Département de chirurgie orthopédique et traumatologique - Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris (APHP), 184 rue du faubourg Saint Antoine, 75012, Paris, France.
Department of Hand, upper extremity and microsurgery, Prisma Health System, Greenville, SC, USA.
BMC Musculoskelet Disord. 2021 Apr 5;22(1):331. doi: 10.1186/s12891-021-04197-6.
Irreparable rotator cuff tears are common and difficult to treat. Techniques for "filling the loss of substance" require fixation to the rotator cuff stump (tendon augmentation) or to the glenoid (superior capsular reconstruction), which are complicated by the narrow working zone of the subacromial space. The main objective of this study was to determine whether a braided graft of gracilis (GR) and semitendinosus (ST) could fill a loss of tendon substance from an irreparable rupture of the supra- and infraspinatus, by fixing the graft to the greater tuberosity and the spine of the scapula.
This was a cadaveric study with the use of ten specimens. The GRA and ST tendons were harvested, braided and reinforced with suture. An experimental tear of the supraspinatus (SS) and upper infraspinatus (IS) retracted at the glenoid was made. The GRAST transplant was positioned over the tear. The transplant was attached to the greater tuberosity by two anchors and then attached to the medial third of the scapular spine by trans-osseous stitching. The percentage of filling obtained was then measured and passive mobility of the shoulder was assessed. We proceeded to the same technique under arthroscopy for a 73 years old patient whom we treated for a painful shoulder with irreparable cuff tear. We inserted a GRAST graft using arthroscopy.
The Braided-GRAST allowed a 100% filling of the loss of tendon substance. Mobility was complete in all cases.
This technique simplifies the medial fixation and restores the musculo-tendinous chain where current grafting techniques only fill a tendinous defect. The transplant could have a subacromial "spacer" effect and lower the humeral head. The donor site morbidity and the fate of the transplant in-vivo are two limits to be discussed. This anatomical study paves the way for clinical experimentation.
不可修复的肩袖撕裂很常见，且难以治疗。“填补物质损失”的技术需要固定在肩袖残端（肌腱增强）或盂骨（上囊重建），这在肩峰下空间的狭窄工作区变得复杂。本研究的主要目的是确定 gracilis（GR）和半腱肌（ST）编织移植物是否可以通过将移植物固定在大结节和肩胛骨脊柱上来填充不可修复的上和下肩袖撕裂的肌腱物质损失。
这是一项使用十个标本的尸体研究。采集 GRA 和 ST 肌腱，编织并缝合加固。在盂骨上制作了一个回缩的上肩袖（SS）和上肩胛下肌（IS）的实验性撕裂。将 GRAST 移植物放置在撕裂上方。移植物通过两个锚钉固定在大结节上，然后通过经骨缝合固定在肩胛骨脊柱的内侧三分之一处。然后测量获得的填充百分比，并评估肩部的被动活动度。我们在一名 73 岁的患者身上进行了相同的关节镜技术，该患者因不可修复的肩袖撕裂导致肩部疼痛。我们使用关节镜插入 GRAST 移植物。
编织 GRAST 允许 100%填充肌腱物质损失。所有病例的活动度均完全。
该技术简化了内侧固定，并恢复了肌肉肌腱链，而当前的移植物技术仅填补了肌腱缺陷。移植物可能具有肩峰下“间隔物”效应，并降低肱骨头。供体部位发病率和移植物在体内的命运是两个需要讨论的限制。这项解剖学研究为临床实验铺平了道路。
