Sanchez George, Rossy William H, Lavery Kyle P, McHale Kevin J, Ferrari Marcio B, Sanchez Anthony, Provencher Matthew T
Steadman Phillipon Research Institute, Vail, Colorado, U.S.A.
Princeton Orthopaedic Associates, Princeton, New Jersey, U.S.A.
Arthrosc Tech. 2017 Aug 28;6(4):e1399-e1404. doi: 10.1016/j.eats.2017.05.020. eCollection 2017 Aug.
Massive, irreparable rotator cuff tears are challenging to treat and associated with pain and severe limitation in shoulder elevation due to the proximal migration of the humeral head and, consequently, subacromial impingement. Furthermore, retraction of the tendons in combination with fat infiltration and muscular weakness results in unpredictable treatment outcomes. While conservative treatment may be warranted for low-demand patients, surgical treatment is often indicated for a successful return to activities of daily living as well as an improved quality of life. The reported failure rate of rotator cuff repair for the treatment of a massive rotator cuff tear varies. However, this failure is often found at the interface between the tendon and tendon footprint. Several techniques have been reported to address this pathology, including muscular transfer, arthroscopic debridement, augmentation procedures, and superior capsule reconstruction. In particular, superior capsule reconstruction has been reported as a safe and effective method to treat a massive, irreparable rotator cuff tear. The purpose of this Technical Note is to describe our preferred technique of a superior capsule reconstruction for the treatment of a massive, irreparable rotator cuff tear.
巨大的、无法修复的肩袖撕裂治疗具有挑战性，由于肱骨头近端移位，进而导致肩峰下撞击，会引起疼痛和肩部抬高严重受限。此外，肌腱回缩、脂肪浸润和肌肉无力共同作用，导致治疗结果难以预测。对于需求较低的患者，保守治疗可能是必要的，但手术治疗通常是恢复日常生活活动以及提高生活质量的必要手段。报道的用于治疗巨大肩袖撕裂的肩袖修复失败率各不相同。然而，这种失败通常出现在肌腱与肌腱附着点之间的界面处。已有多种技术被报道用于解决这一病理问题，包括肌肉转移、关节镜清创、增强手术以及上盂唇重建。特别是，上盂唇重建已被报道为治疗巨大的、无法修复的肩袖撕裂的一种安全有效的方法。本技术说明的目的是描述我们治疗巨大的、无法修复的肩袖撕裂时首选的上盂唇重建技术。
