Department of Orthopedics, Kurashiki Central Hospital, Kurashiki, Japan.
Department of Orthopedics, Kurashiki Central Hospital, Kurashiki, Japan.
J Shoulder Elbow Surg. 2021 Nov;30(11):e659-e675. doi: 10.1016/j.jse.2021.04.019. Epub 2021 Apr 28.
Superior capsular reconstruction (SCR) has recently gained popularity as a surgical solution for patients with massive rotator cuff tears or shoulder pseudoparalysis (PPS). Good clinical outcomes have been reported after SCR; however, the factors that influence its clinical outcomes remain unclear. Therefore, in this study, we aimed to clarify the factors influencing postoperative outcomes after SCR using tensor fascia lata graft, for which we evaluated the Hamada grade, patients with or without PPS, and the status of the subscapularis tendon (SSC).
In total, 54 consecutive patients with irreparable rotator cuff tears or PPS who underwent SCR between June 2014 and October 2018 were included. The enrolled patients were grouped and compared as follows: (1) Hamada grade 2 (11 patients) and Hamada grade 3 (43 patients) and (2) non-PPS (22 patients), moderate PPS (16 patients), and severe PPS (16 patients). For subanalysis, the 32 PPS patients were divided into 3 groups: intact SSC (11 patients), repairable SSC (16 patients), and irreparable SSC (5 patients). To assess shoulder function, the American Shoulder and Elbow Surgeons (ASES) score was evaluated before surgery and at 24 months postoperatively; shoulder range of motion was evaluated at 2, 3, 4, 5, 6, 8, 10, 12, and 24 months postoperatively.
No significant differences in postoperative ASES scores and shoulder range of motion were observed between the Hamada grade 2 and grade 3 groups or between the non-PPS, moderate PPS, and severe PPS groups. However, significant differences in postoperative shoulder elevation and ASES scores were observed between the intact SSC and irreparable SSC groups (P = .006) and between the repairable SSC and irreparable SSC groups (P = .003).
This study demonstrated that the status of the SSC, rather than the Hamada grade or the presence or absence of PPS, influences the clinical outcomes after SCR. Therefore, reparability or intactness of the SSC is an important factor in considering the surgical indication for SCR.
作为治疗巨大肩袖撕裂或肩部假性瘫痪（PPS）的手术方法，肩袖上囊重建（SCR）最近受到了广泛关注。SCR 后可获得良好的临床效果；然而，影响其临床效果的因素尚不清楚。因此，在这项研究中，我们旨在使用阔筋膜张肌移植物阐明影响 SCR 术后结果的因素，我们评估了 Hamada 分级、有无 PPS 以及肩胛下肌腱（SSC）的状态。
2014 年 6 月至 2018 年 10 月，共纳入 54 例接受 SCR 的不可修复肩袖撕裂或 PPS 连续患者。将纳入的患者分组并进行比较如下：（1）Hamada 分级 2 级（11 例）和 Hamada 分级 3 级（43 例）；（2）无 PPS（22 例）、中度 PPS（16 例）和重度 PPS（16 例）。对于亚分析，将 32 例 PPS 患者分为 3 组：完整 SSC（11 例）、可修复 SSC（16 例）和不可修复 SSC（5 例）。为了评估肩部功能，在术前和术后 24 个月评估美国肩肘外科医师协会（ASES）评分；在术后 2、3、4、5、6、8、10、12 和 24 个月评估肩关节活动度。
Hamada 分级 2 级和 3 级组或无 PPS、中度 PPS 和重度 PPS 组之间，术后 ASES 评分和肩关节活动度无显著差异。然而，完整 SSC 组和不可修复 SSC 组之间（P =.006）以及可修复 SSC 组和不可修复 SSC 组之间（P =.003）的术后肩关节抬高和 ASES 评分存在显著差异。
本研究表明，SSC 的状态，而不是 Hamada 分级或有无 PPS，影响 SCR 后的临床效果。因此，SSC 的可修复性或完整性是考虑 SCR 手术适应证的一个重要因素。
