Superior capsular reconstruction of irreparable rotator cuff tear using autologous hamstring graft | Revista Española de Cirugía Ortopédica y Traumatología (English Edition)

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Gómez Cáceres, J.S. Lucena Jiménez, Á.L. Reyes Martín, J. Moriel Durán, B. Sobrino Diaz, D. García de Quevedo Puerta" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Gómez Cáceres" ] 1 => array:2 [ "nombre" => "J.S." "apellidos" => "Lucena Jiménez" ] 2 => array:2 [ "nombre" => "Á.L." "apellidos" => "Reyes Martín" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Moriel Durán" ] 4 => array:2 [ "nombre" => "B." "apellidos" => "Sobrino Diaz" ] 5 => array:2 [ "nombre" => "D." "apellidos" => "García de Quevedo Puerta" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1888441518301516" "doi" => "10.1016/j.recot.2018.10.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441518301516?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885618300981?idApp=UINPBA00004N" "url" => "/19888856/0000006300000001/v1_201901100606/S1988885618300981/v1_201901100606/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Superior capsular reconstruction of irreparable rotator cuff tear using autologous hamstring graft" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1" "paginaFinal" => "6" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A.P. Rosales-Varo, M. Zafra, M.A. García-Espona, M.A. Flores-Ruiz, O. Roda" "autores" => array:5 [ 0 => array:4 [ "nombre" => "A.P." "apellidos" => "Rosales-Varo" "email" => array:1 [ 0 => "aprosalesv@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "M." "apellidos" => "Zafra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "M.A." "apellidos" => "García-Espona" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "M.A." "apellidos" => "Flores-Ruiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "O." "apellidos" => "Roda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Área de Traumatología, Hospital de Torrecárdenas, Almería, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto Traumatológico de Córdoba, Córdoba, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Área de Radiodiagnóstico, Hospital de Torrecárdenas, Almería, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Área de Traumatología, Hospital del Mar, Cádiz, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Departamento de Anatomía Humana y Embriología, Facultad de Medicina, Universidad de Granada, Granada, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reconstrucción de la cápsula superior en las roturas irreparables del manguito mediante injerto autógeno de isquiotibiales" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 678 "Ancho" => 900 "Tamanyo" => 74667 ] ] "descripcion" => array:1 [ "en" => "Drawing of the superior capsule reconstruction with hamstring allograft." ] ] ] "textoCompleto" => "IntroductionTreating patients with irreparable rotator cuff tear remains a challenge for orthopaedic surgeons. Several surgical treatments have been used, such as: debridement with or without biceps tenotomy,<a class="elsevierStyleCrossRefs" href="#bib0160">1–4</a> partial repair,<a class="elsevierStyleCrossRefs" href="#bib0180">5–10</a> tendon transfer,<a class="elsevierStyleCrossRefs" href="#bib0210">11,12</a> interposition grafting<a class="elsevierStyleCrossRefs" href="#bib0220">13–15</a> or reverse prosthesis.<a class="elsevierStyleCrossRef" href="#bib0235">16</a> However, the results of these techniques are not optimal for treating young patients.There is now a new option, originally developed by Dr. Mihata,<a class="elsevierStyleCrossRef" href="#bib0240">17</a> who demonstrated the importance of the superior capsule of the shoulder as a stabilising structure, so that in the event of a postero-superior irreparable symptomatic tear (PSIRCT) the capsule at least, should be reconstructed in an attempt to restore the shoulder's normal fulcrum, and thus enable shoulder stability and function. In the original description, superior capsule reconstruction (SCR) was performed with fascia lata. There is no information on this reconstruction using an autologous graft other than fascia lata.The aim of this study was to research the clinical results and radiographic findings after SCR for PSIRCT using a new SCR technique using autologous hamstring graft.Our hypothesis was that SCR using the hamstring could increase the acromiohumeral (AH) distance and improve the functional results of PSIRCT.Materials and methodsA clinical, prospective study, on a pilot sample of 8 patients to evaluate the clinical results and radiographic findings of an SCR using autologous hamstring graft.The subjects included in the study were patients on the waiting list from our hospital's clinics, who were admitted between 2015 and 2016 with a PSIRCT, and who met the following inclusion criteria: complete irreparable tear of the supraspinatus or infraspinatus; conservative treatment failure; no or minimal joint degeneration; aged between 40 and 65 years at the time of first consultation, and having given their written consent for intervention.A tendon was considered irreparable when it could not be repaired to its original footprint at the major tuberosity and, although the final decision was intraoperative, we were guided by various signs of irreparability such as: upper migration of the humerus with an AH distance of less than 7mm, Patte stage 3 tendon retraction, Goutallier grade 3 and 4 fatty infiltration, and Thomazeau's stage 3 muscle atrophy.The exclusion criteria were: joint degeneration (Hamada<a class="elsevierStyleCrossRef" href="#bib0245">18</a> stages 3, 4 or 5), severe upper migration of the humeral head that did not descend with arm traction, deltoid deficiency, irreparable injury to the subscapularis or shoulder rigidity.The patients were assessed by the same surgeon in the clinic, with a standard history and physical examination that included the Constant and SST test, before the operation, and at 12 months following it. Forward flexion was measured at the patient's side, with the axis of the goniometer arm over the arm axis, and the other goniometer arm following the trunk axis, supported on the ribcage. We measured external rotation in front of the patient asking them to perform active and non-painful external rotation manoeuvres; we measured internal rotation from behind the patient, and asked them to perform active, non-painful internal rotation manoeuvres; we observed the point that they could reach with the tip of the thumb. We assessed strength with a dynamometer: the patient's spine supported by the back of a chair, they lifted their arm on the plane of the scapula, with their hand in pronation and palm facing towards the floor. Tying the strap to the proximal hook of the dynamometer supported by the wrist, we pulled the distal hook downwards exerting constant force, and the cursor showed us on the scale the kg that the patient managed to bear. We took 3 measurements, and took the maximum score achieved as the benchmark.An imaging study was performed using plain X-rays in 2 views (true AP and Y). Glenohumeral degeneration was also measured by the Hamada scale, and AH distance by the method described by Ellman.<a class="elsevierStyleCrossRef" href="#bib0250">19</a> MR images were taken on the coronal, sagittal and axial planes, enabling us to assess the type of tear, its size, its retraction and the quality of the tendons affected, and to gain an idea of its repair capacity. We assessed fatty degeneration using Goutallier's system.<a class="elsevierStyleCrossRef" href="#bib0255">20</a> The plain X-rays and MRI were undertaken preoperatively, and at one year's follow-up.All the interventions were performed under general anaesthesia, with the patient in the deckchair position, and by the same surgeon. After the superior approach, the irreparability was assessed of the tendon tear and of the tendons involved. Only one patient underwent subacromial decompression due to a type 3 acromion. Once the injury had been assessed, the SCR was performed with a hamstring allograft. After gentle debridement of the upper area of the glenoid and the footprint of the greater tuberosity, medial fixation was obtained to the glenoid bone in its upper area, at 12 o’clock, from the central area of the graft (with metallic screw 5 with 4 strands). Lateral fixation was also obtained (with the same type of screw as in the glenoid cavity) of the 2 ends of the graft in the humeral head at two points: one antero-superior, next to the entry area of the bicipital groove and to the area of the interval and subscapularis; and a second fixed behind, in the postero-superior area near the infraspinatus, which was also sutured to the plasty (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–3</a>). The lateral fixation was performed under tension and in an arm position at about 30° abduction, neutral rotation, and 20–30° flexion.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>All the subjects followed the same protocolised rehabilitation regimen, using a sling for 2 weeks, starting passive exercises at 2 weeks, active exercises at 6–8 weeks, and strengthening exercises for the cuff and scapula stabilisers from 10 to 12 weeks.A descriptive analysis of the variables was performed, and the non-parametric sign test was used, comparing the measurements taken before the operation, and at 12 months after it.ResultsFour males and four females were operated, with a mean age of 59.66 years (range from 55 to 63 years) at the time of the surgery. The mean duration of symptoms (pain and functional) before the operation was 25.3 months (from 12 to 60 months). The stage of arthrosis prior to surgery was classified using the Hamad system<a class="elsevierStyleCrossRef" href="#bib0315">21</a>: we found 3 shoulders in stage 1, and 5 in stage 2 (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The non-parametric signs test was used, with statistically significant differences in the Constant test (p<.01). We observed an improvement from 49 before the SCR to 77.25 one year after it.The range of active motion significantly improved after the SCR until the end of follow-up (12 months). Mean active flexion increased from 99.3° preoperatively to 142.5° (p<.01); mean external rotation increased from 32.5° to 43.7° (p<.01) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>, <a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia>There were no surgical, intraoperative or postoperative complications in the year of follow-up.The mean preoperative AH distance was 5.25mm (range from 3 to 7mm), in 5 shoulders it was less than 7mm. After the SCR, the mean AH distance increased significantly to 8.18 (range from 6 to 10.5) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>No tears were observed on MRI during follow-up of the implanted hamstring plasty.DiscussionThe results in this paper show a functional improvement in patients with irreparable rotator cuff tear. In those who underwent a SCR with autologous hamstring graft, we observed, at one year's follow-up, an increased AH distance, and improved active flexion.Patients with PSIRCT have a defect of the superior joint capsule. SCR for PSIRCT restores superior glenohumeral stability and improves shoulder function.<a class="elsevierStyleCrossRefs" href="#bib0260">22,23</a>Because most rotator cuff tears are reparable, the treatment of patients with PSIRCT remains a challenge for orthopaedic surgeons. The available treatments include traditional patch grafts using different materials inserted in the injured tendon, but they have shown a high re-tear rate<a class="elsevierStyleCrossRefs" href="#bib0270">24-26</a> without significantly altering the AH distance.Audenaert et al.<a class="elsevierStyleCrossRef" href="#bib0285">27</a> published that the AH distance was not significantly modified after conventional patch grafts placed medially to the tendon, and laterally to the greater tuberosity for massive rotator cuff tears.Clitherow et al.<a class="elsevierStyleCrossRef" href="#bib0290">28</a> described an autologous hamstring graft reconstruction to augment retracted rotator cuff tendons, attempting to restore the length of the musculotendinous unit, but without performing an SCR.Despite the interest in this technique, current knowledge on SCR is based essentially on biomechanical studies<a class="elsevierStyleCrossRefs" href="#bib0295">29-31</a>: there are few clinical studies on SCR for irreparable rotator cuff tears. In addition to Mihata's classical clinical study with autogenous fascia, with 24 shoulders in 23 patients, we only found one multicentre study with dermal allograft by Denard.<a class="elsevierStyleCrossRef" href="#bib0010">32</a> We saw clear differences between both studies: there was a low rate of graft healing with the dermal allograft (45%), and they found no increase in AH distance one year afterwards, which is different to Mihata's results with autogenous fascia lata. However, 100% of the patients with a healthy graft had successful results, which makes us believe that it is important to prevent the graft tearing after an SCR, and that we must define the type of graft to be used to achieve this outcome.Our data indicate that SCR, using the described hamstring graft technique, results in an increased mean AH distance of 5.25–8.18mm. This is in line with the data published by Mihata<a class="elsevierStyleCrossRef" href="#bib0315">21</a> where the SCR, using fascia lata graft, obtained an increased mean AH distance of .46–8.7mm (significant increase of 4.1±1.7mm after SCR). We, like this author, had no tears of the graft we used.The functional results of PSIRCT repair with fatty degeneration of the infraspinatus have been traditionally disappointing. Our results with SCR using hamstring allograft, like those of Mihata, provided improvement, despite fatty infiltration of the infraspinatus.These data confirm the stabilising role of the superior shoulder capsule, so the rotator cuff is neither the only nor the main stabiliser of the shoulder. It undertakes dynamic action, reinforces stabilisation of the capsule, and restores the strength of the shoulder. This fact explains how when faced with an PSIRCT we can, at least, reconstruct the capsule restoring the normal fulcrum of the shoulder, and thus enable it to become stable and functioning.This study's limitations are the small number of patients, the lack of a control group, and the short follow-up time. The statistically significant differences, despite the small sample size, are because the effect size (pre- and postoperative difference) is very large.We believe that it is important to show the preliminary results of this new technique given the current interest and debate surrounding it, and because there are so few published clinical studies. We are aware that there are important aspects that we do not know, such as the most appropriate graft, the indications or the time it might last, and that we must approach all new techniques with due care.ConclusionsSCR with hamstring allograft improves the function of the shoulder in PSIRCT: it is an alternative treatment technique for these injuries without closing the door to other surgery.Level of evidenceLevel of evidence iii.Conflict of interestsThe authors have no conflict of interests to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres1135216" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1067319" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1135217" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1067318" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Level of evidence" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interests" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-12-24" "fechaAceptado" => "2018-08-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1067319" "palabras" => array:5 [ 0 => "Superior capsule" 1 => "Irreparable" 2 => "Rotator cuff" 3 => "Autograft" 4 => "Hamstring" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1067318" "palabras" => array:5 [ 0 => "Cápsula superior" 1 => "Irreparable" 2 => "Manguito de los rotadores" 3 => "Autoinjerto" 4 => "Isquiotibiales" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveThe aim of this study was to investigate the clinical results and radiographic findings after superior capsular reconstruction (SCR) of postero-superior symptomatic irreparable rotator cuff tears (PSIRCT) using a new SCR technique using autologous hamstring graft. Material and methodsFrom 2014 to 2016, 8 shoulders of 8 patients (mean age 59.6 years) with PSIRCT underwent SCR using autologous hamstring graft.Physical examination, X-ray and MRI were performed before the surgery and 12 months after it. A descriptive analysis was performed of the variables, and the non-parametric test of signs comparing the measurements taken before the operation and 12 months after it. ResultsWe found an improvement in the Constant test from 49 before the SCR to 77.25 one year after the operation. The mean active flexion significantly increased from 99.3° to 142.5°. The mean preoperative AH distance increased from 5.25 (range from 3 to 7) before surgery to 8.18 (range from 6 to 10.5) after the SCR. There were no tears of the graft during follow-up. ConclusionSCR with a hamstring graft improves the function of the shoulder in PSIRCT, and is an alternative technique for treating these injuries without closing the door to other types of surgery." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoEl objetivo de este estudio es investigar los resultados clínicos y los hallazgos radiográficos tras la reconstrucción de la cápsula superior (RCS) en las roturas irreparables posterosuperiores sintomáticas (RIPS) del manguito de los rotadores mediante una nueva técnica de RCS utilizando injerto autógeno de isquiotibiales. Material y métodosDesde 2014 hasta 2016, 8 hombros en 8 pacientes (edad media de 59,6 años) con RIPS fueron tratados con la RCS utilizando injerto autógeno de isquiotibiales. El examen físico, Rx y RM fueron realizados antes de la cirugía y a los 12 meses. Se ha realizado un análisis descriptivo de las variables y se ha utilizado test no paramétrico de los signos para comparar las medidas tomadas antes de la cirugía y a los 12 meses. ResultadosEncontramos una mejoría en el test de Costant: de 49 antes de ser intervenido a 77,25 al año de la RCS. La media de flexión activa aumentó de forma significativa de 99,3° a 142,5°. La distancia media HA preoperatoria aumentó de 5,25mm (rango de 3 a 7mm) antes de la cirugía a 8,18mm (rango de 6 a 10,5) tras la RCS. No hubo roturas del injerto durante el seguimiento. ConclusiónLa RCS con injerto de isquiotibiales mejora la función del hombro en las RIPS. Es una técnica alternativa al tratamiento de dichas lesiones sin cerrar las puertas a otras cirugías." 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Rev Esp Cir Ortop Traumatol. 2019;63:1–6." ] ] "multimedia" => array:7 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 678 "Ancho" => 900 "Tamanyo" => 74667 ] ] "descripcion" => array:1 [ "en" => "Drawing of the superior capsule reconstruction with hamstring allograft." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1998 "Ancho" => 1500 "Tamanyo" => 357931 ] ] "descripcion" => array:1 [ "en" => "Intraoperative image with graft anchor in the glenoid at 12 o’clock." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1998 "Ancho" => 1500 "Tamanyo" => 368351 ] ] "descripcion" => array:1 [ "en" => "Intraoperative image of lateral fixation in the humeral head at 2 points: (1) antero-superior, next to the entry area to the bicipital groove, tenodesis with the biceps; (2) behind, fixation in the postero-superior area near the infraspinatus, which must be fixed to the plasty." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 625 "Ancho" => 1500 "Tamanyo" => 119967 ] ] "descripcion" => array:1 [ "en" => "Patient 1, one year after the SCR, the range of motion in flexion, external rotation and internal rotation has been completely restored." ] ] 4 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Shoulder \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Work \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Duration of symptoms \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Surgery \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tendon \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hamada \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Manual \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1st \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Manual \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2nd \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SS/IS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Housewife \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1st \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SS/IS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Manual \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1st \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SS/IS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Manual \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1st \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Manual \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1st \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Manual \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1st \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SS/IS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Housewife \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1st \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">SS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="8" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mean \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1936683.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Summary of the patients." ] ] 5 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Flexion</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Active ext. rot.</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Shoulder \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Preop. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Postop. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Preop. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Postop. \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">135 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">180 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">150 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">135 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">160 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">120 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">180 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">180 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">135 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">180 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Median \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">105 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">160 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1936685.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Summary of the patients’ range of motion." ] ] 6 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">AH distance (mm)</th></tr><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Shoulder \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Preop. \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Postop. \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Median \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.25 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1936684.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Acromiohumeral distance and MRI findings." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" 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Original Article

Superior capsular reconstruction of irreparable rotator cuff tear using autologous hamstring graft

Reconstrucción de la cápsula superior en las roturas irreparables del manguito mediante injerto autógeno de isquiotibiales

A.P. Rosales-Varoa,

Corresponding author

aprosalesv@gmail.com

Corresponding author.

, M. Zafrab, M.A. García-Esponac, M.A. Flores-Ruizd, O. Rodae

a Área de Traumatología, Hospital de Torrecárdenas, Almería, Spain

b Instituto Traumatológico de Córdoba, Córdoba, Spain

c Área de Radiodiagnóstico, Hospital de Torrecárdenas, Almería, Spain

d Área de Traumatología, Hospital del Mar, Cádiz, Spain

e Departamento de Anatomía Humana y Embriología, Facultad de Medicina, Universidad de Granada, Granada, Spain

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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Drawing of the superior capsule reconstruction with hamstring allograft&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Treating patients with irreparable rotator cuff tear remains a challenge for orthopaedic surgeons&#46; Several surgical treatments have been used&#44; such as&#58; debridement with or without biceps tenotomy&#44;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#8211;4</span></a> partial repair&#44;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">5&#8211;10</span></a> tendon transfer&#44;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">11&#44;12</span></a> interposition grafting<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">13&#8211;15</span></a> or reverse prosthesis&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">16</span></a> However&#44; the results of these techniques are not optimal for treating young patients&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">There is now a new option&#44; originally developed by Dr&#46; Mihata&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">17</span></a> who demonstrated the importance of the superior capsule of the shoulder as a stabilising structure&#44; so that in the event of a postero-superior irreparable symptomatic tear &#40;PSIRCT&#41; the capsule at least&#44; should be reconstructed in an attempt to restore the shoulder&#39;s normal fulcrum&#44; and thus enable shoulder stability and function&#46; In the original description&#44; superior capsule reconstruction &#40;SCR&#41; was performed with fascia lata&#46; There is no information on this reconstruction using an autologous graft other than fascia lata&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this study was to research the clinical results and radiographic findings after SCR for PSIRCT using a new SCR technique using autologous hamstring graft&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Our hypothesis was that SCR using the hamstring could increase the acromiohumeral &#40;AH&#41; distance and improve the functional results of PSIRCT&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">A clinical&#44; prospective study&#44; on a pilot sample of 8 patients to evaluate the clinical results and radiographic findings of an SCR using autologous hamstring graft&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The subjects included in the study were patients on the waiting list from our hospital&#39;s clinics&#44; who were admitted between 2015 and 2016 with a PSIRCT&#44; and who met the following inclusion criteria&#58; complete irreparable tear of the supraspinatus or infraspinatus&#59; conservative treatment failure&#59; no or minimal joint degeneration&#59; aged between 40 and 65 years at the time of first consultation&#44; and having given their written consent for intervention&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A tendon was considered irreparable when it could not be repaired to its original footprint at the major tuberosity and&#44; although the final decision was intraoperative&#44; we were guided by various signs of irreparability such as&#58; upper migration of the humerus with an AH distance of less than 7<span class="elsevierStyleHsp" style=""></span>mm&#44; Patte stage 3 tendon retraction&#44; Goutallier grade 3 and 4 fatty infiltration&#44; and Thomazeau&#39;s stage 3 muscle atrophy&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The exclusion criteria were&#58; joint degeneration &#40;Hamada<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a> stages 3&#44; 4 or 5&#41;&#44; severe upper migration of the humeral head that did not descend with arm traction&#44; deltoid deficiency&#44; irreparable injury to the subscapularis or shoulder rigidity&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The patients were assessed by the same surgeon in the clinic&#44; with a standard history and physical examination that included the Constant and SST test&#44; before the operation&#44; and at 12 months following it&#46; Forward flexion was measured at the patient&#39;s side&#44; with the axis of the goniometer arm over the arm axis&#44; and the other goniometer arm following the trunk axis&#44; supported on the ribcage&#46; We measured external rotation in front of the patient asking them to perform active and non-painful external rotation manoeuvres&#59; we measured internal rotation from behind the patient&#44; and asked them to perform active&#44; non-painful internal rotation manoeuvres&#59; we observed the point that they could reach with the tip of the thumb&#46; We assessed strength with a dynamometer&#58; the patient&#39;s spine supported by the back of a chair&#44; they lifted their arm on the plane of the scapula&#44; with their hand in pronation and palm facing towards the floor&#46; Tying the strap to the proximal hook of the dynamometer supported by the wrist&#44; we pulled the distal hook downwards exerting constant force&#44; and the cursor showed us on the scale the kg that the patient managed to bear&#46; We took 3 measurements&#44; and took the maximum score achieved as the benchmark&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">An imaging study was performed using plain X-rays in 2 views &#40;true AP and Y&#41;&#46; Glenohumeral degeneration was also measured by the Hamada scale&#44; and AH distance by the method described by Ellman&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">19</span></a> MR images were taken on the coronal&#44; sagittal and axial planes&#44; enabling us to assess the type of tear&#44; its size&#44; its retraction and the quality of the tendons affected&#44; and to gain an idea of its repair capacity&#46; We assessed fatty degeneration using Goutallier&#39;s system&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">20</span></a> The plain X-rays and MRI were undertaken preoperatively&#44; and at one year&#39;s follow-up&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">All the interventions were performed under general anaesthesia&#44; with the patient in the deckchair position&#44; and by the same surgeon&#46; After the superior approach&#44; the irreparability was assessed of the tendon tear and of the tendons involved&#46; Only one patient underwent subacromial decompression due to a type 3 acromion&#46; Once the injury had been assessed&#44; the SCR was performed with a hamstring allograft&#46; After gentle debridement of the upper area of the glenoid and the footprint of the greater tuberosity&#44; medial fixation was obtained to the glenoid bone in its upper area&#44; at 12 o&#8217;clock&#44; from the central area of the graft &#40;with metallic screw 5 with 4 strands&#41;&#46; Lateral fixation was also obtained &#40;with the same type of screw as in the glenoid cavity&#41; of the 2 ends of the graft in the humeral head at two points&#58; one antero-superior&#44; next to the entry area of the bicipital groove and to the area of the interval and subscapularis&#59; and a second fixed behind&#44; in the postero-superior area near the infraspinatus&#44; which was also sutured to the plasty &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1&#8211;3</a>&#41;&#46; The lateral fixation was performed under tension and in an arm position at about 30&#176; abduction&#44; neutral rotation&#44; and 20&#8211;30&#176; flexion&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">All the subjects followed the same protocolised rehabilitation regimen&#44; using a sling for 2 weeks&#44; starting passive exercises at 2 weeks&#44; active exercises at 6&#8211;8 weeks&#44; and strengthening exercises for the cuff and scapula stabilisers from 10 to 12 weeks&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">A descriptive analysis of the variables was performed&#44; and the non-parametric sign test was used&#44; comparing the measurements taken before the operation&#44; and at 12 months after it&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">Four males and four females were operated&#44; with a mean age of 59&#46;66 years &#40;range from 55 to 63 years&#41; at the time of the surgery&#46; The mean duration of symptoms &#40;pain and functional&#41; before the operation was 25&#46;3 months &#40;from 12 to 60 months&#41;&#46; The stage of arthrosis prior to surgery was classified using the Hamad system<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">21</span></a>&#58; we found 3 shoulders in stage 1&#44; and 5 in stage 2 &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The non-parametric signs test was used&#44; with statistically significant differences in the Constant test &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46; We observed an improvement from 49 before the SCR to 77&#46;25 one year after it&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The range of active motion significantly improved after the SCR until the end of follow-up &#40;12 months&#41;&#46; Mean active flexion increased from 99&#46;3&#176; preoperatively to 142&#46;5&#176; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#59; mean external rotation increased from 32&#46;5&#176; to 43&#46;7&#176; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#44; <a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">There were no surgical&#44; intraoperative or postoperative complications in the year of follow-up&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The mean preoperative AH distance was 5&#46;25<span class="elsevierStyleHsp" style=""></span>mm &#40;range from 3 to 7<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; in 5 shoulders it was less than 7<span class="elsevierStyleHsp" style=""></span>mm&#46; After the SCR&#44; the mean AH distance increased significantly to 8&#46;18 &#40;range from 6 to 10&#46;5&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">No tears were observed on MRI during follow-up of the implanted hamstring plasty&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">The results in this paper show a functional improvement in patients with irreparable rotator cuff tear&#46; In those who underwent a SCR with autologous hamstring graft&#44; we observed&#44; at one year&#39;s follow-up&#44; an increased AH distance&#44; and improved active flexion&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Patients with PSIRCT have a defect of the superior joint capsule&#46; SCR for PSIRCT restores superior glenohumeral stability and improves shoulder function&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">22&#44;23</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Because most rotator cuff tears are reparable&#44; the treatment of patients with PSIRCT remains a challenge for orthopaedic surgeons&#46; The available treatments include traditional patch grafts using different materials inserted in the injured tendon&#44; but they have shown a high re-tear rate<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">24-26</span></a> without significantly altering the AH distance&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Audenaert et al&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> published that the AH distance was not significantly modified after conventional patch grafts placed medially to the tendon&#44; and laterally to the greater tuberosity for massive rotator cuff tears&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Clitherow et al&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> described an autologous hamstring graft reconstruction to augment retracted rotator cuff tendons&#44; attempting to restore the length of the musculotendinous unit&#44; but without performing an SCR&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Despite the interest in this technique&#44; current knowledge on SCR is based essentially on biomechanical studies<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">29-31</span></a>&#58; there are few clinical studies on SCR for irreparable rotator cuff tears&#46; In addition to Mihata&#39;s classical clinical study with autogenous fascia&#44; with 24 shoulders in 23 patients&#44; we only found one multicentre study with dermal allograft by Denard&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">32</span></a> We saw clear differences between both studies&#58; there was a low rate of graft healing with the dermal allograft &#40;45&#37;&#41;&#44; and they found no increase in AH distance one year afterwards&#44; which is different to Mihata&#39;s results with autogenous fascia lata&#46; However&#44; 100&#37; of the patients with a healthy graft had successful results&#44; which makes us believe that it is important to prevent the graft tearing after an SCR&#44; and that we must define the type of graft to be used to achieve this outcome&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Our data indicate that SCR&#44; using the described hamstring graft technique&#44; results in an increased mean AH distance of 5&#46;25&#8211;8&#46;18<span class="elsevierStyleHsp" style=""></span>mm&#46; This is in line with the data published by Mihata<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">21</span></a> where the SCR&#44; using fascia lata graft&#44; obtained an increased mean AH distance of &#46;46&#8211;8&#46;7<span class="elsevierStyleHsp" style=""></span>mm &#40;significant increase of 4&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;7<span class="elsevierStyleHsp" style=""></span>mm after SCR&#41;&#46; We&#44; like this author&#44; had no tears of the graft we used&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The functional results of PSIRCT repair with fatty degeneration of the infraspinatus have been traditionally disappointing&#46; Our results with SCR using hamstring allograft&#44; like those of Mihata&#44; provided improvement&#44; despite fatty infiltration of the infraspinatus&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">These data confirm the stabilising role of the superior shoulder capsule&#44; so the rotator cuff is neither the only nor the main stabiliser of the shoulder&#46; It undertakes dynamic action&#44; reinforces stabilisation of the capsule&#44; and restores the strength of the shoulder&#46; This fact explains how when faced with an PSIRCT we can&#44; at least&#44; reconstruct the capsule restoring the normal fulcrum of the shoulder&#44; and thus enable it to become stable and functioning&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">This study&#39;s limitations are the small number of patients&#44; the lack of a control group&#44; and the short follow-up time&#46; The statistically significant differences&#44; despite the small sample size&#44; are because the effect size &#40;pre- and postoperative difference&#41; is very large&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">We believe that it is important to show the preliminary results of this new technique given the current interest and debate surrounding it&#44; and because there are so few published clinical studies&#46; We are aware that there are important aspects that we do not know&#44; such as the most appropriate graft&#44; the indications or the time it might last&#44; and that we must approach all new techniques with due care&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0155" class="elsevierStylePara elsevierViewall">SCR with hamstring allograft improves the function of the shoulder in PSIRCT&#58; it is an alternative treatment technique for these injuries without closing the door to other surgery&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Level of evidence</span><p id="par0160" class="elsevierStylePara elsevierViewall">Level of evidence <span class="elsevierStyleSmallCaps">iii&#46;</span></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interests</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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            2 => "Rotator cuff"
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            0 => "C&#225;psula superior"
            1 => "Irreparable"
            2 => "Manguito de los rotadores"
            3 => "Autoinjerto"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to investigate the clinical results and radiographic findings after superior capsular reconstruction &#40;SCR&#41; of postero-superior symptomatic irreparable rotator cuff tears &#40;PSIRCT&#41; using a new SCR technique using autologous hamstring graft&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">From 2014 to 2016&#44; 8 shoulders of 8 patients &#40;mean age 59&#46;6 years&#41; with PSIRCT underwent SCR using autologous hamstring graft&#46;</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Physical examination&#44; X-ray and MRI were performed before the surgery and 12 months after it&#46; A descriptive analysis was performed of the variables&#44; and the non-parametric test of signs comparing the measurements taken before the operation and 12 months after it&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We found an improvement in the Constant test from 49 before the SCR to 77&#46;25 one year after the operation&#46; The mean active flexion significantly increased from 99&#46;3&#176; to 142&#46;5&#176;&#46; The mean preoperative AH distance increased from 5&#46;25 &#40;range from 3 to 7&#41; before surgery to 8&#46;18 &#40;range from 6 to 10&#46;5&#41; after the SCR&#46; There were no tears of the graft during follow-up&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">SCR with a hamstring graft improves the function of the shoulder in PSIRCT&#44; and is an alternative technique for treating these injuries without closing the door to other types of surgery&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
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          1 => array:2 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio es investigar los resultados cl&#237;nicos y los hallazgos radiogr&#225;ficos tras la reconstrucci&#243;n de la c&#225;psula superior &#40;RCS&#41; en las roturas irreparables posterosuperiores sintom&#225;ticas &#40;RIPS&#41; del manguito de los rotadores mediante una nueva t&#233;cnica de RCS utilizando injerto aut&#243;geno de isquiotibiales&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Desde 2014 hasta 2016&#44; 8 hombros en 8 pacientes &#40;edad media de 59&#44;6 a&#241;os&#41; con RIPS fueron tratados con la RCS utilizando injerto aut&#243;geno de isquiotibiales&#46; El examen f&#237;sico&#44; Rx y RM fueron realizados antes de la cirug&#237;a y a los 12 meses&#46; Se ha realizado un an&#225;lisis descriptivo de las variables y se ha utilizado test no param&#233;trico de los signos para comparar las medidas tomadas antes de la cirug&#237;a y a los 12 meses&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Encontramos una mejor&#237;a en el test de Costant&#58; de 49 antes de ser intervenido a 77&#44;25 al a&#241;o de la RCS&#46; La media de flexi&#243;n activa aument&#243; de forma significativa de 99&#44;3&#176; a 142&#44;5&#176;&#46; La distancia media HA preoperatoria aument&#243; de 5&#44;25<span class="elsevierStyleHsp" style=""></span>mm &#40;rango de 3 a 7<span class="elsevierStyleHsp" style=""></span>mm&#41; antes de la cirug&#237;a a 8&#44;18<span class="elsevierStyleHsp" style=""></span>mm &#40;rango de 6 a 10&#44;5&#41; tras la RCS&#46; No hubo roturas del injerto durante el seguimiento&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La RCS con injerto de isquiotibiales mejora la funci&#243;n del hombro en las RIPS&#46; Es una t&#233;cnica alternativa al tratamiento de dichas lesiones sin cerrar las puertas a otras cirug&#237;as&#46;</p></span>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Shoulder&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Work&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Duration of symptoms&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Surgery&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tendon&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Hamada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Manual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1st&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">SS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Manual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2nd&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">SS&#47;IS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Housewife&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1st&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">SS&#47;IS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Manual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1st&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">SS&#47;IS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Manual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1st&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">SS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Manual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1st&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">SS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Manual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1st&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">SS&#47;IS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Housewife&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1st&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">SS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="8" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Mean</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">58&#46;25</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">25</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Flexion</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Active ext&#46; rot&#46;</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Shoulder&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Postop&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">135&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">150&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">135&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 19888856
Original language: English

DOI:10.1016/j.recote.2018.12.006

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Year/Month	Html	Pdf	Total

2024 November	3	0	3
2024 October	23	5	28
2024 September	24	6	30
2024 August	20	5	25
2024 July	13	7	20
2024 June	25	1	26
2024 May	17	5	22
2024 April	18	12	30
2024 March	35	4	39
2024 February	44	6	50
2024 January	32	12	44
2023 December	31	13	44
2023 November	23	18	41
2023 October	35	21	56
2023 September	34	8	42
2023 August	23	11	34
2023 July	16	5	21
2023 June	35	3	38
2023 May	48	10	58
2023 April	38	0	38
2023 March	35	9	44
2023 February	23	2	25
2023 January	40	9	49
2022 December	37	7	44
2022 November	48	8	56
2022 October	48	8	56
2022 September	55	7	62
2022 August	45	13	58
2022 July	30	10	40
2022 June	19	10	29
2022 May	30	8	38
2022 April	36	11	47
2022 March	39	13	52
2022 February	24	5	29
2022 January	24	3	27
2021 December	64	9	73
2021 November	62	10	72
2021 October	137	15	152
2021 September	22	12	34
2021 August	26	11	37
2021 July	13	5	18
2021 June	15	5	20
2021 May	29	5	34
2021 April	70	13	83
2021 March	36	8	44
2021 February	19	7	26
2021 January	29	7	36
2020 December	2	1	3
2020 July	1	0	1
2019 June	4	0	4
2019 January	4	0	4

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