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

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

doi:10.1016/j.jse.2021.04.002

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

J Shoulder Elbow Surg. 2021 Jul;30(7S):S38-S47. doi: 10.1016/j.jse.2021.04.002. Epub 2021 Apr 21.

Authors

Daniel P Berthold¹, Ryan Bell², Lukas N Muench¹, Andrew E Jimenez², Mark P Cote², Elifho Obopilwe², Cory M Edgar³

Affiliations

¹ Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA; Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.
² Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA.
³ Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA. Electronic address: cedgar@uchc.edu.

PMID: 33892119
DOI: 10.1016/j.jse.2021.04.002

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.

Keywords: Superior capsular reconstruction; allograft; biomechanics; posterosuperior rotator cuff tears; rotator cuff.

MeSH terms

Allografts
Biomechanical Phenomena
Cadaver
Humans
Range of Motion, Articular
Rotator Cuff / surgery
Rotator Cuff Injuries* / surgery
Shoulder Joint*