Orthopädiezentrum Sachsenortho, Breitscheidstrasse 13, 08209, Auerbach, Germany.
Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstrasse 20, 04103, Leipzig, Germany.
Arch Orthop Trauma Surg. 2022 Jul;142(7):1385-1393. doi: 10.1007/s00402-021-03757-8. Epub 2021 Jan 23.
Inferior tendon quality, wide retraction, and tendon stumps that cannot be mobilized define the limits of what is technically feasible for open and arthroscopic rotator cuff reconstruction. The aim of this study was to develop a procedure that enables the open reconstruction of otherwise non-reconstructable rotator cuff tears.
From 2014 to 2018, 23 operations were performed on 21 patients (mean age 63) using open procedure involving separating the infraspinatus tendon from the point of insertion on the greater tubercle and mobilizing it proximally and ventrally into the defective area. Any remaining defects were augmented using an autologous biceps tendon interposition graft. This augmentation was performed to achieve complete closure of the defect. Furthermore, the augmentation of the rupture zone was intended to strengthen the tendon stumps of the SSP and ISP to better neutralize the initial tensile forces. After a postoperative period of 12 months-4 years, clinical examination and functional tests were carried out, the Constant score was determined, and radiological and magnetic resonance imaging check-up examinations were performed.
The technique resulted in a low-tension closure of an otherwise "non-repairable" superior rotator cuff defect. All patients experienced a significant functional improvement, a reduction in pain, and an increase in muscle strength. An improvement in the Constant score from 48 points preoperatively to 87 points postoperatively (p < 0.05) was observed. In 19 patients (90%), the magnetic resonance image showed an intact reconstruction. Re-rupture was seen in three patients (14%).
The surgical procedure using infraspinatus tendon shift and autologous biceps tendon interposition grafts resulted in the successful reconstruction of otherwise non-reconstructable massive rotator cuff lesions. The complete closure of the defect was observed.
跟腱质量差、广泛回缩以及无法活动的跟腱残端定义了开放式和关节镜下肩袖重建技术可行的极限。本研究旨在开发一种能使原本无法重建的肩袖撕裂得以重建的手术方法。
2014 年至 2018 年，21 例患者（平均年龄 63 岁）接受了 23 例手术，采用开放式手术，将冈下肌肌腱从大结节的附着点处分离，并将其向近端和腹侧移动到缺损区域。使用自体二头肌肌腱间置移植物对任何剩余的缺损进行修复。这种修复是为了实现缺损的完全闭合。此外，增加撕裂区的强度旨在加强 SSP 和 ISP 的跟腱残端，以更好地中和初始拉伸力。术后 12-4 年进行临床检查和功能测试，确定 Constant 评分，并进行影像学和磁共振成像检查。
该技术实现了对原本“无法修复”的上肩袖缺损的低张力闭合。所有患者的功能均显著改善，疼痛减轻，肌肉力量增强。Constant 评分从术前的 48 分提高到术后的 87 分（p<0.05）。19 例患者（90%）磁共振图像显示重建完整。3 例患者（14%）出现再撕裂。
使用冈下肌肌腱移位和自体二头肌肌腱间置移植物的手术程序成功重建了原本无法重建的巨大肩袖病变。观察到缺损完全闭合。
