Superior Capsule Reconstruction With a 3 mm–Thick Dermal Allograft Partially Restores Glenohumeral Stability in Massive Posterosuperior Rotator Cuff Deficiency: A Dynamic Robotic Shoulder Model - Matthew Provencher, MD | Orthopedic Knee & Shoulder Surgeon

Authors:

Lucca Lacheta, MD, Alex Brady, MSc, Samuel I. Rosenberg, BA, Travis J. Dekker, MD, Ritesh Kashyap, MSc, Payam Zandiyeh, PhD, Grant J. Dornan, MS, Matthew T. Provencher, MD, CAPT, MC, USNR, Peter J. Millett, MD, MSc

Abstract:

Background:

Superior capsule reconstruction (SCR) has been shown to improve shoulder function and reduce pain in patients with isolated irreparable supraspinatus tendon tears. However, the effects of SCR on biomechanics in a shoulder with an extensive posterosuperior rotator cuff tear pattern remain unknown.

Purpose/Hypothesis:

The purpose was to (1) establish a dynamic robotic shoulder model, (2) assess the influence of rotator cuff tear patterns, and (3) assess the effects of SCR on superior humeral head translation after a posterosuperior rotator cuff tear. It was hypothesized that a posterosuperior rotator cuff tear would increase superior humeral head translation when compared with the intact and supraspinatus tendon–deficient state and that SCR would reduce superior humeral head translation in shoulders with massive rotator cuff tears involving the supraspinatus and infraspinatus tendons.

Study Design:

Controlled laboratory study.

Methods:

Twelve fresh-frozen cadaveric shoulders were tested using a robotic arm. Kinematic testing was performed in 4 conditions: (1) intact, (2) simulated irreparable supraspinatus tendon tear, (3) simulated irreparable supra- and infraspinatus tendon tear, and (4) SCR using a 3 mm–thick dermal allograft (DA). Kinematic testing consisted of static 40-N superior force tests at 0°, 30°, 60°, and 90° of abduction and dynamic flexion, abduction, and scaption motions. In each test, the superior translation of the humeral head was reported.

Results:

In static testing, SCR significantly reduced humeral superior translation compared with rotator cuff tear at all abduction angles. SCR restored the superior stability back to native at 60° and 90° of abduction, but the humeral head remained significantly and superiorly translated at neutral position and at 30° of abduction. The results of dynamic testing showed a significantly increased superior translation in the injured state at lower elevation angles, which diminished at higher elevation, becoming nonsignificant at elevation >75°. SCR reduced the magnitude of superior translation across all elevation angles, but translation remained significantly different from the intact state up to 60° of elevation.

Conclusion:

Massive posterosuperior rotator cuff tears increased superior glenohumeral translation when compared with the intact and supraspinatus tendon–insufficient rotator cuff states. SCR using a 3-mm DA partially restored the superior stability of the glenohumeral joint even in the presence of a simulated massive posterosuperior rotator cuff tear in a static and dynamic robotic shoulder model.

Clinical Relevance:

The biomechanical performance concerning glenohumeral stability after SCR in shoulders with large posterosuperior rotator cuff tears is unclear and may affect clinical outcomes in daily practice.

To request access to the study from AOSSM, click the link below:

Superior Capsule Reconstruction With a 3 mm–Thick Dermal Allograft Partially Restores Glenohumeral Stability in Massive Posterosuperior Rotator Cuff Deficiency: A Dynamic Robotic Shoulder Model

Matthew Provencher, MD

Average rating:

64 reviews

Gene reiling

Jul 21, 2023

by Gene reiling on Matthew Provencher, MD

Success

If you are planning to see Dr Provencher ,do not hesitate ,do it. In 2018 Dr Provencher replaced my LCL. I had no complications and very little pain. I did my physical therapy as prescribed. I was able to ski 30 plus days the winter of 2019-2020. Before seeing dr Provencher I had spent a years time trying to solve my problem locally. I saw a pain specialist, orthopedic urgent care and a orthopedic surgeon. All had access to an mri done locally. It was also read by local radiologist. Pain dr gave injections as did orthopedic urgent care. No relief from pain. Orthopedic surgeon told me about arthritis, meniscus needing cleaning up and general deterioration from age. Told me to take ibuprofen for pain. At that time I reached out to Steadman Clinic. By luck of the draw I was assigned Dr Provencher. I took with me the mri that had been done locally and viewed by 3 local Drs and 1 PA. It took Dr Provencher less than a minute to tell me my problem was my LCL after viewing my mri. He told me my options . I selected surgery as I wanted to continue an active life style. It was a complete success!!

THEODORE Wirecki

by THEODORE Wirecki on Matthew Provencher, MD

My reverse shoulder replacement

I had my reverse shoulder replacement with Dr.Provencher four months ago. Took an hour, home an hour later. No pain with the meds cocktail, ice machine, and lidocaine pump. My recovery was incredible quick and effortless, no pain and good range of motion. Dr.Provencher is really the best surgeon, and a genuine and kind human being. If you are able to have Dr. Provencher do your shoulder you would be a fool to go anywhere else. The Steadman Clinic is state of the art, extremely efficient, using tranexamic acid intravenously right before surgery to minimize bleeding and many other sophisticated strategies not available in community hospitals. The process and the outcome way exceeded my expectations. If you would like more detail about the experience email me or call on my cell, 3036182303.
Ted Wirecki MD

Alvin Hrubes

Feb 1, 2023

by Alvin Hrubes on Matthew Provencher, MD

My shoulder was ruined in a car accident. I am 82 years old and Dr. Provencher did more than I had ever hoped for. He did a reverse shoulder and at 2 weeks the range of motion exceeded what I had before replacement. He is my hero! Thank you, Dr. Provencher!!

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