Michael B Eppler, Ioanna K Bolia, James E Tibone, Seth C Gamradt, George F Hatch, Reza Omid, Alexander E Weber, Frank A Petrigliano
For irreparable rotator cuff tears, superior capsular reconstruction (SCR) has become an option for restoring glenohumeral joint stability and reversing proximal humeral migration. Signs of irreparable rotator cuff tears include pain from subacromial impingement, muscle weakness, and pseudoparalysis. In biomechanical studies, Mihata et al. showed SCR with fascia lata graft and side-to-side suturing to remaining infraspinatus tendon restored superior stability of the shoulder joint. Adding acromioplasty decreased the subacromial contact area without altering the humeral head position, superior translation, or subacromial peak contact pressure...
June 2021: Arthroscopy
Lucca Lacheta, Alex Brady, Samuel I Rosenberg, Travis J Dekker, Ritesh Kashyap, Payam Zandiyeh, Grant J Dornan, Matthew T Provencher, Peter J Millett
BACKGROUND: Superior capsule reconstruction (SCR) has been shown to improve shoulder function and reduce pain in patients with isolated irreparable supraspinatus tendon tears. However, the effects of SCR on biomechanics in a shoulder with an extensive posterosuperior rotator cuff tear pattern remain unknown. PURPOSE/HYPOTHESIS: The purpose was to (1) establish a dynamic robotic shoulder model, (2) assess the influence of rotator cuff tear patterns, and (3) assess the effects of SCR on superior humeral head translation after a posterosuperior rotator cuff tear...
June 3, 2021: American Journal of Sports Medicine
Tong Zhou, Xu Zhang, Xiaofei Yu, Yanbin Bai, Huan Chen, Jia Li, Hongjie Li, Yadong Yu
Purpose: This study was performed to evaluate a modified method of reconstructing the thumb abduction function in children undergoing surgical treatment of thumb duplication. Methods: This retrospective study included 33 children (38 thumbs) with Wassel type III to VII thumb duplication who underwent excision of the polydactylism and osteotomy of the preserved thumb. Among them, 16 children (19 thumbs) underwent reconstruction of the attachment of the articular capsule and collateral ligament of the metacarpophalangeal joint, abductor pollicis brevis and flexor pollicis brevis by the anchor technique (Group A), while 17 children (19 thumbs) underwent suturing the attachment of the above-mentioned soft tissues to the periosteum (Group B)...
April 19, 2021: Journal of Children's Orthopaedics
Robin Martin, Kyle Robert Kirkham, Trieu Hoai Nam Ngo, Erin Gonvers, Jean Lambert, Eric Albrecht
BACKGROUND AND OBJECTIVES: Femoral triangle block and local infiltration analgesia are two effective analgesic techniques after anterior cruciate ligament reconstruction. Recently, the iPACK block (infiltration between the popliteal artery and the capsule of the posterior knee) has been described to relieve posterior knee pain. This randomized controlled triple-blinded trial tested the hypothesis that the combination of femoral triangle block and iPACK provides superior analgesia to local infiltration analgesia after anterior cruciate ligament reconstruction...
May 26, 2021: Regional Anesthesia and Pain Medicine
Patrick J Denard, Seungbum Chae, Christen Chalmers, Jae Hyuk Choi, Michelle H McGarry, Gregory Adamson, Max Park, Thay Q Lee
Purpose: To quantitatively biomechanically assess superior stability, subacromial contact pressures, and glenohumeral kinematics of an in situ biceps tenodesis and a box-shaped long head of the biceps tendon (LHBT) superior capsule reconstruction (SCR) in a superior massive rotator cuff tear (MCT) model. Methods: Eight cadaveric shoulders (mean age, 62 years; range, 46-70 years) were tested with a custom testing system used to evaluate range of motion, superior translation, and subacromial contact pressure at 0°, 20°, and 40° of abduction...
April 2021: Arthroscopy, sports medicine, and rehabilitation
Erica Kholinne, Yucheng Sun, Jae-Man Kwak, Hyojune Kim, Kyoung Hwan Koh, In-Ho Jeon
Background: Superior capsular reconstruction (SCR) is an alternative to reverse shoulder arthroplasty for irreparable rotator cuff tears (IRCTs). The reconstructed capsule acts as a static restraint to prevent superior migration of the humeral head. Traditional SCR uses a fascia lata autograft, which has shown failure at the greater tuberosity. An Achilles tendon-bone allograft has been proposed to improve the failure rate. Purpose: To evaluate the surgical outcomes of SCR using an Achilles tendon-bone allograft for the treatment of IRCTs...
May 2021: Orthopaedic Journal of Sports Medicine
Edmund Chan, Ryan Howle, Desire Onwochei, Neel Desai
BACKGROUND: The infiltration between the popliteal artery and the capsule of the knee (IPACK) block has been described as an alternative analgesic strategy for knee pain. OBJECTIVE: Our aim was to perform a narrative review to examine the place and value that the IPACK block has in comparison to and in conjunction with other regional anesthesia modalities. EVIDENCE REVIEW: Following an extensive search of electronic databases, we included anatomical studies, letters, comparative observational studies, and non-randomized and randomized controlled trials that examined the IPACK block in relation to surgery on the knee under general or neuraxial anesthesia...
May 14, 2021: Regional Anesthesia and Pain Medicine
Alessandro DE Benedictis, Carlo E Marras, Laurent Petit, Silvio Sarubbo
INTRODUCTION: Since its first description in the early 19th century, the inferior frontooccipital fascicle (IFOF) and its anatomo-functional features were neglected in the neuroscientific literature for the last century. In the last decade, the rapid development of in vivo imaging for the reconstruction of white matter (WM) connectivity (i.e., tractography) and the consequent interest in more traditional ex vivo methods (postmortem dissection) have allowed a renewed debate about course, termination territories, anatomical relationships, and functional roles of this fascicle...
May 3, 2021: Journal of Neurosurgical Sciences
Daniel P Berthold, Ryan Bell, Lukas N Muench, Andrew Jimenez, Mark P Cote, Elifho Obopilwe, Cory M Edgar
BACKGROUND: Superior capsular reconstruction (SCR) treatment of massive, symptomatic, irreparable rotator cuff tears (RCT) has become a more recently utilized 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 due to 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 allograft (STT) and a combination graft with the tendon of the long head of the biceps (LHBT) in an established massive posterosuperior RCT cadaver model...
April 20, 2021: Journal of Shoulder and Elbow Surgery
Doosup Kim, Jaewoong Um, Junhyeok Lee, Jaehyeon Kim
PURPOSE: The objective of this study was to investigate the clinical and radiologic outcomes after superior capsule reconstruction (SCR) with biceps tendon (BT) for irreparable rotator cuff tears. METHODS: The retrospective study period was May 2015 through February 2018. The average follow-up was 32 months (24 to 48 months) after surgery. Study inclusion criteria included an arthroscopic SCR performed using only our technique and minimum 2-year clinical follow-up by office visit and survey...
April 20, 2021: Arthroscopy
Micah Sommer, Eric Wagner, Sophie Zhu, Sheila McRae, Peter McDonald, Dan Ogborn, Jarret Woodmass
PURPOSE: The purpose of this systematic review is to characterize the complications associated with Superior Capsule Reconstruction (SCR) for the treatment of Functionally Irreparable Rotator Cuff Tears (FIRCTs). METHODS: This systematic review was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two independent reviewers completed a search of PubMed, Embase and Medline databases. Studies were deemed eligible for inclusion if they reported post-operative outcomes of arthroscopic SCR for FIRCTs and considered at least one post-operative complication...
April 19, 2021: Arthroscopy
Chen-Hao Chiang, Leo Shaw, Wei-Hsing Chih, Ming-Long Yeh, Hsiao-Hsien Ting, Chang-Hao Lin, Chao-Ping Chen, Wei-Ren Su
PURPOSE: To retrospectively assess the clinical outcomes of the patients with large to massive reparable rotator cuff tears (RCTs) treated by arthroscopic rotator cuff repair (ARCR) combined with modified superior capsule reconstruction (mSCR) using the long head of biceps tendon (LHBT) as reinforcement with a minimum of 2 years of follow-up. METHODS: We retrospectively evaluated 40 patients with large to massive reparable RCTs who underwent ARCR and mSCR (Group I) between February 2017 and June 2018 (18 patients) or underwent ARCR and tenotomy of LHBT performed at the insertion site (Group II) between January 2015 and January 2017 (22 patients)...
April 14, 2021: Arthroscopy
Jens Heichel, Hans-Gert Struck, Friedrich Paulsen, Mohammad Javed Ali, Arne Viestenz
Periocular injuries during a caesarean section are extremely rare. The case report of a five hour old newborn addresses the trauma management concerning diagnostics, therapy, and post-operative care of a deep periocular soft tissue injury. The pattern of injury consisted of full thickness wounds of the medial and lateral lid margins, opening of the superior conjunctival fornix, and penetration of Tenon's capsule. The reconstruction was performed layer by layer while an autostable monocanaliculonasal lacrimal intubation was inserted...
April 6, 2021: HNO
Raffaele Garofalo, Alessandro Castagna
Surgical management of chronic acromioclavicular joint (ACJ) dislocations is a matter of controversy. In the acute setting of high-grade acromioclavicular separation, if a surgical repair of the ACJ capsule and ligaments and deltotrapezial fascia could allow biological healing of the ligaments themselves, this could be enough to restore the functional biomechanics of the joint; unfortunately, this is not true for chronic cases. In the latter situation, a surgical technique using biological augmentation such as autograft or allograft should be preferred...
April 2021: Arthroscopy
Jonathan D Hughes, Gillian Kane, Clarissa M LeVasseur, Alexandra S Gabrielli, Adam J Popchak, William J Anderst, Albert Lin
BACKGROUND: A viable treatment option for young patients with massive, irreparable rotator cuff tears is arthroscopic superior capsule reconstruction (SCR). SCR theoretically improves shoulder stability and function and decreases pain. However, no prospective studies to date have correlated magnetic resonance imaging (MRI) healing with in vivo kinematic data. The purpose of this study was to evaluate the association between graft healing and in vivo kinematics, range of motion (ROM), strength, and patient-reported outcomes (PROs)...
March 26, 2021: Journal of Shoulder and Elbow Surgery
Nobuyuki Yamamoto, Eiji Itoi
The treatment of irreparable rotator cuff tears with severe muscle atrophy and fatty infiltration remains a challenge, especially in young patients. Many surgical procedures for these tears have been reported. No one surgical treatment has proven to be an optimal solution. Recently, reconstruction of the superior capsule with an allograft or autograft has gained popularity. In this manuscript, we reviewed the biomechanical and clinical reports that have assessed superior capsular reconstruction and clarified the issues about the surgical techniques and indication which have been discussed recently...
March 27, 2021: Journal of Experimental Orthopaedics
Juha O Ranne, Severi O Salonen, Janne T Lehtinen
The purpose of this study is to introduce an arthroscopy-assisted technique to treat chronic acromioclavicular (AC) dislocation. The method involves reconstructing both the coracoclavicular (CC) and AC ligaments in a practical and reliable way using a semi-tendon graft and knot-hiding implants. In the CC reconstruction, the anterior graft limb replaces the trapezoid ligament, whereas the dorsal limb is wrapped around the dorsal edge of the clavicle to reconstruct the conoid ligament. One 5.5-mm drill hole is needed in the clavicle since the semitendinosus graft and the interconnecting supportive suture share the same drill hole...
March 2021: Arthroscopy Techniques
Bernardo Barcellos Terra, Tannous Jorge Sassine, Benno Ejnisman, Alberto de Castro Pochini, Paulo Santoro Belangero
Superior capsule reconstruction is a valuable intervention for some patients who present symptomatic irreparable posterosuperior rotator cuff tears. Superior capsule reconstruction techniques most commonly use either fascia lata autograft or dermal allograft. Both options have literature support but also present a few drawbacks such as donor site issues, potential allergic reactions, and high cost of the operation. The long head of biceps is a potential graft for rotator cuff tears and may be particularly useful in bridging the gap in irreparable massive rotator cuff tears, specifically as an alternative to more traditional superior capsular reconstruction...
March 2021: Arthroscopy Techniques
Akihiko Hasegawa, Teruhisa Mihata, Yasuo Itami, Kunimoto Fukunishi, Masashi Neo
BACKGROUND: Superior capsule reconstruction (SCR) has been developed to improve shoulder function and relieve pain in the treatment of irreparable rotator cuff tears. Previous studies have reported that graft healing can enhance favorable outcomes after SCR. On the other hand, graft tear often leads to less desirable outcomes and sometimes requires additional surgeries. However, the healing process underlying this remains unclear. In this study, we aimed to investigate histological changes occurring during the healing process associated with autologous fascia lata graft after SCR in vivo...
March 11, 2021: Journal of Shoulder and Elbow Surgery
Raffy Mirzayan, Karimdad A Otarodifard, Anshuman Singh
Superior capsule reconstruction has gained popularity as a treatment option for massive rotator cuff tears. The initial graft described was a tensor fascia lata. In the United States, acellular dermal matrix or dermal allograft has gained popularity. The results from published reports have been promising, but graft tear on postoperative imaging has been reported in several studies. Strives are being made to reduce the graft tear rate. One such way is to increase the thickness of the graft. Biomechanical studies have shown that thicker and stiffer grafts perform better in restoring superior stability...
February 2021: Arthroscopy Techniques
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