Use of Gracile and semi-tendinosus tendons (GRAST) for the reconstruction of irreparable rotator cuff tears

BMC Musculoskeletal Disorders

M. Christian Moody¹  Marie Protais²  Maxime Laurent-Perrot²  Alain Sautet²  Mickaël Artuso²  Marc Soubeyrand³ 

[1] Department of Hand, upper extremity and microsurgery, Prisma Health System, Greenville, SC, USA;Département de chirurgie orthopédique et traumatologique – Hôpital Saint-Antoine, Assistance Publique – Hôpitaux de Paris (APHP), 184 rue du faubourg Saint Antoine, 75012, Paris, France;Unité de chirurgie du membre supérieur, Clinique Saint Jean l’Ermitage, 272 avenue Marc Jacquet, 77000, Melun, France;

关键词: Irreparable rotator cuff tear;    Arthroscopy;    Gracilis;    Semitendinosus;   

DOI  :  10.1186/s12891-021-04197-6

来源: Springer

【 摘 要 】

BackgroundIrreparable rotator cuff tears are common and difficult to treat. Techniques for “filling the loss of substance” require fixation to the rotator cuff stump (tendon augmentation) or to the glenoid (superior capsular reconstruction), which are complicated by the narrow working zone of the subacromial space. The main objective of this study was to determine whether a braided graft of gracilis (GR) and semitendinosus (ST) could fill a loss of tendon substance from an irreparable rupture of the supra- and infraspinatus, by fixing the graft to the greater tuberosity and the spine of the scapula.MethodsThis was a cadaveric study with the use of ten specimens. The GRA and ST tendons were harvested, braided and reinforced with suture. An experimental tear of the supraspinatus (SS) and upper infraspinatus (IS) retracted at the glenoid was made. The GRAST transplant was positioned over the tear. The transplant was attached to the greater tuberosity by two anchors and then attached to the medial third of the scapular spine by trans-osseous stitching. The percentage of filling obtained was then measured and passive mobility of the shoulder was assessed. We proceeded to the same technique under arthroscopy for a 73 years old patient whom we treated for a painful shoulder with irreparable cuff tear. We inserted a GRAST graft using arthroscopy.ResultsThe Braided-GRAST allowed a 100% filling of the loss of tendon substance. Mobility was complete in all cases.ConclusionThis technique simplifies the medial fixation and restores the musculo-tendinous chain where current grafting techniques only fill a tendinous defect. The transplant could have a subacromial “spacer” effect and lower the humeral head. The donor site morbidity and the fate of the transplant in-vivo are two limits to be discussed. This anatomical study paves the way for clinical experimentation.

【 授权许可】

CC BY