Department of Orthopaedic Surgery, Stanford University, Stanford, California, U.S.A..
Department of Orthopaedic Surgery, Stanford University, Stanford, California, U.S.A.
Arthroscopy. 2021 Feb;37(2):720-746. doi: 10.1016/j.arthro.2020.09.016. Epub 2020 Nov 20.
To evaluate surgical techniques and clinical outcomes of arthroscopic superior capsular reconstruction (SCR) for the treatment of massive irreparable rotator cuff tears.
A systematic review was registered with PROSPERO and performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The PubMed, Scopus, and Cochrane databases were searched. Studies investigating SCR with reported surgical techniques were included. Animal studies, cadaveric studies, review studies, and letters to the editor were excluded. The technical aspects of the surgical techniques for SCR were analyzed in each article, which included graft type, glenoid fixation method, greater tuberosity fixation method, graft passage technique, suture management, margin convergence, concomitant procedures, and postoperative rehabilitation protocol. Clinical outcomes, when available, were also analyzed.
We screened 365 articles, of which 29 described surgical techniques for SCR. According to the Modified Coleman Methodology Score, 24 articles were rated as poor (score < 55), 4 were rated as fair (score between 55 and 69), and 1 was rated as good (score between 70 and 84), with an average score of 25.8 ± 20.9. The most commonly performed technique for SCR used the following: an acellular dermal allograft, 2 biocomposite suture anchors for glenoid fixation, transosseous-equivalent double-row suture anchor fixation for greater tuberosity fixation with 2 biocomposite medial-row anchors and 2 biocomposite lateral-row anchors, the double-pulley technique combined with an arthroscopic grasper and/or pull suture to pass the graft into the shoulder, the performance of both anterior and posterior margin convergence, and a native rotator cuff repair when possible. Only 8 studies reported clinical outcomes, and they showed that SCR provides significant improvement in patient-reported outcomes, significant improvement in shoulder range of motion, variable graft failure rates, low complication rates, and variable reoperation rates. There were no studies comparing outcomes among the various surgical techniques.
Many surgical techniques exist for arthroscopic SCR. However, no superior technique was shown because there were no studies comparing clinical outcomes among these various techniques.
Level V, systematic review of Level III, IV, and V studies.
评估关节镜下上肩袖重建（SCR）治疗巨大不可修复肩袖撕裂的手术技术和临床结果。
本研究通过 PROSPERO 进行了系统评价，并按照 PRISMA（系统评价和荟萃分析的首选报告项目）指南进行。检索了 PubMed、Scopus 和 Cochrane 数据库。纳入了报道 SCR 手术技术的研究。排除了动物研究、尸体研究、综述研究和给编辑的信。对每篇文章中 SCR 的手术技术的技术方面进行了分析，包括移植物类型、肩胛盂固定方法、大结节固定方法、移植物通过技术、缝线管理、边缘收敛、伴随手术和术后康复方案。如果有临床结果，也进行了分析。
我们筛选了 365 篇文章，其中 29 篇描述了 SCR 的手术技术。根据改良 Coleman 方法学评分，24 篇文章评为差（评分<55），4 篇文章评为中等（评分 55-69），1 篇文章评为好（评分 70-84），平均评分为 25.8±20.9。SCR 最常使用的技术包括：脱细胞真皮同种异体移植物、肩胛盂固定用 2 个生物复合材料缝合锚、大结节固定用双隧道等长缝线锚、2 个生物复合材料内侧排锚和 2 个生物复合材料外侧排锚、双滑轮技术结合关节镜抓钳和/或拉缝线将移植物送入肩部、前、后边缘收敛、尽可能修复原生肩袖。只有 8 项研究报告了临床结果，表明 SCR 可显著改善患者报告的结果、显著改善肩部活动范围、不同的移植物失败率、低并发症率和不同的再次手术率。没有研究比较不同手术技术的结果。
关节镜下 SCR 有许多手术技术，但由于没有研究比较这些不同技术的临床结果，因此没有显示出哪种技术更优。
5 级，系统评价 III、IV 和 V 级研究。
