Makki Daoud, Tang Quen O, Sandher Dilraj, Morgan Barnes W, Ravenscroft Matt
Orthopedics. 2020 Jul 1;43(4):215-220. doi: 10.3928/01477447-20200428-05. Epub 2020 May 7.
Irreparable massive cuff tears in young patients pose a difficult problem for shoulder surgeons. Arthroscopic superior capsular reconstruction has shown promise in recent years in the treatment of this challenging patient population. The majority of the literature is limited to surgical techniques. The authors present the 2-year clinical outcomes of 25 patients undergoing arthroscopic superior capsular reconstruction with dermal allograft from a single center. The Oxford Shoulder Score and range of motion were assessed preoperatively and then at 3 to 6 months, 1 year, and 2 years following surgery. Patient satisfaction was recorded at final follow-up. Magnetic resonance imaging was performed at 3 months postoperatively to assess graft integrity. All patients were available at 1-year follow-up, and 23 were available at 2 years. The mean Oxford Shoulder Score improved by a minimum of 10 points at all time points compared with preoperatively. The mean forward flexion and abduction improved by 20° and external rotation by 7°. Revision to reverse shoulder arthroplasty was seen in 3 patients (12%). Graft failure was seen in 4 patients (16%). Overall, 20 patients had successful outcomes at 1 year (80%) and 18 patients had successful outcomes at 2 years (72%). Superior capsular reconstruction offers a safe and effective short-term bridging option for young patients with irreparable supraspinatus tears in the absence of glenohumeral arthritis. However, long-term outcome studies are required to evaluate the true clinical effectiveness and failure rates. [Orthopedics. 2020;43(4):215-220.].
年轻患者出现不可修复的大面积肩袖撕裂，给肩关节外科医生带来了难题。近年来，关节镜下上盂唇重建术在治疗这类具有挑战性的患者群体方面显示出了前景。大多数文献仅限于手术技术。作者展示了来自单一中心的25例接受同种异体真皮移植关节镜下上盂唇重建术患者的2年临床结果。术前以及术后3至6个月、1年和2年评估牛津肩关节评分和活动范围。在最终随访时记录患者满意度。术后3个月进行磁共振成像以评估移植物完整性。所有患者均完成了1年随访，23例完成了2年随访。与术前相比，所有时间点的牛津肩关节评分平均至少提高了10分。平均前屈和外展分别改善了20°，外旋改善了7°。3例患者（12%）进行了翻转为反式肩关节置换术。4例患者（16%）出现移植物失败。总体而言，20例患者在1年时获得成功结果（80%），18例患者在2年时获得成功结果（72%）。对于没有盂肱关节炎的年轻不可修复的冈上肌撕裂患者，上盂唇重建提供了一种安全有效的短期桥接选择。然而，需要长期结果研究来评估其真正的临床有效性和失败率。[《骨科学》。2020年；43(4):215 - 220。]
