Mirzayan Raffy, Stone Michael A, Batech Michael, Acevedo Daniel C, Singh Anshuman
Department of Orthopaedics, Kaiser Permanente Southern California, Baldwin Park, California, USA.
Department of Orthopaedics, USC Keck School of Medicine, Los Angeles, California, USA.
Orthop J Sports Med. 2019 Aug 20;7(8):2325967119863432. doi: 10.1177/2325967119863432. eCollection 2019 Aug.
Acellular dermal matrices (ADMs) have been used in the treatment of shoulders with massive rotator cuff tears (MRCTs). Despite clinical improvement, correlation of clinical findings with ADM integrity on imaging has not been investigated.
The pain in shoulders with MRCTs is partially due to bone-to-bone contact between the tuberosity and acromion. Coverage of the tuberosity with an intact graft or a graft that is torn in a way that the tuberosity remains covered will act as an interpositional tissue, preventing bone-to-bone contact and leading to clinical improvement.
Case series; Level of evidence, 4.
Between 2006 and 2016, a total of 25 shoulders with MRCTs underwent a procedure with an ADM. Pre- and postoperative visual analog scale (VAS) results, American Shoulder and Elbow Surgeons (ASES) score, Hamada grade, and Goutallier classification were reviewed. A postoperative magnetic resonance imaging (MRI) was obtained in 22 (88%) shoulders. The status of the graft was divided into the following categories: type I, intact graft; type II, graft tear with tuberosity covered; and type III, graft tear with tuberosity uncovered (bare).
The mean patient age was 61 years (range, 49-73 years), and the mean follow-up was 25.6 months (range, 10-80 months). Mean length from surgery to postoperative MRI was 13.9 months (range, 6-80 months). The graft was torn in 59% (13/22 shoulders). Significant improvements were found in VAS and ASES scores (7 vs 0.7 and 32.6 vs 91.2, respectively; < .01) for type I grafts and in VAS and ASES scores (8.1 vs 1.3 and 26.3 vs 84.6, respectively; < .01) for type II grafts. No difference was found in postoperative VAS and ASES (0.7 vs 1.3 and 91.2 vs 84.6, respectively; = .8) between type I and type II grafts. No improvement was seen in VAS (7.3 vs 5.7; = .2) or ASES (30.6 vs 37.2; = .5) for type III grafts.
MRI appearance of the graft has a significant impact on functional outcomes. Patients with an intact graft or a graft tear leaving the tuberosity covered have lower pain and higher functional scores than those in whom the torn graft leaves the tuberosity uncovered.
脱细胞真皮基质（ADM）已用于治疗伴有巨大肩袖撕裂（MRCT）的肩部疾病。尽管临床症状有所改善，但尚未对影像学上临床发现与ADM完整性之间的相关性进行研究。
伴有MRCT的肩部疼痛部分归因于结节与肩峰之间的骨对骨接触。用完整移植物或虽撕裂但结节仍被覆盖的移植物覆盖结节，将起到间置组织的作用，防止骨对骨接触并导致临床症状改善。
病例系列；证据等级，4级。
2006年至2016年期间，共有25例伴有MRCT的肩部接受了ADM手术。回顾术前和术后视觉模拟量表（VAS）结果、美国肩肘外科医师学会（ASES）评分、滨田分级和古塔利耶分类。22例（88%）肩部进行了术后磁共振成像（MRI）检查。移植物状态分为以下几类：I型，完整移植物；II型，移植物撕裂但结节被覆盖；III型，移植物撕裂且结节未被覆盖（裸露）。
患者平均年龄为61岁（范围49 - 73岁），平均随访时间为25.6个月（范围10 - 80个月）。从手术到术后MRI的平均时间为13.9个月（范围6 - 80个月）。59%（13/22例肩部）的移植物发生撕裂。I型移植物的VAS和ASES评分有显著改善（分别为7分对0.7分以及32.6分对91.2分；P <.01），II型移植物的VAS和ASES评分也有显著改善（分别为8.1分对1.3分以及26.3分对84.6分；P <.01）。I型和II型移植物术后VAS和ASES评分无差异（分别为0.7分对1.3分以及91.2分对84.6分；P =.8）。III型移植物的VAS（7.3分对5.7分；P =.2）或ASES（30.6分对37.2分；P =.5）未见改善。
移植物的MRI表现对功能结果有显著影响。与撕裂的移植物使结节未被覆盖的患者相比，移植物完整或撕裂但结节仍被覆盖的患者疼痛程度更低，功能评分更高。
