University of Colorado Health Steadman Hawkins Clinic Denver, Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA.
Princeton Orthopedic Associates, Princeton, NJ, USA.
J Shoulder Elbow Surg. 2021 Aug;30(8):1938-1948. doi: 10.1016/j.jse.2020.10.022. Epub 2020 Nov 19.
Current surgical treatment options for partial-thickness tears (eg, takedown and repair, in situ repair) are limited by the degenerative nature of the underlying tendon and may require extensive intervention that can alter the anatomic footprint. The complexity of available techniques to address these issues led to the development of a resorbable collagen implant, which can be used to create a bioinductive repair of partial-thickness tears.
We prospectively enrolled 33 patients with chronic, degenerative, intermediate-grade (n = 12), or high-grade (n = 21) partial-thickness tears (11 articular, 10 bursal, 4 intrasubstance, and 8 hybrid) of the supraspinatus tendon in a multicenter study. After arthroscopic subacromial decompression without a traditional rotator cuff repair, a bioinductive implant was secured over the bursal surface of the tendon. Clinical outcomes were assessed using American Shoulder and Elbow Surgeons (ASES) and Constant-Murley scores (CMS) preoperatively and at 3 months, 1 year, and 2 years postoperatively. Magnetic resonance imaging was performed to assess postoperative tendon healing and thickness at the original tear site.
At 2-year follow-up, mean ASES and CMS scores improved both clinically and statistically at 1 and 2 years, compared with baseline, for intermediate- and high-grade tears. There was magnetic resonance imaging evidence of new tissue fill-in within the original baseline tear in 100% of the intermediate-grade tears and 95% of the high-grade tears. In 90.9% of the intermediate-grade tears and 84.2% of the high-grade tears, this new tissue fill-in represented at least an additional 50% of the volume of the initial lesion. From baseline to 2-year follow-up, the mean tendon thickness increased by 1.2 mm (standard deviation, 1.3; P = .012) and 1.8 mm (standard deviation, 2.2; P = .003) in the intermediate- and high-grade tears, respectively. The analysis of tear grade and location revealed no statistically significant difference in the change in mean tendon thickness at any time point. One patient with a high-grade articular lesion demonstrated progression to a full-thickness tear; however, the patient was noncompliant and the injury occurred while shoveling snow 1 month after surgery. Neither tear location nor treatment of bicep pathology affected the ASES or CMS scores at any follow-up point. No serious adverse events related to the implant were reported.
Final results from this 2-year prospective study indicate that the use of this resorbable bovine collagen implant for isolated bioinductive repair of intermediate- and high-grade partial-thickness rotator cuff tears of the supraspinatus is safe and effective, regardless of tear grade and location.
目前部分厚度撕裂（例如，拆除和修复，原位修复）的手术治疗选择受到潜在肌腱退行性变的限制，可能需要广泛的干预，从而改变解剖学足迹。为了解决这些问题，可用技术的复杂性导致了可吸收胶原植入物的发展，可用于创建部分厚度撕裂的生物诱导修复。
我们前瞻性地纳入了 33 名患有慢性、退行性、中等程度（n=12）或高度（n=21）肩袖上旋肌腱部分厚度撕裂（11 个关节、10 个滑囊、4 个内部分离和 8 个混合）的患者，这些患者均在多中心研究中接受了关节镜下肩峰下减压术，而没有进行传统的肩袖修复。在肌腱滑囊表面固定生物诱导植入物。使用美国肩肘外科医师协会（ASES）和 Constant-Murley 评分（CMS）在术前和术后 3 个月、1 年和 2 年进行临床评估。磁共振成像（MRI）用于评估术后肌腱愈合和原始撕裂部位的厚度。
在 2 年的随访中，与基线相比，中、高度撕裂的 ASES 和 CMS 评分在 1 年和 2 年均有临床和统计学上的改善。在 100%的中度撕裂和 95%的高度撕裂中，MRI 显示在原始基线撕裂处有新的组织填充。在 90.9%的中度撕裂和 84.2%的高度撕裂中，这种新的组织填充至少代表初始病变体积的额外 50%。从中度撕裂的基线到 2 年的随访，肌腱厚度平均增加了 1.2 毫米（标准差，1.3；P=.012），高度撕裂增加了 1.8 毫米（标准差，2.2；P=.003）。撕裂等级和位置的分析表明，在任何时间点，肌腱厚度的平均变化均无统计学差异。一名高度关节病变的患者进展为全层撕裂；然而，该患者不配合，且在术后 1 个月铲雪时受伤。撕裂位置和肱二头肌病理的治疗均未影响任何随访点的 ASES 或 CMS 评分。没有与植入物相关的严重不良事件报告。
这项为期 2 年的前瞻性研究的最终结果表明，使用这种可吸收牛胶原植入物对孤立的生物诱导修复上旋肌腱的中、高度部分厚度肩袖撕裂是安全有效的，与撕裂等级和位置无关。
