From the Mayo Clinic Arizona, Phoenix, AZ.
J Am Acad Orthop Surg. 2020 Jul 1;28(13):528-537. doi: 10.5435/JAAOS-D-19-00057.
The ideal solution for the irreparable rotator cuff tear remains in question. A recent innovative technique, superior capsular reconstruction (SCR), has demonstrated promising results with some early clinical outcomes demonstrating statistically notable improvements in active forward flexion and American Shoulder and Elbow Surgeons scores. Multiple biomechanical studies have also demonstrated its ability to reduce superior translation of the humerus after massive rotator cuff tear. Even so, these results are still early and durability of the reconstruction over time needs to be determined. Although more than 15,000 SCRs have been done worldwide, there remains a paucity of outcome data and one must be vigilant to not allow enthusiasm to overtake critical evaluation. The potential mechanisms of action, including tenodesis effect, force coupler, or subacromial spacer, need further elucidation and the ideal indications for this procedure, as well as its technical optimization, and limitations have yet to be fully determined. The purpose of this review is to critically evaluate the biomechanical and clinical literature that has assessed SCR, along with the controversies and considerations encountered with this procedure.
对于无法修复的肩袖撕裂，理想的解决方案仍存在争议。最近的一项创新技术，即上囊重建（SCR），已经取得了一些有前途的临床早期结果，在主动前屈和美国肩肘外科医生评分方面显示出统计学上显著的改善。多项生物力学研究也表明，它能够减少巨大肩袖撕裂后肱骨头的上移。即便如此，这些结果还为时过早，需要确定重建的耐久性随时间的推移。尽管全球已经进行了超过 15000 次 SCR，但仍缺乏结果数据，我们必须保持警惕，不要让热情超过对手术的批判性评估。作用机制包括腱固定效应、力耦合器或肩峰下间隙，需要进一步阐明，该手术的理想适应证、技术优化及其局限性尚未完全确定。本文旨在对评估 SCR 的生物力学和临床文献进行批判性评估，同时讨论该手术的争议和注意事项。
