Superior Capsular Reconstruction for Massive Rotator Cuff Tears
A Critical Analysis Review
Galvin, Joseph W., DO1; Kenney, Raymond, MD2; Curry, Emily J., BA3; Parada, Stephen A., MD4; Eichinger, Josef K., MD5; Voloshin, Ilya, MD2; Li, Xinning, MD3
JBJS Reviews: June 04, 2019 - Volume Latest Articles - Issue - p
doi: 10.2106/JBJS.RVW.18.00072

Es actualment un tema controvertit...quan no es tenen mes recursos en ruptures massives. Com tot la indicacio es la clau.
Joves
Massiva ( 2 tendons + 5 cm)
cap signe de artropatia glenohumeral ( cal RM)
Preferible empelt de fascia lata de 8cm de 3mm de gruix.

Al meu criteri, com be diuen esta per veure que resulta mes una protesi o aixó i despres la pròtesi. En fi veurem...

A massive rotator cuff tear is defined as a tear involving >2 tendons or >5 cm of retraction.
Superior capsular reconstruction is done with either a folded fascia lata autograft (6 to 8 mm in thickness) or acellular dermal allograft (3 to 4 mm in thickness). The graft is secured arthroscopically with anchors on the superior glenoid rim and multiple anchors on the humeral head with use of a transosseous-equivalent repair technique.
Superior capsular reconstruction is indicated for younger patients with massive and irreparable rotator cuff tears involving the supraspinatus and infraspinatus with minimal arthritis, intact subscapularis, and a functional deltoid. Contraindications include bone defects, stiffness, and moderate to severe arthropathy.
Arthroscopic superior capsular reconstruction with fascia lata autograft or humeral dermal allograft is a surgical option, with multiple studies showing statistically significant improvement in short-term outcomes for both pain and function among younger patients with massive irreparable rotator cuff tears. The long-term clinical effectiveness and value have yet to be determined.
Biomechanical data suggest improved restoration of superior glenohumeral stability with decreased subacromial contact pressures in association with the use of the 8-mm fascia lata graft as compared with the 4-mm acellular humeral dermal allograft. In addition, fascia lata graft has shown less elongation and thinning than humeral dermal graft.
Either fascia lata autograft or humeral dermal allograft may be used clinically for arthroscopic superior capsular reconstruction; however, a graft thickness of at least 3 mm is recommended to decrease the risk of radiographic and clinical failure.
No comprehensive quality-of-life or cost-comparison analyses are available to compare superior capsular reconstruction, reverse total shoulder arthroplasty (rTSA), tendon transfer, and partial rotator cuff repair for the treatment of massive irreparable rotator cuff tears. However, the potential higher cost of superior capsular reconstruction and the lack of long-term clinical outcomes or revision data suggest that either an attempt at repair or primary arthroplasty may be more cost-effective than superior capsular reconstruction.
Long-term outcome data are essential to determine the role of superior capsular reconstruction for young patients with massive irreparable rotator cuff tears.
Superior capsular reconstruction using fascia lata autograft may provide a different biomechanical and biological healing environment compared to acellular dermal allograft. Thus, the clinical outcome data between the 2 graft methods should not be generalized

Reparacio RTC i atrofia

Article interessant per el resum a 2019 del tema i el recull bibliogràfic que presenta. 

Resultat i atrofia van de la ma 

.JBJS Reviews

Efficacy of Imaging Modalities Assessing Fatty Infiltration in Rotator Cuff Tears. (Troy N. Tenbrunsel, BS).  

DOI :10.2106/JBJS.RVW.18.00042
Open article PDF Download

Mes KINECT

Mes de les eines de estudi del moviment ( kinect) aplicades a la patologia de l'espatlla

Validity and Reliability of Upper Limb Functional Assessment Using the Microsoft Kinect V2 Sensor  Significance. Kinect V2 has great potential as a low-cost, easy implemented device for assessing upper limb angular waveforms when performing functional tasks. The system is suitable for assessing relative within-person change in upper limb motions over time, such as disease progression or improvement due to intervention.

Importància. Kinect V2 té un gran potencial com a dispositiu de baix cost i fàcil implementació per avaluar les formes d'ona angulars superiors en realitzar tasques funcionals. El sistema és adequat per avaluar el canvi relatiu de la persona en els moviments dels membres superiors al llarg del temps, com ara la progressió o la millora de la malaltia a causa de la intervenció.

Video interessant per explicar el tema de la guia...

https://www.djoglobal.com/products/djo-surgical/match-point-system

Rotator cuff tears after total shoulder arthroplasty in primary osteoarthritis: A systematic review

David M Levy¹, Geoffrey D Abrams², Joshua D Harris³, Bernard R Bach¹, Gregory P Nicholson¹, Anthony A Romeo¹

Aquesta revisió sistemàtica suggereix que la disfunció del manegot després de la pròtesi total d'espatlla  pot ser més comuna del que es va informar anteriorment.

Al final totes seran inverses!!

GUIES PER LA COLOCACIÓ DE LA GLENA

Totes les companyies que fan protesi van en la mateixa direcció i Materialise talla el bacalla en el tema de les guies personalitzada 3D.

  Zimmer-biomet,

 DJO ( Frankle)

 Mathys

 Wrigth

Materialise llançara Surgi Case Connect 1.0  un soft per implementar la planificacio+ impressio 3D als hospitals. 

Mes de plaquetes mes factorets per FACTURAR

ttps://doi.org/10.1016/j.jse.2018.05.003

Platelet-rich plasma in fibrin matrix to augment rotator cuff repair: a prospective, single-blinded, randomized study with 2-year follow-up

Our results showed no benefit from PRPFM used for rotator cuff repair according to the WORC Index, Simple Shoulder Test, and shoulder strength index.