Early effectiveness of arthroscopic superior fulcrum reconstruction in treatment of irreparable massive rotator cuff tear_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Hongyan , FANG Run ,  NING Rende

Department of Orthopedics, the Third Affiliated Hospital of Anhui Medical University (the First People’s Hospital of Hefei), Hefei Anhui, 230001, P. R. China;

Corresponding author：

NING Rende, Email: nrd1972@outlook.com

Keywords：

Irreparable massive rotator cuff tear; arthroscopy; superior fulcrum reconstruction

DOI：

10.7507/1002-1892.202307070

Video：

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Objective To investigate early effectiveness of arthroscopic superior fulcrum reconstruction in the treatment of irreparable massive rotator cuff tear (IMRCT). Methods A retrospective analysis was conducted on the clinical data of 24 patients with IMRCT who met the inclusion criteria between January 2020 and April 2022. Among them, there were 11 males and 13 females with an average age of 56.2 years (range, 42-68 years). There were 12 cases of falling injuries, 3 cases of traction injuries, and the other 9 cases had no obvious causes. The disease duration ranged from 1 to 25 months (median, 6 months). The rotator cuff tears were classified as Hamada grade 2 in 18 cases and grade 3 in 6 cases, and Goutallier grade 1 in 3 cases, grade 2 in 20 cases, and grade 3 in 1 case. All patients were treated with arthroscopic superior fulcrum reconstruction. Visual analogue scale (VAS) score, Constant-Murley score, the University of California at Los Angeles (UCLA) score, and the American Shoulder and Elbow Surgeons (ASES) score were recorded before operation and at 1, 3, 6, and 12 months after operation. Results The operations were all successfully completed. The incisions healed by first intention and no related complications occurred. All patients were followed up 12-33 months (mean, 24.6 months). The VAS, Constant-Murley, UCLA, and ASES scores at different time points after operation were superior to those before operation (P<0.05). All of the above indicators further improved with time. Except for no significant difference in VAS and Constant-Murley scores between 6 and 12 months (P>0.05), the differences between the other time points were significant (P<0.05). At 12 months after operation, according to UCLA scoring standard, shoulder joint function was rated as excellent in 4 cases, good in 19 cases, and poor in 1 case, with an excellent and good rate of 96.0%. MRI showed that there was no graft re-tear and the transplanted tendon and bone tunnel healed. Conclusion The arthroscopic superior fulcrum reconstruction for IMRCT can effectively relieve the pain, improve the shoulder range of motion, and restore good shoulder function.

Citation： LI Hongyan, FANG Run, NING Rende. Early effectiveness of arthroscopic superior fulcrum reconstruction in treatment of irreparable massive rotator cuff tear. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(12): 1453-1458. doi: 10.7507/1002-1892.202307070 Copy

1.	Zumstein MA, Jost B, Hempel J, et al. The clinical and structural long-term results of open repair of massive tears of the rotator cuff. J Bone Joint Surg (Am), 2008, 90(11): 2423-2431.
2.	Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg (Am), 2000, 82(4): 505-515.
3.	Dey Hazra ME, Dey Hazra RO, Hanson JA, et al. Treatment options for massive irreparable rotator cuff tears: a review of arthroscopic surgical options. EFORT Open Rev, 2023, 8(1): 35-44.
4.	Kucirek NK, Hung NJ, Wong SE. Treatment options for massive irreparable rotator cuff tears. Curr Rev Musculoskelet Med, 2021, 14(5): 304-315.
5.	Berth A, Neumann W, Awiszus F, et al. Massive rotator cuff tears: functional outcome after debridement or arthroscopic partial repair. J Orthop Traumatol, 2010, 11(1): 13-20.
6.	Ortiz JA. Clinical outcomes in breast reconstruction patients using a sterile acellular dermal matrix allograft. Aesthetic Plast Surg, 2017, 41(3): 542-550.
7.	Sommer MC, Wagner E, Zhu S, et al. Complications of superior capsule reconstruction for the treatment of functionally irreparable rotator cuff tears: a systematic review. Arthroscopy, 2021, 37(9): 2960-2972.
8.	Kriechling P, Zaleski M, Loucas R, et al. Complications and further surgery after reverse total shoulder arthroplasty : report of 854 primary cases. Bone Joint J, 2022, 104-B(3): 401-407.
9.	Zafra M, Carpintero P, Carrasco C. Latissimus dorsi transfer for the treatment of massive tears of the rotator cuff. Int Orthop, 2009, 33(2): 457-462.
10.	Makovicka JL, Chung AS, Patel KA, et al. Superior capsule reconstruction for irreparable rotator cuff tears: a systematic review of biomechanical and clinical outcomes by graft type. J Shoulder Elbow Surg, 2020, 29(2): 392-401.
11.	Bilsel K, Aliyev O, Altintas B, et al. Subacromial spacer implantation during arthroscopic partial repair in patients with massive irreparable rotator cuff tears provides satisfactory clinical and radiographic outcomes: a retrospective comparative study. Arthrosc Sports Med Rehabil, 2022, 4(3): e1051-e1057.
12.	Burnier M, Elhassan BT, Sanchez-Sotelo J. Surgical management of irreparable rotator cuff tears: what works, what does not, and what is coming. J Bone Joint Surg (Am), 2019, 101(17): 1603-1612.
13.	余浩, 邓晚秋, 桑鹏, 等. 关节镜下自体同侧腓骨长肌腱重建膝关节前交叉韧带. 中国修复重建外科杂志, 2020, 34(7): 843-847.
14.	Hamada K, Fukuda H, Mikasa M, et al. Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res, 1990(254): 92-96.
15.	Goutallier D, Postel JM, Gleyze P, et al. Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg, 2003, 12(6): 550-554.
16.	Tauro TM, Wagner KR, DeFroda SF, et al. Technical note: arthroscopic rotator cuff repair with patch augmentation with acellular dermal allograft. Arthrosc Tech, 2022, 11(2): e121-e125.
17.	Ishikawa H, Smith KM, Wheelwright JC, et al. Rotator cuff muscle imbalance associates with shoulder instability direction. J Shoulder Elbow Surg, 2023, 32(1): 33-40.
18.	Cartucho A. Tendon transfers for massive rotator cuff tears. EFORT Open Rev, 2022, 7(6): 404-413.
19.	Reuther KE, Thomas SJ, Tucker JJ, et al. Disruption of the anterior-posterior rotator cuff force balance alters joint function and leads to joint damage in a rat model. J Orthop Res, 2014, 32(5): 638-644.
20.	Khandare S, Arce RA, Vidt ME. Muscle compensation strategies to maintain glenohumeral joint stability with increased rotator cuff tear severity: A simulation study. J Electromyogr Kinesiol, 2022, 62: 102335.
21.	Mundakkal A, Kanakkayil MM, Nambiar R, et al. Arthroscopic subscapularis tendon repair using the lasso-loop technique through anterolateral viewing portal. Arthrosc Tech, 2022, 12(1): e83-e89.
22.	Li X, Shen P, Su W, et al. Into-tunnel repair versus onto-surface repair for rotator cuff tears in a rabbit model. Am J Sports Med, 2018, 46(7): 1711-1719.
23.	Ruiz Ibán MA, Sanchez Alepuz E, Diaz Heredia J, et al. Footprint preparation with nanofractures in a supraspinatus repair cuts in half the retear rate at 1-year follow-up. A randomized controlled trial. Knee Surg Sports Traumatol Arthrosc, 2021, 29(7): 2249-2256.
24.	刘飞, 宁仁德, 谢杰, 等. 关节镜下缝线桥修补联合手法松解治疗肩袖撕裂合并关节粘连的疗效. 局解手术学杂志, 2021, 30(4): 306-310.

1. Zumstein MA, Jost B, Hempel J, et al. The clinical and structural long-term results of open repair of massive tears of the rotator cuff. J Bone Joint Surg (Am), 2008, 90(11): 2423-2431.
2. Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg (Am), 2000, 82(4): 505-515.
3. Dey Hazra ME, Dey Hazra RO, Hanson JA, et al. Treatment options for massive irreparable rotator cuff tears: a review of arthroscopic surgical options. EFORT Open Rev, 2023, 8(1): 35-44.
4. Kucirek NK, Hung NJ, Wong SE. Treatment options for massive irreparable rotator cuff tears. Curr Rev Musculoskelet Med, 2021, 14(5): 304-315.
5. Berth A, Neumann W, Awiszus F, et al. Massive rotator cuff tears: functional outcome after debridement or arthroscopic partial repair. J Orthop Traumatol, 2010, 11(1): 13-20.
6. Ortiz JA. Clinical outcomes in breast reconstruction patients using a sterile acellular dermal matrix allograft. Aesthetic Plast Surg, 2017, 41(3): 542-550.
7. Sommer MC, Wagner E, Zhu S, et al. Complications of superior capsule reconstruction for the treatment of functionally irreparable rotator cuff tears: a systematic review. Arthroscopy, 2021, 37(9): 2960-2972.
8. Kriechling P, Zaleski M, Loucas R, et al. Complications and further surgery after reverse total shoulder arthroplasty : report of 854 primary cases. Bone Joint J, 2022, 104-B(3): 401-407.
9. Zafra M, Carpintero P, Carrasco C. Latissimus dorsi transfer for the treatment of massive tears of the rotator cuff. Int Orthop, 2009, 33(2): 457-462.
10. Makovicka JL, Chung AS, Patel KA, et al. Superior capsule reconstruction for irreparable rotator cuff tears: a systematic review of biomechanical and clinical outcomes by graft type. J Shoulder Elbow Surg, 2020, 29(2): 392-401.
11. Bilsel K, Aliyev O, Altintas B, et al. Subacromial spacer implantation during arthroscopic partial repair in patients with massive irreparable rotator cuff tears provides satisfactory clinical and radiographic outcomes: a retrospective comparative study. Arthrosc Sports Med Rehabil, 2022, 4(3): e1051-e1057.
12. Burnier M, Elhassan BT, Sanchez-Sotelo J. Surgical management of irreparable rotator cuff tears: what works, what does not, and what is coming. J Bone Joint Surg (Am), 2019, 101(17): 1603-1612.
13. 余浩, 邓晚秋, 桑鹏, 等. 关节镜下自体同侧腓骨长肌腱重建膝关节前交叉韧带. 中国修复重建外科杂志, 2020, 34(7): 843-847.
14. Hamada K, Fukuda H, Mikasa M, et al. Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res, 1990(254): 92-96.
15. Goutallier D, Postel JM, Gleyze P, et al. Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg, 2003, 12(6): 550-554.
16. Tauro TM, Wagner KR, DeFroda SF, et al. Technical note: arthroscopic rotator cuff repair with patch augmentation with acellular dermal allograft. Arthrosc Tech, 2022, 11(2): e121-e125.
17. Ishikawa H, Smith KM, Wheelwright JC, et al. Rotator cuff muscle imbalance associates with shoulder instability direction. J Shoulder Elbow Surg, 2023, 32(1): 33-40.
18. Cartucho A. Tendon transfers for massive rotator cuff tears. EFORT Open Rev, 2022, 7(6): 404-413.
19. Reuther KE, Thomas SJ, Tucker JJ, et al. Disruption of the anterior-posterior rotator cuff force balance alters joint function and leads to joint damage in a rat model. J Orthop Res, 2014, 32(5): 638-644.
20. Khandare S, Arce RA, Vidt ME. Muscle compensation strategies to maintain glenohumeral joint stability with increased rotator cuff tear severity: A simulation study. J Electromyogr Kinesiol, 2022, 62: 102335.
21. Mundakkal A, Kanakkayil MM, Nambiar R, et al. Arthroscopic subscapularis tendon repair using the lasso-loop technique through anterolateral viewing portal. Arthrosc Tech, 2022, 12(1): e83-e89.
22. Li X, Shen P, Su W, et al. Into-tunnel repair versus onto-surface repair for rotator cuff tears in a rabbit model. Am J Sports Med, 2018, 46(7): 1711-1719.
23. Ruiz Ibán MA, Sanchez Alepuz E, Diaz Heredia J, et al. Footprint preparation with nanofractures in a supraspinatus repair cuts in half the retear rate at 1-year follow-up. A randomized controlled trial. Knee Surg Sports Traumatol Arthrosc, 2021, 29(7): 2249-2256.
24. 刘飞, 宁仁德, 谢杰, 等. 关节镜下缝线桥修补联合手法松解治疗肩袖撕裂合并关节粘连的疗效. 局解手术学杂志, 2021, 30(4): 306-310.

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Early effectiveness of arthroscopic superior fulcrum reconstruction in treatment of irreparable massive rotator cuff tear

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