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![Page 1: Reconstruction of Massive Rotator Cuff Tear Using Embroidered Polyester Cuff Reinforcement Nottingham Shoulder and Elbow Unit I-H Jeon, WA Wallace, L Neumann,](https://reader035.fdocuments.us/reader035/viewer/2022062322/56649f285503460f94c4034c/html5/thumbnails/1.jpg)
Reconstruction of Massive Rotator Cuff Tear Using Embroidered Polyester Cuff Reinforcement
Nottingham Shoulder and Elbow UnitNottingham Shoulder and Elbow Unit
I-H Jeon, WI-H Jeon, WAA Wallace, L Neumann, Wallace, L Neumann,
J Ellis, A McLeodJ Ellis, A McLeod
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Introduction
Treatment of rotator cuff tear has been Treatment of rotator cuff tear has been
evolved. However, there are no definite evolved. However, there are no definite
solution for massive rotator cuff tear.solution for massive rotator cuff tear.
Conservative treatmentConservative treatment
DebridementDebridement
Muscle transferMuscle transfer
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Introduction
Modes of failure in bone tunnel methodModes of failure in bone tunnel method
suture migration through bonesuture migration through bone Modes of failure in Modes of failure in
Mode of failure in suture anchor techniqueMode of failure in suture anchor technique
Loosening and backing out of anchor screws Loosening and backing out of anchor screws
(different behaviour of (different behaviour of humeral anchors humeral anchors thanthan glenoid glenoid
anchorsanchors) )
Augmentation deviceAugmentation device
Treatment of rotator cuff tear has been Treatment of rotator cuff tear has been
evolved. However, there are no definite evolved. However, there are no definite
solution for massive rotator cuff tear.solution for massive rotator cuff tear.
Conservative treatmentConservative treatment
DebridementDebridement
Muscle transferMuscle transfer
![Page 4: Reconstruction of Massive Rotator Cuff Tear Using Embroidered Polyester Cuff Reinforcement Nottingham Shoulder and Elbow Unit I-H Jeon, WA Wallace, L Neumann,](https://reader035.fdocuments.us/reader035/viewer/2022062322/56649f285503460f94c4034c/html5/thumbnails/4.jpg)
Introduction
Augmentation deviceAugmentation device
Gerber C, Schneeberger AG, Perren SM, Nyffeler RW.Experimental rotator cuff repair. A preliminary study.J Bone Joint Surg Am. 1999 Sep;81(9):1281-90.
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Introduction
Polyester has been proposed for ligament Polyester has been proposed for ligament
augmentation device and substitute in the augmentation device and substitute in the
knee.Literature demonstrated thatknee.Literature demonstrated that
Scaffold for soft tissue ingrowthScaffold for soft tissue ingrowth
Mechanical support: Mechanical support: appropriate initial strength appropriate initial strength
to meet the biomechanical demands of the injured to meet the biomechanical demands of the injured
area, area,
Less foreign body reactionLess foreign body reaction
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Introduction
The purpose of this study was to
evaluate the application of
Polyester Embroidery
Reinforcement (Nottingham
augmentation device) and
investigate the outcome in massive
full thickness RCTs previously
considered irreparable using this
method.
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Materials and Methods
Patients were added to the study if they had clinical Patients were added to the study if they had clinical
weakness and pain and if magnetic resonance weakness and pain and if magnetic resonance
imaging confirmed a imaging confirmed a massive massive rotator cuff tear. rotator cuff tear.
2222 patients ( patients (1313 men men/ 9 women/ 9 women) )
13 patients followed up > 10 months13 patients followed up > 10 months
MeanMean age of age of 6060 years (range 4 years (range 466-78) -78)
Patients with combined glenohumeral Patients with combined glenohumeral
arthritis have been excluded.arthritis have been excluded.
F.UF.U 1010--2323 months (mean months (mean 1212 months). months).
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DDuration of symptoms uration of symptoms : : 19 (4-36) months. 19 (4-36) months.
Pre-op symptoms were moderate to severe Pre-op symptoms were moderate to severe
shoulder pain on lifting and shoulder shoulder pain on lifting and shoulder
weakness. weakness.
Materials and Methods
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Pre-op MRI scans in 8 cases revealed FT large Pre-op MRI scans in 8 cases revealed FT large
or massive tears of the RC with Goutallier or massive tears of the RC with Goutallier
grade III-IV fatty degeneration. grade III-IV fatty degeneration.
Materials and Methods
**
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Operative Technique
1
2
Identify the retracted distal stump and release adhesion
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Operative Technique
3
4
Insertion involves anchoring the device to the undersurface of the retracted RC tendon with 10-12 stitches
Make a bone tunnel under the G.T.
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Operative Technique
5
6
PPass the other end of the device ass the other end of the device through a tunnel under the through a tunnel under the greater tuberositygreater tuberosity
AAnchoring the device, under nchoring the device, under tension, to the proximal humerus tension, to the proximal humerus with 1 or 2 large AO screwswith 1 or 2 large AO screws
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Operative Technique
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The proximal fixation is The proximal fixation is similar to “spot-welding” similar to “spot-welding” The The distal fixation is a distal fixation is a “flexible plate” type of “flexible plate” type of fixation. fixation.
Operative Technique
The device is made of polyester, The device is made of polyester, embroidered for good tissue embroidered for good tissue ingrowth ingrowth and provides good initial and provides good initial mechanical strength, mechanical strength, thus fixing the thus fixing the cuff to the headcuff to the head during the healing during the healing processprocess
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Clinical Results-Constant score
Pain score
0
2
4
6
8
10
12
14
1 2 3 4 5 6 7 8 9 10 11 12 13 14No of cases
Pain
Sco
re
Pain(Pre)Pain(Post)
10.3
7.6
0
2
4
6
8
10
12
14
Preop Postop
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ADL Score
0
2
4
6
8
10
1 2 3 4 5 6 7 8 9 10 11 12 13No of cases
AD
L Sco
re
ADL (Pre)ADL(Post)
4.7
6.7
0
2
4
6
8
10
Preop Postop
Clinical Results-Constant score
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Range of motion
0
5
10
15
20
25
30
35
40
1 2 3 4 5 6 7 8 9 10 11 12 13
ROM(Pre)ROM(Post)
Clinical Results-Constant score
0
5
10
15
20
25
30
35
40
preop postop
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Power at abduction 90
0
5
10
15
20
25
1 2 3 4 5 6 7 8 9 10 11 12 13
Power(Pre)Power(Post)
Clinical Results-Constant score
Abuction Power
5.5 6.1
0
5
10
15
20
25
preop postop
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Overall Constant Score:
0
20
40
60
80
100
1 2 3 4 5 6 7 8 9 10 11 12 13
PreCSPostCS
Clinical Results-Constant score
59 59
44.2
61
0
10
20
30
40
50
60
70
80
preop postop
AA
A*A*
N-AN-A
N-A*N-A*
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TenTen reported a marked improvement in the reported a marked improvement in the
early post-operative period. early post-operative period.
Results
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Radiographic Results
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Case-1
F/69 Postop 12 moCS: 3578
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Case-1
Preop Preop
Elevation 90Elevation 90ER 50ER 50Constant score:Constant score:87/34 (R/L)87/34 (R/L)
PostopPostop
Elevation 180Elevation 180ER 90ER 90Constant score:Constant score:90/67 (R/L)90/67 (R/L)
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Case- 3
CS 64 CS 64 25256161
M/62 postop 6mo
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Case-2
Postop 4 mo F/46 Preop
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Case-2
Postop 4 mo CS:38/85
Severe fatty degeneration at supra+infra
Re-rupture of tendon at 10 months postop
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Re-rupture of RC: 2 Re-rupture of RC: 2
Stiff Stiff shouldershoulder: 1 (MUA+ arthro debriment) : 1 (MUA+ arthro debriment)
Deep infection: 0 (No foreign body reaction)Deep infection: 0 (No foreign body reaction)
Complications
M/46 re-rupture of supraspinatus at 12 monthsM/46 re-rupture of supraspinatus at 12 months
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Biomechanical property of Biomechanical property of
Nottingham Augmentation Device (in vitro)Nottingham Augmentation Device (in vitro)
Discussion
Fatigue test in saline Fatigue test in saline at 200 and 300N, maximum elongation of 0.38mm. at 200 and 300N, maximum elongation of 0.38mm.
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Reaction of Polyester
Discussion
Polyester fibres
Fibrin
Fascia-likeCollagen
HPF: Patient 4 (at 14 years)
P Durani, I-H Jeon, TA McCulloch, A McLeod, WA Wallace The Histological In-growth of soft tissue into the Nottingham hood prosthesis, British Orthop Research Society 2003
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Treatment of massive RC tears is Treatment of massive RC tears is
still controversial.still controversial.
This polyester augmentation device This polyester augmentation device
provides initial mechanical strength, provides initial mechanical strength,
prevent tendon stripping, &prevent tendon stripping, &
provides scaffold for soft tissue ingrowth with provides scaffold for soft tissue ingrowth with
less foreign body reaction.less foreign body reaction.
Conclusion
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Biomechanical study of polyester Biomechanical study of polyester
augmentation deviceaugmentation device
What happens to tendon-device interfaceWhat happens to tendon-device interface
How to adjust proper tensionHow to adjust proper tension
Future Study
Randomized comparative Randomized comparative
study between repair and study between repair and
debridementdebridement
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Thank YouThank You