Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal.
ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
Am J Sports Med. 2020 Jul;48(9):2115-2128. doi: 10.1177/0363546520928649.
The clinical importance of graft type and integrity in arthroscopic superior capsular reconstruction (ASCR) remains controversial.
To assess 3-year clinical and magnetic resonance imaging (MRI) outcomes of ASCR using a minimally invasively harvested fascia lata autograft (FLA) for irreparable rotator cuff tears (IRCTs) and to determine the clinical importance of graft integrity and whether the results change from year 2 to 3.
Case series; Level of evidence, 4.
A total of 22 consecutive patients who underwent ASCR with a minimally invasively harvested FLA were enrolled in a prospective single-arm study. At 3 years, the patients answered a satisfaction questionnaire and underwent a clinical examination and MRI. The MRI scans were independently reviewed by 3 raters to determine the graft integrity, acromiohumeral interval, supraspinatus atrophy, and fatty degeneration of the rotator cuff muscles. Reliability statistics were calculated, and the outcomes were compared across subgroups of patients with and without complete graft tears.
Overall, 21 patients (95.5%) answered the questionnaire, 20/21 (95.2%) were satisfied, 4/20 (20.0%) reported donor site pain, and 19 patients (86.4%) underwent examinations. From preoperatively to 3 years, the mean improvement was 73.68° in elevation (95% CI, 47.59°-99.77°), 89.21° in abduction (95% CI, 66.56°-111.86°), 24.74° in external rotation (95% CI, 4.72°-34.75°), 3.00 in internal rotation (95% CI, 2.36-3.64), 2.61 kg in abduction strength (95% CI, 1.76-3.45 kg), 50.79 on the Constant score (CS; 95% CI, 41.99-59.58), 7.47 on the Simple Shoulder Test (SST; 95% CI, 5.19-9.75), and 36.05% on the subjective shoulder value (SSV; 95% CI, 23.19%-48.92%), which were all significant ( < .05). From 2 to 3 years, the mean improvement in abduction was 20.26° (95% CI, 5.44°-35.09°), which was significant ( = .010). At 3 years, the raters perfectly agreed (kappa = 1; = .000013) that 4 patients (21.1%) had complete graft tears; this subgroup of patients had decreased external rotation strength at 90° of abduction (1.77 ± 0.17 vs 4.45 ± 2.55 kg, respectively; = .027) and increased grades of infraspinatus (3.50 ± 0.58 vs 2.20 ± 1.01, respectively; = .030) and teres minor fatty degeneration (3.25 ± 0.96 vs 1.53 ± 0.64, respectively; = .005) compared with those without a complete graft tear, but the mean CS, SST, and SSV scores did not differ from those of the overall group (69.50 ± 5.20 vs 69.63 ± 18.25; 9.00 ± 2.31 vs 9.74 ± 4.73; and 72.50 ± 15.00 vs 71.58 ± 26.70, respectively).
The 3-year clinical outcomes of ASCR using a minimally invasively harvested FLA for IRCTs were good, despite donor site morbidity. Active abduction improved significantly from 2 to 3 years. Complete graft tears were correlated with significantly decreased external rotation strength at 90° of shoulder abduction and increased grades of infraspinatus and teres minor fatty degeneration.
NCT03663036 (ClinicalTrials.gov identifier).
关节镜下肩袖上囊重建（ASCR）中移植物类型和完整性的临床重要性仍存在争议。
评估使用微创获取的阔筋膜移植物（FLA）治疗不可修复性肩袖撕裂（IRCT）的 ASCR 的 3 年临床和磁共振成像（MRI）结果，并确定移植物完整性的临床重要性以及结果是否会从第 2 年到第 3 年发生变化。
病例系列；证据水平，4 级。
共纳入 22 例连续接受微创获取 FLA 的 ASCR 患者，进行前瞻性单臂研究。3 年后，患者回答满意度问卷，并接受临床检查和 MRI 检查。MRI 扫描由 3 位评估者独立进行评估，以确定移植物完整性、肩峰肱骨关节间隙、冈上肌萎缩和肩袖肌肉脂肪变性。计算可靠性统计数据，并对有和无完全移植物撕裂的患者亚组进行比较。
总体而言，21 例患者（95.5%）回答了问卷，20/21 例（95.2%）满意，4/20 例（20.0%）报告供区疼痛，19 例（86.4%）接受了检查。从术前到 3 年，外展的平均改善为 73.68°（95%CI，47.59°-99.77°），外旋的平均改善为 24.74°（95%CI，4.72°-34.75°），内旋的平均改善为 3.00（95%CI，2.36-3.64），外展力量的平均改善为 2.61kg（95%CI，1.76-3.45kg），Constant 评分的平均改善为 50.79（95%CI，41.99-59.58），Simple Shoulder Test 的平均改善为 7.47（95%CI，5.19-9.75），主观肩部值的平均改善为 36.05%（95%CI，23.19%-48.92%），所有改善均有统计学意义（ <.05）。从第 2 年到第 3 年，外展的平均改善为 20.26°（95%CI，5.44°-35.09°），差异有统计学意义（ =.010）。3 年后，评估者完全一致（kappa = 1； =.000013）认为 4 例（21.1%）患者存在完全移植物撕裂；该亚组患者在 90°外展时的外旋力量下降（分别为 1.77 ± 0.17 与 4.45 ± 2.55kg， =.027），冈下肌和小菱形肌的脂肪变性程度增加（分别为 3.50 ± 0.58 与 2.20 ± 1.01， =.030），且小圆肌的脂肪变性程度增加（分别为 3.25 ± 0.96 与 1.53 ± 0.64， =.005），与无完全移植物撕裂的患者相比，差异均有统计学意义，但 CS、SST 和 SSV 评分与总体组无差异（69.50 ± 5.20 与 69.63 ± 18.25；9.00 ± 2.31 与 9.74 ± 4.73；72.50 ± 15.00 与 71.58 ± 26.70）。
使用微创获取的 FLA 治疗不可修复性肩袖撕裂的 ASCR 患者，3 年临床结果良好，尽管存在供区并发症。主动外展从第 2 年到第 3 年显著改善。完全移植物撕裂与肩外展 90°时的外旋力量明显下降和冈下肌、小菱形肌脂肪变性程度增加有关。
NCT03663036（ClinicalTrials.gov 标识符）。
