Oregon Shoulder Institute, Medford, Oregon, U.S.A.
Shoulder & Elbow Surgery Midwest Orthopaedics at Rush Chicago, Illinois, U.S.A.
Arthroscopy. 2022 Nov;38(11):2957-2959. doi: 10.1016/j.arthro.2022.08.004.
Large and massive rotator cuff tears continue to be challenging for shoulder surgeons. Given the high percentage of retears after repair of these tears, several surgical technical advancements have been proposed. The use of grafts (xenograft, synthetic, and allograft) as an augmentation of the repair has been growing over the last several years in an attempt to improve structural integrity and postoperative outcomes. Patch augmentation with dermal allografts is the most commonly used, showing promising biomechanical, structural, and functional outcomes. Several factors have been associated with healing outcomes, including age, tear size, and fatty degeneration. The rotator cuff healing index can be used to assess for patients with Hamada grades 1 and 2 with elevated retear risk and potential indications for repair with graft augmentation. A score of 7 points represents a reasonable threshold for the addition of a dermal allograft due to a significant reduction in healing rates when comparing patients with a score of 6 points (66%) to 7 points (only 38%) without augmentation of the repair. Biomechanical studies have demonstrated a greater maximum failure load compared with standard repair. The healing rates of rotator cuff repairs using scaffolds range between 60% and 85%, compared with 40% with nonaugmented repairs. Moreover, the use of repair augmentation has been associated with improved range of motion and functional scores compared with nonaugmented repairs, with allografts showing the best visual analog scale pain score and postoperative external rotation results. Given these favorable healing rates, functional outcomes, and low complication rates, augmenting rotator cuff repairs with a dermal allograft may be a suitable option in active patients with a diminished chance of postoperative healing.
巨大且广泛的肩袖撕裂仍然是肩部外科医生面临的挑战。鉴于这些撕裂修复后再撕裂的比例很高，因此提出了几种手术技术的改进。在过去的几年中，使用移植物（同种异体、合成和同种异体）作为修复的增强物来增加结构完整性和术后结果的方法越来越多。真皮同种异体移植物的补片增强是最常用的方法，显示出有前途的生物力学、结构和功能结果。几个因素与愈合结果有关，包括年龄、撕裂大小和脂肪变性。肩袖愈合指数可用于评估 Hamada 分级 1 和 2 的患者，这些患者有较高的再撕裂风险和潜在的修复指征，需要进行移植物增强。当将评分 6 分（66%）的患者与无修复增强的评分 7 分（仅 38%）的患者进行比较时，7 分代表了添加真皮同种异体移植物的合理阈值，因为愈合率显著降低。生物力学研究表明，与标准修复相比，最大失效负荷更高。与非增强修复相比，使用支架修复肩袖的愈合率在 60%至 85%之间，而修复增强的愈合率更高。此外，与非增强修复相比，修复增强与改善运动范围和功能评分相关，同种异体移植物显示出最佳的视觉模拟量表疼痛评分和术后外旋结果。鉴于这些有利的愈合率、功能结果和低并发症发生率，在术后愈合机会较小的活动患者中，用真皮同种异体移植物增强肩袖修复可能是一种合适的选择。
