Biomechanical Assessment of a V-Shaped Semitendinosus Allograft Anterior Cable Reconstruction for Irreparable Rotator Cuff Tears.

Purpose: The purpose of this study was to biomechanically assess superior stability, subacromial contact pressures, and glenohumeral kinematics of a V-shaped anterior cable reconstruction with semitendinosus allograft (VST) in a massive rotator cuff tear (MCT) model.

Methods: Eight cadaveric shoulders (mean age, 66 years; range, 48 to 72 years) were tested with a custom testing system used to evaluate superior translation, subacromial contact pressure, and glenohumeral kinematics at 0°, 20°, and 40° glenohumeral abduction and 0°, 30°, 60°, and 90° of external rotation (ER). Conditions tested included (1) native state, (2) MCT (complete supraspinatus and ½ infraspinatus), a (3) VST. The VST was secured medially on the glenoid with 1 anchor and on the greater tuberosity with a double-row configuration using 4 anchors.

Results: The VST significantly decreased superior translation compared to the MCT at 0° and 20° glenohumeral abduction for 0°, 30°, and 60° humeral rotation and at 40° abduction and 0° degrees humeral rotation (P < .05). Superior translation following the VST remained significantly greater than the intact state at 0° abduction and 60° and 90° ER (P = .039 and 0.007, respectively) and 20° abduction and 30°, 60°, and 90° ER (P = .048, .003, and .004, respectively). The VST restored peak subacromial contact pressure to intact levels for all positions except 40° abduction and 60° ER. The VST did not statistically affect humeral head kinematics compared to the intact condition.

Conclusions: In a biomechanical model, a VST anterior cable reconstruction partially restores superior stability and reduces peak subacromial contact pressure associated with an MCT, without affecting glenohumeral kinematics. The technique may be a consideration in the treatment of an irreparable MCT with isolated anterior cable disruption.

Clinical Relevance: The VST may provide an option for treatment of irreparable MCTs with anterior rotator cable disruption.