Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany; Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, U.S.A..
Orthoteam Centre, Manchester, UK.
Arthroscopy. 2022 Feb;38(2):297-306.e2. doi: 10.1016/j.arthro.2021.07.021. Epub 2021 Jul 28.
To investigate the effect of bursal acromial reconstruction (BAR) using an acellular dermal allograft on glenohumeral joint kinematics including maximum abduction angle, glenohumeral superior translation, cumulative deltoid force, and subacromial contact pressure.
In this dynamic biomechanical cadaveric shoulder study, 8 fresh-frozen cadaveric shoulders (age 53.4 ± 14.2 years, mean ± standard deviation) were tested using a dynamic shoulder testing system. Maximum abduction angle (MAA), glenohumeral superior translation (ghST), maximum cumulative deltoid force (cDF), and subacromial peak contact pressure (sCP) were compared across 3 conditions: (1) intact shoulder; (2) massive retracted irreparable posterosuperior rotator cuff tear (psRCT) according to Patte III; and (3) BAR. Additionally, humeral head containment was measured using contact pressure.
Compared with the simulated psRCT, BAR significantly increased mean MAA and significantly decreased ghST (P < .001, respectively) and cDF (P = .017) Additionally, BAR was found to significantly decrease sCP compared with psRCT (P = .024).
In a dynamic biomechanical cadaveric shoulder simulator, resurfacing the undersurface of the acromion using the BAR technique leads to significantly improved ghST, MAA, cDF, and sCP compared with the irreparable rotator cuff tear.
With the BAR technique, native humeral containment may be restored, which can potentially delay progressive subacromial and glenoidal abrasive wear and improve overall shoulder function. As such, the proposed BAR technique can be considered as a technically feasible and potentially cost- and timesaving procedure, as no bone anchors are needed, glenoidal or humeral side graft ruptures can be avoided, and postoperative rehabilitation can be started immediately. However, future clinical studies are needed.
研究使用脱细胞真皮移植物进行肩盂肱骨关节囊重建（BAR）对包括最大外展角度、盂肱关节上移、累积三角肌力和肩峰下接触压力在内的肩关节运动学的影响。
在这项动态生物力学尸体肩关节研究中，使用动态肩关节测试系统对 8 个新鲜冷冻的尸体肩关节（年龄 53.4±14.2 岁，均值±标准差）进行了测试。在 3 种情况下比较了最大外展角度（MAA）、盂肱关节上移（ghST）、最大累积三角肌力（cDF）和肩峰下峰值接触压力（sCP）：（1）完整肩关节；（2）根据 Patte III 分类的巨大回缩不可修复的后上方肩袖撕裂（psRCT）；（3）BAR。此外，还使用接触压力测量了肱骨头的包容情况。
与模拟的 psRCT 相比，BAR 显著增加了平均 MAA，显著降低了 ghST（P<.001）和 cDF（P=.017），同时还显著降低了 sCP 与 psRCT 相比（P=.024）。
在动态生物力学尸体肩关节模拟器中，使用 BAR 技术覆盖肩峰下表面可显著改善 ghST、MAA、cDF 和 sCP，与不可修复的肩袖撕裂相比。
通过 BAR 技术，可能恢复了盂肱关节的固有包容，这可能会延迟进行性肩峰下和盂肱关节的磨蚀性磨损，并改善整体肩关节功能。因此，所提出的 BAR 技术可以被认为是一种技术上可行的、潜在的节省成本和时间的方法，因为不需要骨锚，避免了盂肱关节侧移植物的破裂，并且可以立即开始术后康复。但是，还需要进行未来的临床研究。
