Luciani Pierfrancesco, Farinelli Luca, De Berardinis Luca, Gigante Antonio
Clinical Orthopaedics, Department of Clinical and Molecular Sciences, UniversitàPolitecnicadelle Marche, Ancona, Italy.
Front Surg. 2021 Dec 6;8:624100. doi: 10.3389/fsurg.2021.624100. eCollection 2021.
Superior capsular reconstruction (SCR) has shown good results in the management of irreparable rotator cuff tears due to the depressive effect on the humeral head, but it is a technically demanding and expensive procedure. We hypothesized that an intra-articular neoligament that prevents the superior translation of the humeral head could give similar results in terms of the superior translation of humerus (STH) and range of motion (ROM). To compare our proposed technique and the SCR, we conducted a biomechanical study on 10 porcine shoulders in a custom shoulder testing system. STH and total rotational ROM were quantified in the following four scenarios: (1) when the rotator cuff was intact, (2) after cutting the supraspinatus tendon, (3) after the reconstruction of the superior capsule by long head of the biceps tendon (LHB), and (4) after an arthroscopic intra-articular stabilization by an intra-articular graft. Our proposed technique provides the creation of a humeral and glenoid tunnel, the passage of a graft through these tunnels under arthroscopic guidance, and the graft fixation in the two tunnels. We analyzed the STH and total ROM in each scenario. With respect to the STH, we reported that the present proposed technique is characterized by a significant reduction of superior translation at 0 and 45° compared to scenario 2. In addition, the comparison between our proposed technique and SCR showed a significant difference of the STH at 0° of abduction. Total rotational ROMs of the two tenchinques were similar to scenario 2. Therefore, the use of an intra-articular ligament that prevents the STH can restore shoulder stability in irreparable rotator cuff injuries at both 0 and 45° of glenohumeral abduction without apparently limiting the total rotational ROM. Our proposed technique could be an important treatment option in irreparable rotator cuff tears, especially in patients under 65 years in whom reverse shoulder arthroplasty (RSA) has shown poor results and many complications.
由于对肱骨头具有下压作用，上盂唇重建术（SCR）在治疗不可修复的肩袖撕裂方面已显示出良好效果，但该手术技术要求高且费用昂贵。我们推测，一种可防止肱骨头向上移位的关节内新韧带在肱骨向上移位（STH）和活动范围（ROM）方面可能产生类似效果。为比较我们提出的技术与SCR，我们在定制的肩部测试系统中对10个猪肩进行了生物力学研究。在以下四种情况下对STH和总旋转ROM进行了量化：（1）肩袖完整时；（2）切断冈上肌腱后；（3）用肱二头肌长头肌腱（LHB）重建上盂唇后；（4）通过关节内移植物进行关节镜下关节内稳定后。我们提出的技术包括创建肱骨和肩胛盂隧道，在关节镜引导下将移植物穿过这些隧道，并将移植物固定在两个隧道中。我们分析了每种情况下的STH和总ROM。关于STH，我们报告称，与情况2相比，目前提出的技术在0°和45°时的向上移位明显减少。此外，我们提出的技术与SCR之间的比较显示，在外展0°时STH存在显著差异。两种技术的总旋转ROM与情况2相似。因此，使用可防止STH的关节内韧带可在肱盂外展0°和45°时恢复不可修复的肩袖损伤的肩部稳定性，且不会明显限制总旋转ROM。我们提出的技术可能是治疗不可修复的肩袖撕裂的重要选择，特别是对于65岁以下的患者，在这些患者中，反式肩关节置换术（RSA）效果不佳且并发症众多。
