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- Title
Biomechanical Comparison Between Superior Capsular Reconstruction and Lower Trapezius Tendon Transfer in Irreparable Posterosuperior Rotator Cuff Tears.
- Authors
Baek, Gyuna; Kim, Jung Gon; Baek, Gyu Rim; Hui, Aaron T.; McGarry, Michelle H.; Baek, Chang Hee; Lee, Thay Q.
- Abstract
Background: Superior capsular reconstruction (SCR) and lower trapezius tendon transfer (LTT) have recently been used to manage irreparable posterosuperior rotator cuff tears (PSRCTs). There has been a paucity of comparative biomechanical considerations between the 2 procedures. Purpose: To compare the glenohumeral stability and biomechanical properties between SCR and LTT in PSRCTs involving the entire infraspinatus tendon region. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric shoulders were tested at 0°, 20°, and 40° of shoulder abduction. Maximum internal, external, and total humeral range of motion (ROM), superior translation of the humeral head, and subacromial contact characteristics were compared among 4 conditions: (1) intact rotator cuff, (2) PSRCTs involving the entire infraspinatus tendon region, (3) LTT using Achilles allograft (12 N and 24 N of loading), and (4) SCR using fascia lata allograft. Results: Although a decrease in total ROM was noted in LTT with 12 N compared with the tear condition, LTT with both 12 N and 24 N as well as SCR did not restrict total rotational ROM compared with the intact condition. LTT had decreased total ROM compared with tear condition at 20° of abduction (P =.042), while no significant decrease was confirmed at all abduction angles after SCR. SCR and LTT with 24 N decreased superior translation compared with the PSRCT condition at 0° and 20° of abduction (P <.037) but not significantly at 40° of abduction, whereas LTT with a 24-N load decreased glenohumeral superior translation at all abduction angles (P <.039). Both SCR and LTT decreased subacromial contact pressure compared with the tear condition (P <.014) at all abduction angles. SCR decreased subacromial contact pressure at 0° and 40° of abduction (P =.019 and P =.048, respectively) compared with LTT with 12 N of loading, while there was no difference between SCR and LTT with 24 N of loading in all abduction angles. SCR increased the contact area compared with the PSRCT condition at all abduction angles (P <.023), whereas LTT did not increase the contact area. Conclusion: SCR and LTT decreased glenohumeral superior translation and contact pressure compared with PSRCT conditions. The LTT was superior to SCR in terms of superior translation of the humeral head at a higher shoulder abduction angle, whereas the SCR showed more advantageous subacromial contact characteristics compared with LTT. Clinical Relevance: These biomechanical findings provide insights into these 2 fundamentally different procedures for the treatment of young and active patients with PSRCTs involving the entire infraspinatus tendon region.
- Subjects
GLENOHUMERAL joint physiology; TRAPEZIUS muscle physiology; TENDON surgery; BIOMECHANICS; LATISSIMUS dorsi (Muscles); JOINT capsule; HUMAN anatomical models; MEASUREMENT of angles (Geometry); RESEARCH funding; MEDICAL cadavers; PECTORALIS muscle; MULTIPLE regression analysis; DESCRIPTIVE statistics; HOMOGRAFTS; ROTATOR cuff injuries; PLASTIC surgery; COMPARATIVE studies; DATA analysis software; SUPRASPINATUS muscles; RANGE of motion of joints; DELTOID muscles
- Publication
American Journal of Sports Medicine, 2024, Vol 52, Issue 6, p1419
- ISSN
0363-5465
- Publication type
Article
- DOI
10.1177/03635465241235544