Plachel F, Pauly S, Moroder P, Scheibel M
Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin, Augustenburgerplatz 1, 13353, Berlin, Deutschland.
Institut für Sehnen- und Knochenregeneration, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich.
Oper Orthop Traumatol. 2018 Apr;30(2):111-129. doi: 10.1007/s00064-018-0539-7. Epub 2018 Mar 22.
Reconstruction of tendon integrity to maintain glenohumeral joint centration and hence to restore shoulder functional range of motion and to reduce pain.
Isolated or combined full-thickness subscapularis tendon tears (≥upper two-thirds of the tendon) without both substantial soft tissue degeneration and cranialization of the humeral head.
Chronic tears of the subscapularis tendon with higher grade muscle atrophy, fatty infiltration, and static decentration of the humeral head.
After arthroscopic three-sided subscapularis tendon release, two double-loaded suture anchors are placed medially to the humeral footprint. Next to the suture passage, the suture limbs are tied and secured laterally with up to two knotless anchors creating a transosseous-equivalent repair.
The affected arm is placed in a shoulder brace with 20° of abduction and slight internal rotation for 6 weeks postoperatively. Rehabilitation protocol including progressive physical therapy from a maximum protection phase to a minimum protection phase is required. Overhead activities are permitted after 6 months.
While previous studies have demonstrated superior biomechanical properties and clinical results after double-row compared to single-row and transosseous fixation techniques, further mid- to long-term clinical investigations are needed to confirm these findings.
重建肌腱完整性以维持盂肱关节对中，从而恢复肩部功能活动范围并减轻疼痛。
孤立或合并的肩胛下肌腱全层撕裂（≥肌腱上三分之二），且无严重软组织退变和肱骨头高位化。
肩胛下肌腱慢性撕裂伴高级别肌肉萎缩、脂肪浸润和肱骨头静态偏移。
在关节镜下进行三边肩胛下肌腱松解后，在肱骨足迹内侧放置两个双负荷缝线锚钉。在缝线穿过之后，将缝线末端在外侧打结并固定，最多使用两个无结锚钉，形成类似骨隧道的修复。
术后6周将患侧手臂置于外展20°并轻度内旋的肩部支具中。需要康复方案，包括从最大保护阶段到最小保护阶段的渐进性物理治疗。6个月后允许进行过头活动。
虽然先前的研究表明，与单排和骨隧道固定技术相比，双排技术具有更好的生物力学性能和临床效果，但仍需要进一步的中长期临床研究来证实这些发现。
