Gatot Cheryl, Lie Hannah Marian, Tijauw Tjoen Denny Lie
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
Arthrosc Tech. 2022 Nov 17;11(12):e2143-e2151. doi: 10.1016/j.eats.2022.08.015. eCollection 2022 Dec.
The role of biological augmentation in arthroscopic rotator cuff repair surgery has increased over the years. It has shown favorable healing rates and functional outcomes. Patch augmentation is commonly applied in repairs of massively retracted cuff tears, full-thickness tears, revision repair, or open cuff surgery. There is a paucity of literature on the use of patch augmentation when dealing with a chronic degenerate tendon associated with small-sized cuff tears. In recent years, the resorbable bioinductive bovine collagen implant has gained popularity for its application in partial-thickness tears via an isolated bioinductive repair fashion, without traditional rotator cuff repair. These bioinductive implants, albeit promising in their biological properties for tendon repair, lack structural strength and do not confer similar biomechanical advantages as human dermal allograft. We share our surgical technique for an arthroscopic patch augmentation involving human dermal allograft, using a single-lateral row surgical fixation, to address a degenerate cuff tendon with small-sized rotator cuff tear. We believe that our use of a human dermal patch augmentation conferred increased biomechanical advantage and reduced costs while delivering favorable outcomes for patients in our value-driven care.
多年来,生物增强技术在关节镜下肩袖修复手术中的作用不断增加。它已显示出良好的愈合率和功能结果。补片增强技术通常应用于巨大回缩性肩袖撕裂、全层撕裂、翻修修复或开放性肩袖手术。在处理与小尺寸肩袖撕裂相关的慢性退变肌腱时,关于使用补片增强技术的文献较少。近年来,可吸收生物诱导牛胶原蛋白植入物因其通过孤立的生物诱导修复方式应用于部分厚度撕裂,而无需传统肩袖修复,而受到欢迎。这些生物诱导植入物虽然在肌腱修复的生物学特性方面很有前景,但缺乏结构强度,并且不具备与人类真皮同种异体移植物类似的生物力学优势。我们分享了一种关节镜下使用人类真皮同种异体移植物进行补片增强的手术技术,采用单侧排手术固定,以处理伴有小尺寸肩袖撕裂的退变肩袖肌腱。我们相信,在我们以价值为导向的医疗中,使用人类真皮补片增强技术在为患者带来良好结果的同时,赋予了更大的生物力学优势并降低了成本。