A combination of subescapularis tendon transfer and small-head hemi for cuff tear atrhopaty

Carta al Dr Fukanoshi per concretar el seu tractment de les CTA publicat el agost del 2015 al journal of bone ( Britanic)

Dear Professor T. Funakoshi,

My name is Jordi Huguet and I am currently the Chef of the Shoulder and Elbow Surgery Unit of the Hospital Universitari Parc Taulí from Sabadell (Barcelona).

I am writting to you because I have recently read your paper A combination of subescapularis tendon transfer and small-head hemi for cuff tear atrhopaty from the Bone & Joint Journal, and I found it really interesting. Thereby, I would like to ask you some questions about the treatement methodology exposed.Please find attached a powerpoint presentation I have prepared with my specific questions.

1.     Do you control the radius of curvature of the prosthetic head in order to be paralel at glena curvature? Or isn´t necessary?The most important thing for select the small head is to consider the volume of humeral head. We prefer to use thinner head and one small diameter. Less volume provides to easy to repair cuff and transfer tendon.

2.     Do you also resect the greather tuberosity?Yes, we always do. We have to take care of impingment when smaller head was used. And also take care too much resection.Too much resection, insufficient bone for repair or transfer tendon.
3.     Which is your solution..Excentric head, Control of the stem’s deep with a bone graft, Osteotomy of great tuberosity, All?
All is my answer. We are not able to select excentric because of small physique in Japanese.
We always graft autologous tip and artificial bone to the medial canal for control deep and varus implantation.

4.     Which is the percentage (%) of the subscapularis tendon that you use in a transfer?
upper 2/3 or 1/2.
5.     Do you always close the rotator cuff with the suture?
If possible, we always suture. However, it depends on the patient. Sometimes not enough.

Es interessant com a mètode de tractament de la CTA.