Abstract
Transosseous repair of a supraspinatus tendon (SSP) defect (Patte size II) can be difficult if the tendon is retracted and the muscle atrophied. In this situation alternatives are margin convergence techniques, local tendon transfers or distant tendon transfers in massive tears. The object of this study was to compare two local tendon transfers in terms of the feasibility of the shift, the area covered by the shift and the force needed to accomplish the shift. Thirteen fresh-frozen cadaver shoulders were used. First a supraspinatus defect extending to the apex of the humeral head (Patte size II) was created. Transosseous repair was attempted with the infraspintus (ISP) and with the subscapularis (SCP) in all cases; repair was successful in all ISP cases, while use of the SCP resulted in a successful repair in only 8 of the 13 (61.5%). A significantly (P=0.012) larger defect area was covered by the ISP transfer than by the SCP shift: 89.7±8.5% versus 31.2±31.1% of the original defect, respectively. The tensile force needed to accomplish the shift was significantly (P=0.004) lower when the ISP was used (15±11 N) than with the SCP (37.1±15 N). In this cadaver model the ISP shift proved more favourable than the SCP shift for covering a Patte size II SSP defect.
Résumé
La réinsertion transosseuse du tendon du sus épineux (SSP) (Patte II) peut être difficile si le tendon est rétracté et le muscle atrophié. Dans ces conditions il faut utiliser une chirurgie de rapprochement des bords et des transferts tendineux dans les ruptures massives. Le but de cette étude est de comparer deux techniques de transferts tendineux, en termes de faisabilité, avec étude de la surface couverte par glissement et la force nécessaire pour accomplir celui-ci. 13 épaules de cadavres ont été utilisées, une perte de substance a été créée dans le sus épineux à l’apex de la tête humérale (Patte II). Une réparation transosseuse a été réalisée avec le tendon du sous épineux du sous scapulaire. La réparation a été possible dans tous les cas avec utilisation du sous épineux mais, seulement dans 8 cas sur 13 lorsqu’on a utilisé le sous scapulaire (61,5%). Un defect beaucoup plus large, peut être couvert par un lambeau du sous épineux plutôt que par un lambeau du sous scapulaire (89,7±8,5% versus 31,2±31,1%) du défect. La force nécessaire pour accomplir cette translation est significativement plus basse avec le sous épineux qu’avec le sous scapulaire (15±11 N versus 37,1±15 N). Un lambeau de rapprochement sous épineux semble plus favorable qu’un glissement sous scapulaire pour couvrir les pertes de substances Patte type II du sus épineux.
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Kasten, P., Loew, M. & Rickert, M. Repair of large supraspinatus rotator-cuff defects by infraspinatus and subscapularis tendon transfers in a cadaver model. International Orthopaedics (SICO 31, 11–15 (2007). https://doi.org/10.1007/s00264-006-0142-7
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DOI: https://doi.org/10.1007/s00264-006-0142-7