Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
J Shoulder Elbow Surg. 2021 Jul;30(7S):S48-S56. doi: 10.1016/j.jse.2021.02.026. Epub 2021 Mar 26.
A viable treatment option for young patients with massive, irreparable rotator cuff tears is arthroscopic superior capsule reconstruction (SCR). SCR theoretically improves shoulder stability and function and decreases pain. However, no prospective studies to date have correlated magnetic resonance imaging (MRI) healing with in vivo kinematic data. The purpose of this study was to evaluate the association between graft healing and in vivo kinematics, range of motion (ROM), strength, and patient-reported outcomes (PROs).
Ten patients (8 men and 2 women; mean age, 63 ± 7 years) with irreparable rotator cuff tears underwent arthroscopic SCR with dermal allograft. Strength was measured with isometric internal rotation and external rotation (ER) at 0° of abduction, ER at 90° of abduction, and scapular-plane abduction, whereas ROM was measured during shoulder flexion, abduction, and ER and internal rotation at 90° of abduction both before and 1 year after SCR. PROs included American Shoulder and Elbow Surgeons, Western Ontario Rotator Cuff Index, and Disabilities of the Arm, Shoulder and Hand surveys that were collected before and 1 year after SCR. Synchronized biplane radiographs were collected at 50 images/s before and 1 year after SCR while patients performed 3 trials of scapular-plane abduction. A validated volumetric tracking technique with submillimeter accuracy determined 6-df glenohumeral and scapular kinematics. The acromiohumeral distance (AHD), humeral head translation, and scapulohumeral rhythm (SHR) were calculated from the in vivo kinematics. Healing at 5 locations was evaluated on 1-year postoperative MRI scans: anterior and posterior glenoid, anterior and posterior humerus, and posteriorly along the infraspinatus. Each subject was given a score from 0 to 5 based on number of sites healed.
Of the 10 patients, 9 (90%) had complete (n = 4) or partial (n = 5) healing of the graft whereas 1 (10%) had complete failure at the glenoid. No correlation existed between MRI healing and the AHD, SHR, strength, ROM, or PROs. American Shoulder and Elbow Surgeons, Western Ontario Rotator Cuff Index, and Disabilities of the Arm, Shoulder and Hand scores all significantly improved from before to 1 year after SCR regardless of graft healing.
The rate of complete or partial graft healing on MRI mimics findings of prior reports in the literature. MRI healing was correlated with humeral head anterior-posterior translation but not with the static and dynamic AHDs, SHR, humeral head superior-inferior translation, ROM, strength, or PROs 1 year after SCR. All PROs improved significantly from before to 1 year after SCR regardless of graft status on MRI. In vivo kinematic changes were small after SCR and not clinically significant, and the data suggest that improvements in clinical and functional outcomes may occur in the absence of full graft healing.
对于患有大量不可修复的肩袖撕裂的年轻患者，关节镜下上囊重建（SCR）是一种可行的治疗选择。SCR 理论上可以改善肩部稳定性和功能，减轻疼痛。然而，迄今为止，尚无前瞻性研究将磁共振成像（MRI）愈合与体内运动学数据相关联。本研究的目的是评估移植物愈合与体内运动学、活动范围（ROM）、力量和患者报告的结果（PROs）之间的相关性。
10 例（8 名男性和 2 名女性；平均年龄 63±7 岁）不可修复的肩袖撕裂患者接受关节镜下真皮同种异体 SCR。在肩关节外展 0°时测量等长内旋和外旋（ER）、外展 90°时的 ER 和肩胛骨平面外展时的力量，而在 SCR 前后测量肩关节屈曲、外展和外展 90°时的 ROM 和内旋。PROs 包括美国肩肘外科医师协会、安大略西部肩袖指数和手臂、肩部和手残疾调查，这些调查在 SCR 前后收集。在 SCR 前后，患者进行 3 次肩胛骨平面外展试验时，同步采集双平面射线照片，以每秒 50 帧的速度采集。使用具有亚毫米精度的经过验证的容积跟踪技术确定 6-df 盂肱和肩胛骨运动学。从体内运动学中计算肩峰肱骨头距离（AHD）、肱骨头平移和肩胛骨肩肱节律（SHR）。在术后 1 年的 MRI 扫描上评估 5 个部位的愈合情况：前盂唇、后盂唇、前肱骨、后肱骨和肩胛下肌沿后缘。根据愈合部位的数量，每位患者的评分从 0 到 5 分。
在 10 名患者中，9 名（90%）的移植物完全（n=4）或部分（n=5）愈合，1 名（10%）的盂唇完全失败。MRI 愈合与 AHD、SHR、力量、ROM 或 PROs 之间无相关性。美国肩肘外科医师协会、安大略西部肩袖指数和手臂、肩部和手残疾评分在 SCR 前后均显著改善，无论移植物愈合情况如何。
MRI 上的完全或部分移植物愈合率与文献中的先前报告相似。MRI 愈合与肱骨头前后平移相关，但与静态和动态 AHD、SHR、肱骨头上下平移、ROM、力量或 SCR 后 1 年的 PROs 无关。所有 PROs 在 SCR 前后均显著改善，无论 MRI 上的移植物状态如何。SCR 后体内运动学变化较小，无临床意义，数据表明，在没有完全移植物愈合的情况下，临床和功能结果的改善可能会发生。
