Arthroscopic double Mac surgical technique for repairing massive rotator cuff tears
Main Article Content
Andres Arismendi, MD
http://orcid.org/0000-0003-2071-3422
Ana María Arcila, MD
http://orcid.org/0009-0001-1438-1524
Ana Milena Herrera, MD, PhD
http://orcid.org/0000-0002-7382-5631
http://orcid.org/0000-0003-2071-3422
Ana María Arcila, MD
http://orcid.org/0009-0001-1438-1524
Ana Milena Herrera, MD, PhD
http://orcid.org/0000-0002-7382-5631
Abstract
Background: Massive rotator cuff tears pose a challenge to shoulder surgeons. Numerous surgical management strategies have been utilized, and studies have shown varied results regarding shoulder pain, range of motion, strength, and overall function. The novel double Mac technique combines the biomechanical properties of the double-row suture and Mac stitch for the massive rotator cuff tears repair.
Aims: To describe the short and mid-term clinical and functional results of the complete repair of massive rotator cuff tears using the double Mac technique in a cohort of carefully selected patients.
Methods: Clinical records of patients operated using the double Mac technique for massive rotator cuff tears (≥ 2 tendons) from January 2018 to October 2022 were retrieved. The surgical technique is described. A prospective follow-up of patients with a minimum of six months postoperative was carried out. The Constant-Murley Shoulder Score was used to assess the function of the operated and contralateral side. Pain level was investigated using a visual analog scale, and the retearing and complications incidences. Follow-up were categorized as short (up to 34 months) and mid-term (34 to 60 months). Descriptive and bivariate statistics were used.
Results: There were 71 patients, with an average age of 61.7 years and 59.2% women. Most (66.2%) massive rotator cuff tears were degenerative, and in 80.3% compromised 4 tendons. The median follow-up was 14 months, 93% short-term. The median visual analog scale was 0. The average Constant-Murley shoulder score was 82.2, corresponding to 100.9% of the contralateral (score 82.5). There were only 3 reported complications consisting of adhesive capsulitis. No events of retearing had occurred. Most patients (91.5%) were very satisfied with the results.
Conclusion: The complete repair of massive rotator cuff tears using the double Mac arthroscopic technique yielded excellent functional results with very low or no pain at short and mid-term follow-ups. The retear rate was zero.
Keywords:
Arthroscopic double Mac surgical technique, surgical technique
Article Details
How to Cite
ARISMENDI, Andres; ARCILA, Ana María; HERRERA, Ana Milena.
Arthroscopic double Mac surgical technique for repairing massive rotator cuff tears.
Medical Research Archives, [S.l.], v. 11, n. 12, dec. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4967>. Date accessed: 15 may 2024.
doi: https://doi.org/10.18103/mra.v11i12.4967.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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2. Harryman DT, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA. Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am. 1991; 73(7):982-989.
3. Bedi A, Dines J, Warren RF, Dines DM. Massive Tears of the Rotator Cuff. Journal of Bone and Joint Surgery. 2010;92(9):1894-1908. doi:10.2106/JBJS.I.01531
4. Sheth MM, Shah AA. Massive and Irreparable Rotator Cuff Tears: A Review of Current Definitions and Concepts. Orthop J Sports Med. 2023;11(5). doi:10.1177/232596 71231154452
5. Gerber C, Fuchs B, Hodler J. The Results of Repair of Massive Tears of the Rotator Cuff*†. The Journal of Bone and Joint Surgery-American Volume. 2000; 82(4):505-515. doi: 10.2106/00004623-200004000-00006
6. DeOrio JK, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am. 1984; 66(4):563-567.
7. Schumaier A, Kovacevic D, Schmidt C, et al. Defining massive rotator cuff tears: a Delphi consensus study. J Shoulder Elbow Surg. 2020;29(4):674-680. doi:10.1016/j.jse. 2019.10.024
8. Berth A, Neumann W, Awiszus F, Pap G. Massive rotator cuff tears: functional outcome after debridement or arthroscopic partial repair. Journal of Orthopaedics and Traumatology. 2010;11(1):13-20. doi:10.1007 /s10195-010-0084-0
9. Walch G, Edwards TB, Boulahia A, Nové-Josserand L, Neyton L, Szabo I. Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: Clinical and radiographic results of 307 cases. J Shoulder Elbow Surg. 2005; 14(3):238-246. doi:10.1016 /j.jse.2004.07.008
10. Cartucho A. Tendon transfers for massive rotator cuff tears. EFORT Open Rev. 2022; 7(6):404-413. doi:10.1530/EOR-22-0023
11. Duralde XA, Bair B. Massive rotator cuff tears: The result of partial rotator cuff repair. J Shoulder Elbow Surg. 2005; 14(2):121-127. doi:10.1016/j.jse.2004.06.015
12. Bond JL, Dopirak RM, Higgins J, Burns J, Snyder SJ. Arthroscopic Replacement of Massive, Irreparable Rotator Cuff Tears Using a GraftJacket Allograft: Technique and Preliminary Results. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2008; 24(4):403.e1-403.e8. doi:10.1016/j.arthro.2007.07.033
13. de Campos Azevedo CI, Ângelo ACLPG, Vinga S. Arthroscopic Superior Capsular Reconstruction With a Minimally Invasive Harvested Fascia Lata Autograft Produces Good Clinical Results. Orthop J Sports Med. 2018; 6(11):232596711880824. doi:10.1177/ 2325967118808242
14. Rosales-Varo AP, Zafra M, García-Espona MA, Flores-Ruiz MA, Roda O. Reconstrucción de la cápsula superior en las roturas irreparables del manguito mediante injerto autógeno de isquiotibiales. Rev Esp Cir Ortop Traumatol. 2019; 63(1):1-6. doi:10.1016/j. recot.2018.08.004
15. Pennington WT, Bartz BA, Pauli JM, Walker CE, Schmidt W. Arthroscopic Superior Capsular Reconstruction With Acellular Dermal Allograft for the Treatment of Massive Irreparable Rotator Cuff Tears: Short-Term Clinical Outcomes and the Radiographic Parameter of Superior Capsular Distance. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2018; 34(6):1764-1773. doi:10.1016/j.arthro.2018.01.009
16. Denard PJ, Brady PC, Adams CR, Tokish JM, Burkhart SS. Preliminary Results of Arthroscopic Superior Capsule Reconstruction with Dermal Allograft. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2018; 34(1):93-99. doi:10. 1016/j.arthro.2017.08.265
17. Kholinne E, Kwak JM, Kim H, Koh KH, Jeon IH. Arthroscopic Superior Capsular Reconstruction With Mesh Augmentation for the Treatment of Irreparable Rotator Cuff Tears: A Comparative Study of Surgical Outcomes. American Journal of Sports Medicine. 2020; 48(13):3328-3338. doi:10. 1177/0363546520958708
18. Sershon RA, Van Thiel GS, Lin EC, et al. Clinical outcomes of reverse total shoulder arthroplasty in patients aged younger than 60 years. J Shoulder Elbow Surg. 2014;23(3):395-400. doi:10.1016/j.jse.2013.07.047
19. Ernstbrunner L, Suter A, Catanzaro S, Rahm S, Gerber C. Reverse Total Shoulder Arthroplasty for Massive, Irreparable Rotator Cuff Tears Before the Age of 60 Years. Journal of Bone and Joint Surgery. 2017; 99(20):1721-1729. doi:10.2106/JBJS.17.00095
20. Henry P, Wasserstein D, Park S, et al. Arthroscopic Repair for Chronic Massive Rotator Cuff Tears: A Systematic Review. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2015; 31(12):2472-2480. doi:10.1016/j.arthro.2015.06.038
21. Denard PJ, Jiwani AZ, Lädermann A, Burkhart SS. Long-Term Outcome of Arthroscopic Massive Rotator Cuff Repair: The Importance of Double-Row Fixation. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2012; 28(7):909-915. doi:10. 1016/j.arthro.2011.12.007
22. Vaishnav S, Millett PJ. Arthroscopic rotator cuff repair: Scientific rationale, surgical technique, and early clinical and functional results of a knotless self-reinforcing double-row rotator cuff repair system. J Shoulder Elbow Surg. 2010; 19(2):83-90. doi:10.1016/ j.jse.2009.12.012
23. Grasso A, Milano G, Salvatore M, Falcone G, Deriu L, Fabbriciani C. Single-Row Versus Double-Row Arthroscopic Rotator Cuff Repair: A Prospective Randomized Clinical Study. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2009; 25(1): 4-12. doi:10.1016/j.arthro.2008.09.018
24. Park MC, ElAttrache NS, Tibone JE, Ahmad CS, Jun BJ, Lee TQ. Part I: Footprint contact characteristics for a transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique. J Shoulder Elbow Surg. 2007; 16(4):461-468. doi:10.1016/j.jse.2006.09.010
25. Hohmann E, König A, Kat CJ, Glatt V, Tetsworth K, Keough N. Single- versus double-row repair for full-thickness rotator cuff tears using suture anchors. A systematic review and meta-analysis of basic biomechanical studies. European Journal of Orthopaedic Surgery & Traumatology. 2018; 28(5):859-868. doi:10.1007/s00590-017 -2114-6
26. Barber FA, Herbert MA, Schroeder FA, Aziz-Jacobo J, Mays MM, Rapley JH. Biomechanical Advantages of Triple-Loaded Suture Anchors Compared With Double-Row Rotator Cuff Repairs. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2010; 26(3):316-323. doi:10.1016/j.arthro. 2009.07.019
27. Lorbach O, Kieb M, Raber F, Busch LC, Kohn D, Pape D. Comparable Biomechanical Results for a Modified Single-Row Rotator Cuff Reconstruction Using Triple-Loaded Suture Anchors Versus a Suture-Bridging Double-Row Repair. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2012; 28(2):178-187. doi:10.1016/j.arthro.2011.08.298
28. Kim KC, Shin HD, Lee WY, Han SC. Repair Integrity and Functional Outcome After Arthroscopic Rotator Cuff Repair. Am J Sports Med. 2012; 40(2):294-299. doi:10.1177/0363 546511425657
29. MacGillivray JD, Ma CB. An arthroscopic stitch for massive rotator cuff tears: the mac stitch. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2004; 20(6):669-671. doi:10.1016/j.arthro.2004.04.065
30. Cheon SJ, Lee HY, Ahn SJ. A Modified Mac Suture Bridge Technique: Clinical and Radiological Outcomes of the Treatment of Rotator Cuff Tear with Poor Tissue Quality. The Journal of the Korean Orthopaedic Association. 2017; 52(5):392. doi:10.4055/ jkoa.2017.52.5.392
31. Arismendi Montoya A, Gallego Eusse HD, Ramírez Montoya JF. Roturas masivas del manguito de los rotadores: resultados clínicos de la reparación artroscópica con técnica doble MAC. Revista Colombiana de Ortopedia y Traumatología. 2018; 32(2):100-107. doi:10.1016/j.rccot.2017.08.006
32. Tokish JM, Alexander TC, Kissenberth MJ, Hawkins RJ. Pseudoparalysis: a systematic review of term definitions, treatment approaches, and outcomes of management techniques. J Shoulder Elbow Surg. 2017; 26(6):e177-e187. doi:10.1016/j.jse.2017.02.024
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