Seetharam Abhijit, Abad Joel, Baessler Aaron, Badman Brian L
Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Orthop J Sports Med. 2022 May 13;10(5):23259671221094848. doi: 10.1177/23259671221094848. eCollection 2022 May.
The rate of retear after primary rotator cuff failure remains unacceptably high (up to 36% for small- to medium-sized tears). Augmentation of cuff repair with scaffold devices has been reported to improve healing after cuff repair.
PURPOSE/HYPOTHESIS: To describe the surgical technique of using an interpositional nanofiber scaffold during rotator cuff repair and report on a retrospective series of patients regarding functional outcomes and postoperative healing on magnetic resonance imaging (MRI). We hypothesized that augmentation of cuff repair with an interpositional scaffold would result in a high rate of tendon healing and excellent functional outcomes.
Case series; Level of evidence, 4.
A total of 33 patients underwent arthroscopic rotator cuff repair augmented with a nanofiber, bioresorbable polymer patch secured as an inlay between the tendon and underlying bone. Patients were evaluated preoperatively and postoperatively with the Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) shoulder score, and active range of motion (ROM) measurements. Postoperative MRI was used to evaluate repair status.
At a minimum follow-up of 6 months, the patients showed significant improvement on SST and ASES scores ( < .0001 for both). ROM in forward flexion, abduction, internal rotation, and external rotation significantly improved at 6 months postoperatively ( < .05 for all). MRI at an average of 11 months postoperatively showed healing in 91% of patients; one patient had a recurrent tear with transtendon failure, and another patient had retear at the insertional site. The patch was not visible on postoperative imaging, suggesting complete resorption in all patients. No adverse events were associated with the patch.
Our results demonstrate the preliminary safety and efficacy of a novel, bioresorbable synthetic scaffold for rotator cuff repair. The use of the scaffold resulted in a 91% tendon healing rate and significant improvements in functional and patient-reported outcome measures. The results are promising for improving the current unacceptably high rate of rotator cuff repair failure.
初次肩袖损伤修复术后再撕裂率仍高得令人难以接受（中小型撕裂的再撕裂率高达36%）。据报道，使用支架装置增强肩袖修复可改善修复后的愈合情况。
目的/假设：描述在肩袖修复过程中使用置入式纳米纤维支架的手术技术，并报告一系列回顾性研究患者的功能结果以及术后磁共振成像（MRI）显示的愈合情况。我们假设使用置入式支架增强肩袖修复将导致肌腱高愈合率和优异的功能结果。
病例系列；证据等级，4级。
共有33例患者接受了关节镜下肩袖修复，并使用一种纳米纤维、生物可吸收聚合物补片作为嵌体固定在肌腱与下方骨骼之间进行增强修复。术前和术后使用简单肩部试验（SST）、美国肩肘外科医师学会（ASES）肩部评分以及主动活动范围（ROM）测量对患者进行评估。术后MRI用于评估修复状态。
至少随访6个月时，患者的SST和ASES评分均有显著改善（两者均P < .0001）。术后6个月时，前屈、外展、内旋和外旋的ROM均有显著改善（均P < .05）。术后平均11个月的MRI显示，91%的患者实现愈合；1例患者出现复发性撕裂伴肌腱断裂，另1例患者在止点处出现再撕裂。术后影像学检查未发现补片，提示所有患者的补片均已完全吸收。未发生与补片相关的不良事件。
我们的结果证明了一种新型生物可吸收合成支架用于肩袖修复的初步安全性和有效性。使用该支架使肌腱愈合率达到91%，并在功能和患者报告的结局指标方面有显著改善。这些结果对于改善目前高得令人难以接受的肩袖修复失败率很有前景。
