Use of Gracile and semi-tendinosus tendons (GRAST) for the reconstruction of irreparable rotator cuff tears

Autor: Marc Soubeyrand, Maxime Laurent-Perrot, Alain Sautet, Mickaël Artuso, M. Christian Moody, Marie Protais
Přispěvatelé: Service de Chirurgie Orthopédique et Traumatologie [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Jazyk: angličtina
Rok vydání: 2021
Předmět:
musculoskeletal diseases
medicine.medical_specialty
lcsh:Diseases of the musculoskeletal system
[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery
Rotator Cuff Injuries
Tendons
03 medical and health sciences
Arthroscopy
Rotator Cuff
0302 clinical medicine
Rheumatology
Scapula
Irreparable rotator cuff tear
Gracilis
medicine
Humans
Orthopedics and Sports Medicine
Rotator cuff
Fixation (histology)
Aged
030222 orthopedics
medicine.diagnostic_test
business.industry
Shoulder Joint
Semitendinosus
030229 sport sciences
musculoskeletal system
Tendon
Surgery
Biomechanical Phenomena
medicine.anatomical_structure
[SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system
Technical Advance
Cuff
lcsh:RC925-935
Cadaveric spasm
business
Greater Tuberosity
Zdroj: BMC Musculoskeletal Disorders
BMC Musculoskeletal Disorders, BioMed Central, 2021, 22, pp.331. ⟨10.1186/s12891-021-04197-6⟩
BMC Musculoskeletal Disorders, Vol 22, Iss 1, Pp 1-8 (2021)
ISSN: 1471-2474
DOI: 10.1186/s12891-021-04197-6⟩
Popis: Background Irreparable rotator cuff tears are common and difficult to treat. Techniques for “filling the loss of substance” require fixation to the rotator cuff stump (tendon augmentation) or to the glenoid (superior capsular reconstruction), which are complicated by the narrow working zone of the subacromial space. The main objective of this study was to determine whether a braided graft of gracilis (GR) and semitendinosus (ST) could fill a loss of tendon substance from an irreparable rupture of the supra- and infraspinatus, by fixing the graft to the greater tuberosity and the spine of the scapula. Methods This was a cadaveric study with the use of ten specimens. The GRA and ST tendons were harvested, braided and reinforced with suture. An experimental tear of the supraspinatus (SS) and upper infraspinatus (IS) retracted at the glenoid was made. The GRAST transplant was positioned over the tear. The transplant was attached to the greater tuberosity by two anchors and then attached to the medial third of the scapular spine by trans-osseous stitching. The percentage of filling obtained was then measured and passive mobility of the shoulder was assessed. We proceeded to the same technique under arthroscopy for a 73 years old patient whom we treated for a painful shoulder with irreparable cuff tear. We inserted a GRAST graft using arthroscopy. Results The Braided-GRAST allowed a 100% filling of the loss of tendon substance. Mobility was complete in all cases. Conclusion This technique simplifies the medial fixation and restores the musculo-tendinous chain where current grafting techniques only fill a tendinous defect. The transplant could have a subacromial “spacer” effect and lower the humeral head. The donor site morbidity and the fate of the transplant in-vivo are two limits to be discussed. This anatomical study paves the way for clinical experimentation.
Databáze: OpenAIRE
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