A new approach to superior capsular reconstruction with hamstring allograft for irreparable posterosuperior rotator cuff tears: a dynamic biomechanical evaluation.

Berthold, Daniel P; Bell, Ryan; Muench, Lukas N; Jimenez, Andrew E; Cote, Mark P; Obopilwe, Elifho; Edgar, Cory M

doi:10.1016/j.jse.2021.04.002

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Professur für Sportorthopädie (N.N.)

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Title:: A new approach to superior capsular reconstruction with hamstring allograft for irreparable posterosuperior rotator cuff tears: a dynamic biomechanical evaluation.
Document type:: Journal Article
Author(s):: Berthold, Daniel P; Bell, Ryan; Muench, Lukas N; Jimenez, Andrew E; Cote, Mark P; Obopilwe, Elifho; Edgar, Cory M
Abstract:: BACKGROUND: Superior capsular reconstruction (SCR) treatment of massive, symptomatic, irreparable rotator cuff tears (RCTs) has become a more recently used procedure. However, there is a lack of consensus surrounding optimal graft choice for the SCR technique, and current dermal grafts have increased cost and are technically challenging because of a need for multiple implants. The purpose of this study was to biomechanically investigate a biological lower-cost alternative as a support for the superior capsule reconstruction concept: an isolated semitendinosus tendon (STT) allograft and a combination graft with the long head of the biceps tendon (LHBT) in an established massive posterosuperior RCT cadaver model. METHODS: Ten fresh-frozen cadaveric shoulders (53.3 ± 12.4 years: range: 26-65) were tested on an established dynamic shoulder simulator using dynamic muscle loading. Cumulative deltoid forces, maximum abduction angle, and superior humeral head translation were compared across 4 testing conditions: (1) intact state, (2) massively retracted (Patte III), irreparable posterosuperior RCT, (3) SCR repair using an STT allograft, and (4) SCR repair using a combined STT-LHBT repair. RESULTS: Intact shoulders required a mean deltoid force of 154.2 ± 20.41 N to achieve maximum glenohumeral abduction (55.3° ± 2.3°). Compared with native shoulders, the maximum abduction angle decreased following a massively retracted posterosuperior RCT by 52% (28.3° ± 8.4°; P < .001), whereas the cumulative deltoid forces increased by 48% (205.3 ± 40.9 N; P = .001). The STT repair and the STT-LHBT repair improved shoulder function compared with the tear state, with a mean maximum abduction angle of 30.6° ± 9.0° and 31.8° ± 7.7° and a mean deltoid force of 205.3 ± 40.9 N and 201.0 ± 34.0 N, respectively, but this was not statistically significant (P > .05). The STT-LHBT repair significantly improved the range of motion with respect to the tear state (P = .04). CONCLUSIONS: In a dynamic shoulder simulator model, both the STT and the STT-LHBT repair techniques improved glenohumeral joint kinematics in an amount similar to previously reported "traditional" SCR techniques for treatment of an irreparable posterosuperior RCT.
Journal title abbreviation:: J Shoulder Elbow Surg
Year:: 2021
Journal volume:: 30
Journal issue:: 7S
Pages contribution:: S38-S47
Fulltext / DOI:: doi:10.1016/j.jse.2021.04.002
Pubmed ID:: http://view.ncbi.nlm.nih.gov/pubmed/33892119
Print-ISSN:: 1058-2746
TUM Institution:: Fachgebiet Sportorthopädie (Prof. Imhoff)
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