Orthopedic Institute of Wisconsin, Milwaukee; and Midwest Orthopedic Specialty Hospital, Franklin, Wisconsin, U.S.A..
Orthopedic Institute of Wisconsin, Milwaukee; and Midwest Orthopedic Specialty Hospital, Franklin, Wisconsin, U.S.A.
Arthroscopy. 2018 Jun;34(6):1764-1773. doi: 10.1016/j.arthro.2018.01.009. Epub 2018 Feb 15.
This outcome analysis presents 88 consecutive shoulders presenting with irreparable rotator cuff tears that we treated with arthroscopic superior capsular reconstruction (SCR) using an acellular dermal allograft. We also present the concept of superior capsular distance to quantitatively measure the decreased distance present upon restoration of superior capsular integrity.
A retrospective review was conducted of patients treated with arthroscopic SCR with a minimum 12-month follow-up. Outcome analysis was performed via an internet-based outcome-tracking system to evaluate visual analog scale (VAS) and American Shoulder and Elbow Surgeons (ASES) scores. Radiographic analysis of anteroposterior radiographs analyzed acromiohumeral interval and superior capsular distance. Digital dynamometric strength and functional range of motion assessments were also obtained. The main inclusion criteria for patients in this analysis was all patients who underwent superior capsular reconstruction during the time period of this report.
Eighty-six patients with an average age of 59.4 years presented with massive rotator cuff tears (Cofield >5 cm). Outcome data revealed improvement in VAS (4.0-1.5), and ASES (52-82) scores at 1 year (P = .005). Radiographic analysis showed increase in acromiohumeral interval (mean 7.1 mm preoperatively to mean 9.7 mm at 1 year) (P = .049) and superior capsular distance (mean 52.9 mm preoperatively to mean 46.2 mm at 1 year) (P = .011). Strength improved significantly (forward flexion/abduction/external rotation of 4.8/4.1/7.7 lb preoperatively to 9.8/9.2/12.3 lb at 1 year) as well as range of motion (forward flexion/abduction of 120°/103° preoperatively to 160°/159° at 1 year) (P = .044/P = .007/P = .02). At follow-up, 90% of patients were satisfied.
This analysis reveals that arthroscopic SCR with acellular dermal allograft has been successful in decreasing pain and improving function in this patient subset. Radiographic analysis has also shown a consistent and lasting decrease in superior capsular distance and increase in acromiohumeral interval, indicating maintenance of superior capsular stability.
Level IV, retrospective case series.
本研究对 88 例经关节镜手术治疗的不可修复性肩袖撕裂患者进行回顾性分析，这些患者均接受了关节镜下带细胞真皮移植物的上囊重建（SCR）。我们还提出了上囊距离的概念，以便定量测量上囊完整性恢复后上囊距离的减小。
对接受关节镜 SCR 治疗且随访时间至少 12 个月的患者进行回顾性研究。通过互联网的结果跟踪系统进行结果分析，以评估视觉模拟量表（VAS）和美国肩肘外科医师协会（ASES）评分。对前后位 X 线片进行分析，评估肩峰肱骨关节间隙和上囊距离。还进行了数字测力计力量和功能活动范围的评估。本分析中患者的主要纳入标准是所有在此报告时间段内接受上囊重建的患者。
86 例平均年龄 59.4 岁的患者患有巨大肩袖撕裂（Cofield>5cm）。结果数据显示 VAS（4.0-1.5）和 ASES（52-82）评分在 1 年时改善（P=0.005）。影像学分析显示肩峰肱骨关节间隙增加（术前平均 7.1mm，术后 1 年平均 9.7mm）（P=0.049）和上囊距离增加（术前平均 52.9mm，术后 1 年平均 46.2mm）（P=0.011）。力量显著改善（术前前屈/外展/外旋 4.8/4.1/7.7 磅，术后 1 年 9.8/9.2/12.3 磅）以及活动范围（术前前屈/外展 120°/103°，术后 1 年 160°/159°）（P=0.044/P=0.007/P=0.02）。在随访时，90%的患者满意。
本分析表明，关节镜下带细胞真皮移植物 SCR 已成功减少疼痛并改善此类患者的功能。影像学分析还显示上囊距离持续且稳定减少，肩峰肱骨关节间隙增加，表明上囊稳定性得到维持。
IV 级，回顾性病例系列。
