Purpose
To compare the biomechanical effectiveness of human dermal allograft (HDA) anterior
capsular reconstruction (ACR) and pectoralis major tendon transfer (PMTT) for treating
irreparable subscapularis tears with capsular insufficiency in human cadaver shoulders.
Methods
Glenohumeral rotational range of motion and translation were measured in 6 cadaveric
shoulders under the following 5 conditions: intact, deficient subscapularis/anterior
capsule, ACR using HDA, HDA ACR with concomitant PMTT, and PMTT alone.
Results
The deficient subscapularis/anterior capsule condition significantly increased external
and total rotational range of motion at 0° (P < .001, P < .001) and 30° (P = .005, P = .002) abduction as well as anterior-inferior translation (P ≤ .001 to .03). HDA ACR, both with and without PMTT, restored anterior-inferior stability
to that of the intact condition; however, PMTT alone did not restore anterior-inferior
translation or rotational range of motion.
Conclusions
HDA ACR for treating irreparable subscapularis tears with capsular insufficiency restored
anterior-inferior glenohumeral translation and rotational range of motion at time
0 in human cadaver shoulders.
Clinical Relevance
Anterior capsule reconstruction may be a viable option for treating massive irreparable
subscapularis tears with capsular insufficiency.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Open reconstruction of the anterior glenohumeral capsulolabral structures with tendon allograft in chronic shoulder instability.Oper Orthop Traumatol. 2011; 23: 29-36
- Complications of thermal capsulorrhaphy of the shoulder: Management of the capsular deficiency.Tech Shoulder Elb Surg. 2007; 8: 111-116
- Revision instability surgery after failed thermal capsulorraphy.Oper Tech Orthop. 2003; 13: 260-268
- Feasibility of latissimus and teres major transfer to reconstruct irreparable subscapularis tendon tear: An anatomic study.J Shoulder Elbow Surg. 2014; 23: 492-499
- Pectoralis major tendon transfer for irreparable subscapularis tears.J Shoulder Elbow Surg. 2014; 23: 909-918
- Revision anterior capsular shoulder stabilization using hamstring tendon autograft and tibialis tendon allograft reinforcement: Minimum two-year follow-up.J Shoulder Elbow Surg. 2007; 16: 268-272
- Open anterior capsular reconstruction of the shoulder for chronic instability using a tibialis anterior allograft.Tech Shoulder Elb Surg. 2008; 9: 102-107
- Decellularized human dermis to treat massive rotator cuff tears: In vitro evaluations.Connect Tissue Res. 2012; 53: 298-306
- Outcome of pectoralis major transfer for the treatment of irreparable subscapularis tears.J Bone Joint Surg Am. 2003; 85: 1944-1951
- Long-term outcome after pectoralis major transfer for irreparable anterosuperior rotator cuff tears.J Bone Joint Surg Am. 2017; 99: 239-245
- Transfer of pectoralis major for the treatment of irreparable tears of subscapularis: Does it work?.J Bone Joint Surg Br. 2008; 90: 1059-1065
- Transfer of segmentally split pectoralis major for the treatment of irreparable rupture of the subscapularis tendon.J Shoulder Elbow Surg. 2007; 16: 837-842
- Pectoralis major transfer for treatment of irreparable subscapularis tear: A systematic review.Knee Surg Sports Traumatol Arthrosc. 2016; 24: 1951-1960
- Anterior capsular reconstruction for irreparable subscapularis tears.Arthrosc Tech. 2017; 6: e951-e958
- Superior capsule reconstruction to restore superior stability in irreparable rotator cuff tears: A biomechanical cadaveric study.Am J Sports Med. 2012; 40: 2248-2255
- Biomechanics of shoulder capsulorrhaphy procedures.J Shoulder Elbow Surg. 2005; 14: 12S-18S
- Anatomic evaluation of the subcoracoid pectoralis major transfer in human cadavers.J Shoulder Elbow Surg. 2001; 10: 453-459
- Pectoralis major tendon transfers above or underneath the conjoint tendon in subscapularis-deficient shoulders: An in vitro biomechanical analysis.J Bone Jt Surg Ser A. 2007; 89: 2477-2484
- Magnetic resonance imaging-controlled results of the pectoralis major tendon transfer for irreparable anterosuperior rotator cuff tears performed with standard and modified fixation techniques.J Shoulder Elbow Surg. 2011; 20: 1155-1162
- Inertia and muscle contraction parameters for musculoskeletal modelling of the shoulder mechanism.J Biomech. 1991; 24: 615-629
- Biomechanical role of capsular continuity in superior capsule reconstruction for irreparable tears of the supraspinatus tendon.Am J Sports Med. 2016; 44: 1423-1430
- Anterior capsulolabral lesions combined with supraspinatus tendon tears: Biomechanical effects of the pathologic condition and repair in human cadaveric shoulders.Arthroscopy. 2013; 29: 1492-1497
- Specimen-specific method for quantifying glenohumeral joint kinematics.Ann Biomed Eng. 2010; 38: 3226-3236
- Preliminary results of arthroscopic superior capsule reconstruction with dermal allograft.Arthroscopy. 2018; 34: 93-99
- Histologic evaluation of a biopsy specimen obtained 3 months after rotator cuff augmentation with GraftJacket matrix.Arthroscopy. 2009; 25: 329-333
Article info
Publication history
Published online: October 16, 2019
Accepted:
May 23,
2019
Received:
May 21,
2018
Footnotes
The authors report the following potential conflicts of interest or sources of funding: T.Q.L. reports board membership and grants from Arthrex, and partial funding by Congress Medical Foundation, VA Rehabilitation Research and Development Merit Review, and the John C. Griswold Foundation. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
See commentary on page 3009
Identification
Copyright
© 2019 Published by Elsevier on behalf of the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Anterior Capsular Reconstruction for Subscapularis Deficiency: The Definitive Treatment or a Helpful Adjunct?ArthroscopyVol. 35Issue 11
- PreviewAnterior glenohumeral instability in the setting of irreparable subscapularis deficiency represents a difficult clinical scenario for the treating shoulder surgeon. Anterior capsular reconstruction with humeral dermal allograft improved glenohumeral translation stability and range of motion to near-normal values whereas pectoralis major tendon transfer was unable to do so. However, placement of a static spacer does not restore the dynamic force couple or shoulder kinematics. Further research is needed to evaluate the functional outcomes using this reconstruction technique.
- Full-Text
- Preview
