Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA.
Campbell Clinic, Memphis, Tennessee, USA.
Am J Sports Med. 2021 Jul;49(8):2042-2047. doi: 10.1177/03635465211015194. Epub 2021 May 20.
Primary rotator cuff repairs in complex cases (older patient age, larger tear sizes, chronic tears) and revision repairs are at high risk for failure of healing.
To examine clinical outcomes and healing rates in complex and revision rotator cuff repairs with dermal allograft augmentation.
Case series; Level of evidence, 4.
A retrospective study was made of cases performed by 3 fellowship-trained surgeons via a uniform technique involving rotator cuff repairs with allograft augmentation. In all cases, a 1.5-mm, human, decellularized dermal graft was tied on top of the tendon at the medial row and compressed to the rotator cuff footprint using a double-row technique. Postoperative magnetic resonance imaging (MRI) was performed at a minimum of 6 months and American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and 12-Item Short Form Health Survey scores were collected at a minimum of 2 years postoperatively.
A total of 35 patients (23 revision repairs, 12 primary complex repairs) were included. The mean patient age was 57.9 years (range, 41.0-70.5 years). All shoulders had 2-tendon tears (supraspinatus and infraspinatus), and 8 included the upper 50% of the subscapularis. At a minimum of 2 years after surgery (mean, 3.2 years), mean ASES and SANE scores improved from 42.4 and 35.3 to 77.6 and 73.5, respectively ( < .001). In the 23 patients (66%) with postoperative MRI evaluation, 11 (48%) had images showing the tendons were retorn. ASES (89.7 vs 66.4; = .04) and SANE (84.1 vs 50.5; = .02) scores were higher in healed patients than those with retears. The retear group had a higher degree of preoperative fatty atrophy of the infraspinatus ( = .024).
Double-row arthroscopic repair with dermal allograft augmentation of complex and revision rotator cuff tears led to improved functional outcomes. Approximately half of patients experienced a failure of healing, which was associated with poorer functional results.
对于复杂病例（老年患者、较大的撕裂尺寸、慢性撕裂）和翻修的原发性肩袖修复，愈合失败的风险很高。
检查真皮移植物增强的复杂和翻修肩袖修复的临床结果和愈合率。
病例系列；证据水平，4 级。
对由 3 名接受过 fellowship 培训的外科医生通过统一技术进行的病例进行回顾性研究，该技术包括肩袖修复和移植物增强。在所有病例中，将 1.5 毫米厚的人脱细胞真皮移植物系在内侧排的肌腱顶部，并使用双排技术将其压缩至肩袖足迹。术后至少 6 个月进行磁共振成像（MRI）检查，术后至少 2 年收集美国肩肘外科医师协会（ASES）、单一评估数字评估（SANE）和 12 项简短健康调查评分。
共纳入 35 例患者（23 例翻修修复，12 例原发性复杂修复）。患者平均年龄为 57.9 岁（范围，41.0-70.5 岁）。所有肩部均有 2 根肌腱撕裂（冈上肌和冈下肌），8 例包括肩胛下肌的上 50%。术后至少 2 年（平均 3.2 年），平均 ASES 和 SANE 评分分别从 42.4 和 35.3 提高到 77.6 和 73.5（<0.001）。在术后 MRI 评估的 23 例患者（66%）中，有 11 例（48%）显示肌腱已返回。与再撕裂患者相比，愈合患者的 ASES（89.7 对 66.4；=0.04）和 SANE（84.1 对 50.5；=0.02）评分更高。再撕裂组术前冈下肌脂肪萎缩程度较高（=0.024）。
对于复杂和翻修肩袖撕裂，双排关节镜修复加真皮移植物增强可改善功能结果。约一半的患者出现愈合失败，这与功能结果较差有关。
