Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Woodland Hills Medical Center, Los Angeles, California, U.S.A..
Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, U.S.A.
Arthroscopy. 2021 May;37(5):1400-1410. doi: 10.1016/j.arthro.2020.12.183. Epub 2020 Dec 23.
To biomechanically assess translation, contact pressures, and range of motion for anterior cable reconstruction (ACR) using hamstring allograft for large to massive rotator cuff tears.
Eight cadaveric shoulders (mean age, 68 years) were tested with a custom testing system. Range of motion (ROM), superior translation of the humeral head, and subacromial contact pressure were measured at 0°, 30°, 60°, and 90° of external rotation (ER) with 0°, 20°, and 40° of glenohumeral abduction. Three conditions were tested: intact, stage III tear (supraspinatus + anterior half of infraspinatus), and stage III tear + allograft ACR (involving 2 supraglenoid anchors for semitendinosus tendon allograft fixation. Allograft ACR included loop-around fixation using 3 side-to-side sutures and an anchor at the articular margin to restore capsular anatomy along the anterior edge of the cuff defect.
ACR with allograft for stage III tears showed significantly higher total ROM compared with intact at all angles (P ≤ .028). Augmentation significantly decreased superior translation for stage III tears at 0°, 30°, and 60° ER for both 0° and 20° abduction, and at 0° and 30° ER for 40° abduction (P ≤ .043). Augmentation for stage III tears significantly reduced overall subacromial contact pressure at 30° ER with 0° and 40° abduction, and at 60° ER with 0° and 20° abduction (P ≤ .016).
Anterior cable reconstruction using cord-like allograft semitendinosus tendon can biomechanically improve superior migration and subacromial contact pressure (primarily in the lower combined abduction and rotation positions), without limiting range of motion for large rotator cuff tendon defects or tears.
In patients with superior glenohumeral instability, using hamstring allograft for ACR may improve rotator cuff tendon defect longevity by providing basic static ligamentous support to the dynamic tendon while helping to limit superior migration, without restricting glenohumeral kinematics.
使用腘绳肌腱同种异体移植物对大型至巨大肩袖撕裂进行前侧锚钉重建（ACR），从生物力学角度评估移植物的翻译、接触压力和活动度。
使用定制的测试系统对 8 个尸体肩关节（平均年龄 68 岁）进行了测试。在 0°、30°和 60°外旋（ER）以及 0°、20°和 40°肩肱外展下，测量了关节活动度（ROM）、肱骨头的上移以及肩峰下的接触压力。共测试了 3 种情况：完整、III 期撕裂（冈上肌+肩胛下肌前半部分）和 III 期撕裂+同种异体移植物 ACR（涉及 2 个上盂唇的锚钉用于固定半腱肌腱同种异体移植物。ACR 移植物包括使用 3 个侧侧缝线和关节缘处的锚钉进行的环扎固定，以沿着肩袖缺损的前边缘重建囊状解剖结构。
与完整组相比，III 期撕裂的 ACR 移植物在所有角度的总 ROM 均显著更高（P≤.028）。对于 III 期撕裂，在 0°、30°和 60° ER 以及 0°和 20°外展下，在 0°和 30° ER 以及 40°外展下，增强均显著降低了上移（P≤.043）。对于 III 期撕裂，在 30° ER 下，增强显著降低了整体肩峰下接触压力，在 0°和 40°外展以及 60° ER 下，在 0°和 20°外展下（P≤.016）。
使用 cord-like 同种异体移植物半腱肌腱的前侧锚钉重建可以从生物力学角度改善上移和肩峰下接触压力（主要在较低的联合外展和旋转位置），而不会限制大型肩袖肌腱缺损或撕裂的关节活动度。
在肩峰上不稳定的患者中，使用腘绳肌腱同种异体移植物进行 ACR 可能会通过为动态肌腱提供基本的静态韧带支持来改善肩袖肌腱缺损的寿命，同时有助于限制上移，而不会限制肩肱关节的运动学。
