 - 45 degrees) to 50 degrees (range, 45 - 60 degrees). Twenty four months after surgery, ASES score improved by an average of 44 points and the pain measured with the visual analog score improved by an average of 5 points. Five patients experienced partial/complete re-tear/failure on the MRI assessment at 24 months (2 and 3 respectively). However, despite the radiographic failures, there was clinical improvement of pain (VAS improved from 8 pre-operative to 4 at latest follow-up on average) and function (ASES improved from 28.33 preoperative to 70 at 24 months follow-up on average)
We describe a surgical technique in which augmentation of arthroscopic repair of the rotator cuff tear (RCT) and reconstruction of the superior capsule is performed, using the proximal portion of the long head of the biceps tendon (BT) in 34 patients with reparable massive rupture of the rotator cuff at risk of re-tear (RCRT) or healing failure.
We present functional postoperative results at a minimum of 24 months, evaluated with VAS and ASES score, as well as healing assessed by magnetic resonance imaging.
During surgery, a distal tenotomy of the long head of the BT is made at its entrance in the bicipital groove, leaving its insertion in the glenoid tubercle intact, and then fixing the distal portion of the proximal stump on the greater tuberosity of the humerus, thus reconstructing the superior capsule. Then, the RCT is sutured, incorporating the tenodesed BT, therefore achieving a biological augmentation.
Using our technique we operated 34 patients (22 women and 12 men) with repairable massive ruptures of the rotator cuff. Mean age at surgery was 66 years (range, 58-72 years) with an average follow-up of 24 months (range, 22 - 30 months). All patients underwent MRI at 24 months to assess tendon integrity. On average, flexion improved from 80 degrees (range, 40 - 100 degrees) to 130 degrees (range, 100 - 160 degrees) and external rotation improved from 25 degrees (range, 10 - 45 degrees) to 50 degrees (range, 45 - 60 degrees). Twenty four months after surgery, ASES score improved by an average of 44 points and the pain measured with the visual analog score improved by an average of 5 points. Five patients experienced partial/complete re-tear/failure on the MRI assessment at 24 months (2 and 3 respectively). However, despite the radiographic failures, there was clinical improvement of pain (VAS improved from 8 pre-operative to 4 at latest follow-up on average) and function (ASES improved from 28.33 preoperative to 70 at 24 months follow-up on average)
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