Felix Rittenschober1,2, Reinhold Ortmaier3. 1. Abteilung für Orthopädie und Traumatologie, Ordensklinikum Barmherzige Schwestern Linz, Seilerstätte 4, 4010, Linz, Österreich. felix.rittenschober@ordensklinikum.at. 2. Trauma Center Linz, Linz, Österreich. felix.rittenschober@ordensklinikum.at. 3. Abteilung für Orthopädie und Traumatologie, Ordensklinikum Barmherzige Schwestern Linz, Seilerstätte 4, 4010, Linz, Österreich.
Abstract
OBJECTIVES: Reconstruction of the superior capsule for treatment of irreparable supraspinatus tendon tears. INDICATIONS: Irreparable supraspinatus tendon tear; centered humeral head; largely intact cartilage; largely intact transversal "force-couple". CONTRAINDICATIONS: Decentered humeral head; osteoarthritis of the glenohumeral joint/cuff tear arthropathy; irreparable anterosuperior and posterosuperior cuff tears. SURGICAL TECHNIQUE: Arthroscopic superior capsule reconstruction (SCR) is performed in beach-chair position. At first the bone bed of the glenoid and the insertion of the supraspinatus tendon are prepared using a bone burr. Now, depending on the integrity of the long biceps tendon, two options are possible. Option 1: In the case of an existing long biceps tendon, a biceps tendon tenodesis to the greater tubercle is performed. Therefore, the long head of the biceps is fixed central to the former insertion of the supraspinatus tendon, using a suture anchor. Option 2: In the case of a nonexisting or degeneratively modified long biceps tendon, a PushLock® anchor (Arthrex, Inc. Naples, FL, USA) loaded with a FiberTape® (Arthrex, Inc. Naples, FL, USA) is placed centrally onto the glenoid. Now, the actual superior capsule reconstruction is completed. Two suture anchors are placed at the glenoid and two SwiveLock® anchors, each loaded with a FiberTape®, (Arthrex, Inc. Naples, FL, USA) are placed at the footprint of the supraspinatus tendon at the greater tubercle. The tapes are shuttled extra-articularly and the graft size is evaluated by measuring the distance between the anchors. The graft is customized to that size and armed with the tapes. Using the tapes of the glenoidal anchors, as tension ropes, the graft is placed intra-articularly. Medially the sutures are tied and laterally the graft is fixed in a knotless lateral row manner. The tails of the tape, of the glenoidal PushLock® (Arthrex, Inc. Naples, FL, USA) anchor are fixed within the lateral row and are tensioned above the graft. Afterwards side-to-side sutures to the infraspinatus and a subacromial decompression are completed. POSTOPERATIVE MANAGEMENT: The arm is placed in a sling for 6 weeks, afterwards active physiotherapy begins. Passive-assisted physiotherapy is started on postoperative day 1. RESULTS: Between 2017 and 2019, 11 patients were treated with SCR. As the combined procedure is our new treatment algorithm, case studies will be presented. For this study, 9 patients treated with singular SCR, with a mean follow-up of 18 months, were recruited. A statistically significant reduction of pain (VAS 6.3 → VAS 2), a good postoperative forward flexion (mean 138°; 56 standard deviation [SD]), and external rotation (mean 37°; 21 SD) were measured. A mean ASES of 76.5 (18 SD) a mean DASH of 17.8 (14 SD) and a mean Constant score of 64.6 (25 SD) were achieved.
OBJECTIVES: Reconstruction of the superior capsule for treatment of irreparable supraspinatus tendon tears. INDICATIONS: Irreparable supraspinatus tendon tear; centered humeral head; largely intact cartilage; largely intact transversal "force-couple". CONTRAINDICATIONS: Decentered humeral head; osteoarthritis of the glenohumeral joint/cuff tear arthropathy; irreparable anterosuperior and posterosuperior cuff tears. SURGICAL TECHNIQUE: Arthroscopic superior capsule reconstruction (SCR) is performed in beach-chair position. At first the bone bed of the glenoid and the insertion of the supraspinatus tendon are prepared using a bone burr. Now, depending on the integrity of the long biceps tendon, two options are possible. Option 1: In the case of an existing long biceps tendon, a biceps tendon tenodesis to the greater tubercle is performed. Therefore, the long head of the biceps is fixed central to the former insertion of the supraspinatus tendon, using a suture anchor. Option 2: In the case of a nonexisting or degeneratively modified long biceps tendon, a PushLock® anchor (Arthrex, Inc. Naples, FL, USA) loaded with a FiberTape® (Arthrex, Inc. Naples, FL, USA) is placed centrally onto the glenoid. Now, the actual superior capsule reconstruction is completed. Two suture anchors are placed at the glenoid and two SwiveLock® anchors, each loaded with a FiberTape®, (Arthrex, Inc. Naples, FL, USA) are placed at the footprint of the supraspinatus tendon at the greater tubercle. The tapes are shuttled extra-articularly and the graft size is evaluated by measuring the distance between the anchors. The graft is customized to that size and armed with the tapes. Using the tapes of the glenoidal anchors, as tension ropes, the graft is placed intra-articularly. Medially the sutures are tied and laterally the graft is fixed in a knotless lateral row manner. The tails of the tape, of the glenoidal PushLock® (Arthrex, Inc. Naples, FL, USA) anchor are fixed within the lateral row and are tensioned above the graft. Afterwards side-to-side sutures to the infraspinatus and a subacromial decompression are completed. POSTOPERATIVE MANAGEMENT: The arm is placed in a sling for 6 weeks, afterwards active physiotherapy begins. Passive-assisted physiotherapy is started on postoperative day 1. RESULTS: Between 2017 and 2019, 11 patients were treated with SCR. As the combined procedure is our new treatment algorithm, case studies will be presented. For this study, 9 patients treated with singular SCR, with a mean follow-up of 18 months, were recruited. A statistically significant reduction of pain (VAS 6.3 → VAS 2), a good postoperative forward flexion (mean 138°; 56 standard deviation [SD]), and external rotation (mean 37°; 21 SD) were measured. A mean ASES of 76.5 (18 SD) a mean DASH of 17.8 (14 SD) and a mean Constant score of 64.6 (25 SD) were achieved.
Authors: Teruhisa Mihata; Michelle H McGarry; Joseph M Pirolo; Mitsuo Kinoshita; Thay Q Lee Journal: Am J Sports Med Date: 2012-08-10 Impact factor: 6.202