Cha Elliot D K, Shultz Kelly, Chan Kelley, Choi Joseph
Geisinger Commonwealth School of Medicine, Scranton, PA, USA.
Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, PA, USA.
J Orthop. 2022 Jun 23;33:31-36. doi: 10.1016/j.jor.2022.06.012. eCollection 2022 Sep-Oct.
Superior capsular reconstruction (SCR) remains an option for irreparable rotator cuff tears, especially for active patients. While fascia lata grafts were first used with SCRs, acellular dermal allografts have demonstrated similar postoperative outcomes and complication rates. Few studies report long-term clinical outcomes following use of acellular dermal allografts. The aim of the current study is to evaluate long-term efficacy of allograft usage in SCR through patient reported clinical outcomes.
A retrospective review of patients undergoing SCR with use of dermal allografts from 2015 to 2021 was performed. Exclusion criteria included patients lost to follow up, revision or removal of graft, and inadequate follow up timepoints. Demographics and operative characteristics were collected. To evaluate efficacy of graft, numerical rating scale (NRS), American Shoulder and Elbow Score (ASES) were assessed postoperatively. Shoulder range of motion (ROM) was also evaluated by the 6-month postoperative timepoint. Improvement in NRS, ASES, and shoulder ROM from baseline values were evaluated using a -test.
The final cohort was 21 patients with two patients undergoing revision and removal of the graft. Mean follow up time was 36.9 months. No major postoperative complications were recorded. Mean preoperative NRS and ASES score was 5.7 and 38.4, which both significantly improved postoperatively (p < 0.001). Patients demonstrated improvements in forward flexion, abduction in 90° rotation, and external and internal rotation.
Use of acellular dermal grafts in SCR procedures for irreparable rotator cuff tears remains a viable long-term solution to restore shoulder function.
对于不可修复的肩袖撕裂，尤其是活跃的患者，上盂唇重建术（SCR）仍是一种选择。虽然阔筋膜移植最初用于上盂唇重建术，但脱细胞真皮同种异体移植物已显示出相似的术后结果和并发症发生率。很少有研究报告使用脱细胞真皮同种异体移植物后的长期临床结果。本研究的目的是通过患者报告的临床结果来评估同种异体移植物在上盂唇重建术中使用的长期疗效。
对2015年至2021年接受使用真皮同种异体移植物的上盂唇重建术的患者进行回顾性研究。排除标准包括失访患者、移植物翻修或移除以及随访时间点不足。收集人口统计学和手术特征。为了评估移植物的疗效，术后采用数字评定量表（NRS）、美国肩肘评分（ASES）进行评估。术后6个月时还评估了肩关节活动范围（ROM）。使用t检验评估NRS、ASES和肩关节ROM相对于基线值的改善情况。
最终队列有21例患者，其中2例患者接受了移植物的翻修和移除。平均随访时间为36.9个月。未记录到重大术后并发症。术前NRS和ASES评分的平均值分别为5.7和38.4，术后均显著改善（p < 0.001）。患者在前屈、90°旋转外展以及内外旋转方面均有改善。
在不可修复的肩袖撕裂的上盂唇重建手术中使用脱细胞真皮移植物仍然是恢复肩关节功能的可行长期解决方案。
