Mihata Teruhisa
Osaka Medical and Pharmaceutical University.
Arthroscopy. 2023 Apr;39(4):931-934. doi: 10.1016/j.arthro.2022.12.020.
Originally, fascia lata autograft was used for superior capsule reconstruction (SCR) to restore glenohumeral stability in irreparable rotator cuff tears. Consistently excellent clinical outcomes with low graft tear rates have been reported, without repair of tears in the supraspinatus and infraspinatus tendons. On the basis of our experience and studies published in the 15 years since the first SCR using fascia lata autograft in 2007, we can say that this technique is the gold standard. SCR using fascia lata autograft can cover all irreparable rotator cuff tears (Hamada grade 1-3; although the indication for SCR using other grafts, including dermal allograft, biceps, and hamstrings, is only Hamada grade 1 or 2); creates excellent clinical outcomes with low graft tear rates in short-term, long-term, and multicenter studies; regenerates the fibrocartilaginous insertions at both the greater tuberosity and superior glenoid according to histological study; and enables complete restoration of shoulder stability and subacromial contact pressure in cadaveric biomechanical studies. In some countries, dermal allograft is preferred for SCR. However, high rates of graft tear and complications have been reported after SCR using dermal allografts, even in limited indications of irreparable rotator cuff tears (Hamada grade 1 or 2). This high failure rate results from the lack of stiffness and thickness of the dermal allograft. Dermal allografts in SCR can be elongated by 15% after only a couple of physiological shoulder movements, whereas fascia lata graft cannot. This 15% graft elongation, which creates less glenohumeral stability and high graft tear after SCR, is a fatal problem of dermal allograft for SCR in irreparable rotator cuff tears. Current research suggests that SCR using dermal allografts is not strongly recommended for the treatment of irreparable rotator cuff tears. Dermal allograft probably should be used only for augmentation of rotator cuff complete repair.
最初，阔筋膜自体移植用于上盂唇重建（SCR），以恢复不可修复的肩袖撕裂患者的盂肱稳定性。据报道，该方法临床效果始终优异，移植物撕裂率低，且无需修复冈上肌和冈下肌腱的撕裂。基于我们的经验以及自2007年首次使用阔筋膜自体移植进行SCR以来15年间发表的研究，我们可以说该技术是金标准。使用阔筋膜自体移植的SCR可覆盖所有不可修复的肩袖撕裂（Hamada 1-3级；尽管使用其他移植物（包括同种异体真皮、肱二头肌和腘绳肌）进行SCR的适应证仅为Hamada 1级或2级）；在短期、长期和多中心研究中均能产生优异的临床效果，且移植物撕裂率低；组织学研究表明，在大结节和上盂唇处均可再生纤维软骨附着；在尸体生物力学研究中，可实现肩部稳定性和肩峰下接触压力的完全恢复。在一些国家，同种异体真皮更常用于SCR。然而，即使在不可修复的肩袖撕裂（Hamada 1级或2级）的有限适应证中，使用同种异体真皮进行SCR后，也有较高的移植物撕裂率和并发症发生率的报道。这种高失败率是由于同种异体真皮缺乏刚度和厚度。在SCR中，同种异体真皮在仅进行几次生理性肩部运动后就可伸长15%，而阔筋膜移植物则不会。这种15%的移植物伸长会降低盂肱稳定性，并在SCR后导致高移植物撕裂率，这是同种异体真皮用于不可修复的肩袖撕裂SCR的致命问题。目前的研究表明，强烈不建议使用同种异体真皮进行SCR来治疗不可修复的肩袖撕裂。同种异体真皮可能仅应在肩袖完全修复的增强手术中使用。
