Kholinne Erica, Sun Yucheng, Kwak Jae-Man, Kim Hyojune, Koh Kyoung Hwan, Jeon In-Ho
Faculty of Medicine, Universitas Trisakti, Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia.
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan, Seoul, Republic of Korea.
Orthop J Sports Med. 2021 May 5;9(5):23259671211002280. doi: 10.1177/23259671211002280. eCollection 2021 May.
Superior capsular reconstruction (SCR) is an alternative to reverse shoulder arthroplasty for irreparable rotator cuff tears (IRCTs). The reconstructed capsule acts as a static restraint to prevent superior migration of the humeral head. Traditional SCR uses a fascia lata autograft, which has shown failure at the greater tuberosity. An Achilles tendon-bone allograft has been proposed to improve the failure rate.
To evaluate the surgical outcomes of SCR using an Achilles tendon-bone allograft for the treatment of IRCTs.
Case series; Level of evidence, 4.
We retrospectively evaluated 6 patients with massive IRCTs who underwent SCR using an Achilles tendon-bone allograft between January 2017 and January 2018. Clinical outcomes were assessed using range of motion, the American Shoulder and Elbow Surgeons score, and the visual analog scale for pain. The acromiohumeral distance and the status of graft integrity were evaluated using serial magnetic resonance imaging. Second-look arthroscopy surgery was performed to evaluate graft integrity at the mean of 7.5 months postoperative.
The mean ± SD clinical follow-up period was 14.5 months (range, 12-17 months). The American Shoulder and Elbow Surgeons and visual analog scale scores improved from 42.8 ± 11.9 and 4.0 ± 1.2 to 62.1 ± 14.7 and 2.8 ± 1.4, respectively. Forward flexion and external rotation improved from 98° ± 36° and 58° ± 4° to 123° ± 20° and 39° ± 8°, respectively. The acromiohumeral distance improved from 3.9 ± 0.8 mm to 6.4 ± 2.2 mm at final follow-up. However, second-look arthroscopy at a mean of 7.6 months postoperatively confirmed a graft failure rate of 83.3%.
SCR using an Achilles tendon-bone allograft for the treatment of IRCTs had a high graft failure rate among patients in this case series.
对于不可修复的肩袖撕裂（IRCTs），上盂唇重建（SCR）是反式肩关节置换术的一种替代方法。重建的盂唇起到静态约束作用，防止肱骨头向上移位。传统的SCR使用阔筋膜自体移植，已显示在大结节处出现失败情况。有人提出使用跟腱-骨同种异体移植来提高成功率。
评估使用跟腱-骨同种异体移植进行SCR治疗IRCTs的手术效果。
病例系列；证据等级，4级。
我们回顾性评估了2017年1月至2018年1月期间接受使用跟腱-骨同种异体移植进行SCR的6例大面积IRCTs患者。使用活动范围、美国肩肘外科医师评分和疼痛视觉模拟量表评估临床效果。使用连续磁共振成像评估肩峰下间隙和移植物完整性状态。在术后平均7.5个月进行二次关节镜检查手术以评估移植物完整性。
平均±标准差的临床随访期为14.5个月（范围12 - 17个月）。美国肩肘外科医师评分和视觉模拟量表评分分别从42.8±11.9和4.0±1.2提高到62.1±14.7和2.8±1.4。前屈和外旋分别从98°±36°和58°±4°提高到123°±20°和39°±8°。最终随访时肩峰下间隙从3.9±0.8 mm提高到6.4±2.2 mm。然而，术后平均7.6个月的二次关节镜检查证实移植物失败率为83.3%。
在本病例系列患者中，使用跟腱-骨同种异体移植进行SCR治疗IRCTs的移植物失败率较高。
