F Plachel1,2, S Pauly1, P Moroder1, M Scheibel3. 1. Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin, Augustenburgerplatz 1, 13353, Berlin, Deutschland. 2. Institut für Sehnen- und Knochenregeneration, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich. 3. Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin, Augustenburgerplatz 1, 13353, Berlin, Deutschland. markus.scheibel@charite.de.
Abstract
OBJECTIVE: Reconstruction of tendon integrity to maintain glenohumeral joint centration and hence to restore shoulder functional range of motion and to reduce pain. INDICATIONS: Isolated or combined full-thickness subscapularis tendon tears (≥upper two-thirds of the tendon) without both substantial soft tissue degeneration and cranialization of the humeral head. CONTRAINDICATIONS: Chronic tears of the subscapularis tendon with higher grade muscle atrophy, fatty infiltration, and static decentration of the humeral head. SURGICAL TECHNIQUE: After arthroscopic three-sided subscapularis tendon release, two double-loaded suture anchors are placed medially to the humeral footprint. Next to the suture passage, the suture limbs are tied and secured laterally with up to two knotless anchors creating a transosseous-equivalent repair. POSTOPERATIVE MANAGEMENT: The affected arm is placed in a shoulder brace with 20° of abduction and slight internal rotation for 6 weeks postoperatively. Rehabilitation protocol including progressive physical therapy from a maximum protection phase to a minimum protection phase is required. Overhead activities are permitted after 6 months. RESULTS: While previous studies have demonstrated superior biomechanical properties and clinical results after double-row compared to single-row and transosseous fixation techniques, further mid- to long-term clinical investigations are needed to confirm these findings.
OBJECTIVE: Reconstruction of tendon integrity to maintain glenohumeral joint centration and hence to restore shoulder functional range of motion and to reduce pain. INDICATIONS: Isolated or combined full-thickness subscapularis tendon tears (≥upper two-thirds of the tendon) without both substantial soft tissue degeneration and cranialization of the humeral head. CONTRAINDICATIONS: Chronic tears of the subscapularis tendon with higher grade muscle atrophy, fatty infiltration, and static decentration of the humeral head. SURGICAL TECHNIQUE: After arthroscopic three-sided subscapularis tendon release, two double-loaded suture anchors are placed medially to the humeral footprint. Next to the suture passage, the suture limbs are tied and secured laterally with up to two knotless anchors creating a transosseous-equivalent repair. POSTOPERATIVE MANAGEMENT: The affected arm is placed in a shoulder brace with 20° of abduction and slight internal rotation for 6 weeks postoperatively. Rehabilitation protocol including progressive physical therapy from a maximum protection phase to a minimum protection phase is required. Overhead activities are permitted after 6 months. RESULTS: While previous studies have demonstrated superior biomechanical properties and clinical results after double-row compared to single-row and transosseous fixation techniques, further mid- to long-term clinical investigations are needed to confirm these findings.
Authors: Bryan M Saltzman; Michael J Collins; Timothy Leroux; Thomas A Arns; Justin W Griffin; Anthony A Romeo; Nikhil N Verma; Brian Forsythe Journal: Arthroscopy Date: 2017-01-09 Impact factor: 4.772
Authors: Christoph Bartl; Markus Scheibel; Petra Magosch; Sven Lichtenberg; Peter Habermeyer Journal: Am J Sports Med Date: 2010-12-28 Impact factor: 6.202
Authors: Peter C Kreuz; Andreas Remiger; Christoph Erggelet; Stefan Hinterwimmer; Philipp Niemeyer; Andre Gächter Journal: Am J Sports Med Date: 2005-09-12 Impact factor: 6.202
Authors: Christoph Bartl; Gian M Salzmann; Gernot Seppel; Stefan Eichhorn; Konstantin Holzapfel; Klaus Wörtler; Andreas B Imhoff Journal: Am J Sports Med Date: 2011-02-18 Impact factor: 6.202