SAN FRANCISCO —
Arthroscopic superior capsule reconstruction can restore
shoulder stability and function in patients with irreparable
rotator cuff tears, according to a presentation at the 2011
Annual Meeting of the Arthroscopy Association of North America.
“For the irreparable rotator cuff tear, we have
developed a new surgical treatment of superior capsule reconstruction in which
the grafts are attached medially to the superior glenoid and laterally to the
greater tuberosity,” Teruhisa Mihata, MD, PhD, said.
The new procedure
Mihata and his group examined 22 consecutive patients
with irreparable supraspinatus and infraspinatus tears from 2007 to 2009, and
prospectively enrolled them in the study. Patients experienced a 20-month
duration of symptoms prior to surgery and had an average follow-up of 33
months.
Surgeons performed arthroscopic superior capsular
reconstruction using fascia lata on each patient and used suture anchors to
attach the graft medially to the superior tubercle of the glenoid, and
laterally to the greater tuberosity. In nine patients, surgeons
arthroscopically repaired a torn subscapularis tendon. Side-to-side sutures
were also added between the graft and the infraspinatus tendon, as well as
between the graft and the subscapularis tendon to help improve shoulder joint
coupling, Mihata said.
Radiographs and MRIs were taken, and physical
examinations were performed preoperatively and postoperatively at 3 months, 6
months, 12 months and 24 months.
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During the superior capsule reconstruction, the
graft is attached medially to the superior tubercle of the glenoid and
laterally to the greater tuberosity (left). Coronal MRI scans are shown
preoperatively (center) and 1 year after arthroscopic superior capsule
reconstruction (right).
Images: Mihata T |
Satisfactory results
Mihata and colleagues found a significant increase in
patients’ mean active flexion, as well as improvements in abduction and
external rotation.
“Muscle strength of the abduction, external
rotation and internal rotation all improved after surgery,” he added.
“There were no surgical complications … in this series.”
Patients with positive preoperative subacromial
impingement tests had negative findings upon postoperative examination.
Furthermore, acromiohumeral distances were found to increase between
preoperative and postoperative values.
Mihata’s team also found that none of the patients
demonstrated any progression of osteoarthritis or tears of grafted fascia lata
by the final follow-up. He noted preoperative fatty degeneration in the
supraspinatus muscle did not change following the operation. Patients also
experienced an improvement in night pain, with symptoms being relieved in 21
patients within 1 week of the surgery. Eight patients who were manual workers
ultimately returned to their jobs.
“In patients with irreparable rotator cuff tears,
superior capsule reconstruction restores the superior stability of the humeral
head, resulting in substantial improvements in shoulder function, strength and
pain relief with few complications,” Mihata concluded. “[It] is an
effective option as an alternative treatment for rotator cuff tears.”
— by Robert Press
Reference:
- Mihata T, Watanabe C, Fukunishi K, Ohue M. Arthroscopic superior
capsule reconstruction restores shoulder stability and function in patients
with irreparable rotator cuff tears: A prospective study. Paper #SS-15.
Presented at the 2011 Annual Meeting of the Arthroscopy Association of North
America. April 14-16. San Francisco.
- Teruhisa Mihata, MD, PhD, can be reached at the Department of
Orthopedic Surgery, Osaka Medical College, 2-7, Daigaku-machi, Takatsuki,
Osaka, 569-8686, Japan; email: tmihata@yahoo.co.jp or
tmihata@poh.osaka-med.ac.jp.
- Disclosure: Mihata has no relevant financial
disclosures.