Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, Vail, CO, USA; Center for Musculoskeletal Surgery, Charité Universitaetsmedizin Berlin, Berlin, Germany.
Center for Outcomes-based Orthopaedic Research, Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA.
J Shoulder Elbow Surg. 2020 Dec;29(12):2514-2522. doi: 10.1016/j.jse.2020.04.002. Epub 2020 Jun 9.
To compare clinical outcomes following arthroscopic superior capsule reconstruction (SCR) using a dermal allograft (DA) with reverse total shoulder arthroplasty (RTSA) when used to treat irreparable posterosuperior rotator cuff tears without glenohumeral osteoarthritis (GHOA) in patients younger than 70 years.
In this case-control study, patients who underwent SCR or RTSA for the treatment of irreparable posterosuperior rotator cuff tears, who were younger than 70 years at the time of surgery, and who were at least 2 years out of surgery were included. Clinical outcomes were assessed using the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Single Assessment Numerical Evaluation (SANE), Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores and the 12-Item Short Form Health Survey (SF-12). Return to sports and patient satisfaction along with clinical failures (recurrent pain or persistent pain or loss of function), revisions, and complications were reported.
Two-year follow-up was obtained on 22/22 patients (100%) in the SCR group and 29/33 patients (88%) in the RTSA group. Group differences were significant for age (SCR mean, 57 ± 6.6 years, vs. RTSA mean, 63 ± 4.9 years; P < .001) and follow-up interval (SCR mean, 2.1 years, vs. RTSA mean, 2.9 years; P = .001). Preoperative outcome scores showed no significant differences (all P > .05) between groups. No significant differences in postoperative outcome scores were detected (P > .05) between SCR and RTSA: the mean ASES score was 82.6 ± 15.5 vs. 79.3 ± 21.4, mean SANE score was 71.4 ± 24.5 vs. 75.4 ± 23.3, mean QuickDASH score was 16.2 ± 16.9 vs. 25.3 ± 21.0, and mean SF-12 was 47.7 ± 8.8 vs. 46.9 ± 10.4. No significant differences in return-to-sport responses were noticed between groups at baseline or postoperatively (P = .585, P = .758). One SCR was revised at 1.2 years with revision SCR and 1 RTSA had the glenoid component revised day 1 postoperatively for instability. Both patient groups achieved successful clinical outcomes.
SCR using DA results in similar postoperative functional outcomes in a younger patient population when compared to RTSA for the treatment of irreparable posterosuperior rotator cuff tears, without GHOA, at short-term follow-up.
比较在小于 70 岁且无肩肱关节炎（GHOA）的患者中，使用真皮移植物（DA）进行关节镜下上囊重建（SCR）与反式全肩关节置换术（RTSA）治疗不可修复的后上肩袖撕裂的临床结果。
在这项病例对照研究中，纳入了接受 SCR 或 RTSA 治疗不可修复的后上肩袖撕裂的患者，这些患者在手术时年龄小于 70 岁，并且手术结束后至少随访 2 年。使用美国肩肘外科医生协会（ASES）标准肩评估表、单一评估数值评估（SANE）、快速上肢肩部和手问卷（QuickDASH）和 12 项简短健康调查（SF-12）评估临床结果。报告了重返运动和患者满意度以及临床失败（复发疼痛或持续疼痛或功能丧失）、翻修和并发症。
在 SCR 组的 22/22 例（100%）和 RTSA 组的 29/33 例（88%）患者中获得了 2 年的随访。两组间在年龄（SCR 组平均 57±6.6 岁，RTSA 组平均 63±4.9 岁；P<.001）和随访间隔（SCR 组平均 2.1 年，RTSA 组平均 2.9 年；P=0.001）上差异显著。术前的结果评分在两组之间无显著差异（均 P>.05）。SCR 和 RTSA 的术后结果评分无显著差异（P>.05）：平均 ASES 评分为 82.6±15.5 分比 79.3±21.4 分，平均 SANE 评分为 71.4±24.5 分比 75.4±23.3 分，平均 QuickDASH 评分为 16.2±16.9 分比 25.3±21.0 分，平均 SF-12 评分为 47.7±8.8 分比 46.9±10.4 分。两组在基线或术后的重返运动反应均无显著差异（P=0.585，P=0.758）。SCR 中有 1 例在 1.2 年时进行了翻修，RTSA 中有 1 例在术后第 1 天因不稳定而行肩胛盂组件翻修。两组患者均获得了成功的临床结果。
在短期随访中，与 RTSA 相比，使用 DA 的 SCR 在治疗无肩肱关节炎的不可修复的后上肩袖撕裂的年轻患者中，术后功能结果相似。
