Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A.; Department of Orthopaedic Sports Medicine, Technical University of Munich, Germany.
Department of Orthopaedic Surgery, UConn Health Center, Farmington, Connecticut, U.S.A.
Arthroscopy. 2020 Jun;36(6):1542-1551. doi: 10.1016/j.arthro.2020.02.006. Epub 2020 Mar 30.
To evaluate the clinical outcomes of patients who underwent biologically enhanced patch augmentation repair for the treatment of revision massive rotator cuff tears.
Twenty-two patients who underwent arthroscopic and mini-open rotator cuff repair using a patch augmented with platelet-rich plasma and concentrated bone marrow aspirate (cBMA) for revision massive (≥2 tendons) rotator cuff tears from 2009 to 2014, with a minimum 1-year follow-up, were included in the study. In this procedure the medial side of the graft is secured to the rotator cuff tendon remaining medially. American Shoulder and Elbow Surgeons (ASES), Simple Shoulder Test, and postoperative Single Assessment Numerical Evaluation scores were evaluated. To determine the clinical relevance of ASES scores, the minimal clinically important difference, substantial clinical benefit (SCB), and the patient-acceptable symptomatic state (PASS) thresholds were used. Clinical success or failure was defined based on whether the patient reached the SCB threshold. In the laboratory, cellular counting along with the concentration of connective tissue progenitor cells were performed on patch samples from the day of surgery. Scaffolds were processed histologically at days 0, 7,14, and 21 of culture.
Patients had significant improvement in the Simple Shoulder Test (2.6 ± 3.0 vs 5.2 ± 4.2, P = .01), whereas improvement in pain scores was found to be nonsignificant (5.6 ± 2.5 vs 4.2 ± 3.4P = .11) at final follow-up. Mean ASES improved by Δ14.6 ± 33.4 points; however, this did not reach statistical significance (40.2 ± 21.6 vs 53.9 ± 31.4P = .10). With regards to ASES score, 45% of patients achieved the minimal clinically important difference, 41% the SCB, and 32% reached or exceeded the PASS criteria. At 21 days, there was a significantly greater cell count in scaffolds from patients who had clinical success than those who were failures (P = .02).
Only 41% of patients undergoing biologically enhanced patch augmentation repair reached substantial clinical benefit, whereas 32% reached or exceeded the PASS criteria.
Case Series: Level IV.
评估采用富含血小板血浆和浓缩骨髓抽吸物（cBMA）增强补丁增强修复治疗复发性巨大肩袖撕裂的患者的临床结果。
2009 年至 2014 年间，对 22 例因复发性（≥2 根肌腱）巨大肩袖撕裂而接受关节镜和小切口肩袖修复的患者进行了研究，这些患者均采用富含血小板血浆和浓缩骨髓抽吸物增强的补片进行修复，这些患者至少随访 1 年。在该手术中，移植物的内侧部分固定在残留在内侧的肩袖肌腱上。评估美国肩肘外科医师协会（ASES）评分、简易肩部测试和术后单项评估数值评分。为了确定 ASES 评分的临床意义，使用了最小临床重要差异、实质性临床获益（SCB）和患者可接受的症状状态（PASS）阈值。根据患者是否达到 SCB 阈值来定义临床成功或失败。在实验室中，对手术当天的补片样本进行细胞计数和结缔组织祖细胞浓度检测。支架在培养的第 0、7、14 和 21 天进行组织学处理。
患者在简易肩部测试中（2.6±3.0 比 5.2±4.2，P=.01）有显著改善，而疼痛评分的改善则无统计学意义（5.6±2.5 比 4.2±3.4，P=.11）。最终随访时平均 ASES 增加了 14.6±33.4 分；然而，这并没有达到统计学意义（40.2±21.6 比 53.9±31.4，P=.10）。关于 ASES 评分，45%的患者达到了最小临床重要差异，41%达到了 SCB，32%达到或超过了 PASS 标准。在第 21 天，临床成功患者的支架细胞计数明显高于失败患者（P=.02）。
只有 41%的接受生物增强补片增强修复的患者达到实质性临床获益，而 32%的患者达到或超过 PASS 标准。
病例系列：IV 级。
