Ultrasonographic measurement of the effect of rotatory cuff repair with coracoacromial ligament transfer on humeral head migration
Süleyman Bülent Bektaşer1, Nadir Yalçın1, Durmuş Ali Öçgüder1, Ali İpek2, Hasan Ulaş Oğur1, Kasım Kılıçarslan1, Temel Oğuz1
1Atatürk Eğitim ve Araştırma Hastanesi, Ortopedi ve Travmatoloji Kliniği;
2Radyoloji Kliniği, Ankara, Türkiye;
Keywords: Coracoacromial ligament transfer; rotator cuff repair; rotator cuff rupture; ultrasonography.
Objectives: In this study we evaluated whether ligament transfer caused humeral head migration in patients whose massive rotator cuff ruptures were repaired with total or partial coracoacromial ligament (CAL) transfer. The necessity of harvesting the ligament totally or partially in massive rotator cuff repairs was investigated with respect to the effect of the excision and transfer of the CAL on humeral head migration.
Patients and methods: Forty patients (12 males, 28 females; mean age 54.3 years; range 39 to 66 years) operated on with free CAL transfer for massive rotator cuff rupture between January 2003 and June 2008 were included in the study. The operations were performed by obtaining total CAL grafts in the first 13 cases and partial CAL grafts in the other 27 cases. Mean follow-up period was 26.5 months (range 12 to 52 months). Twenty-nine patients had the rupture on the right side and 11 patients had the rupture on the left side. In 31 patients the dominant side was affected.
Results: In the early postoperative period (3-6 weeks) adequate acromiohumeral (AH) distance could not be obtained in patients underwent total excision and transfer of CAL (mean 9 mm; range 8.6 to 9.2 mm). Humeral migration was found to be regressed three months after active motion and recovery of normal cuff strength. During the follow-up the mean AH distance was found to be 10 mm (range 8 to 10.5 mm). Humeral head migration was not detected by ultrasonography in the early postoperative period in patiens who underwent repair with partial CAL transfer.
Conclusion: Functionally good results have been obtained in the rotatory cuff repairs performed by CAL excision and transfer. Although humeral head migration was not detected ultrasonographically in the patients who had partial CAL excision and transfer at the early postoperative period, we observed a decrease in the AH distance in the patients who had total CAL excision and transfer. This migration was regressed and the cuff strength was recovered after intense rehabilitation with strengthening exercises and active motion.