Albers Sebastian, Ono Yohei, Kirchner Florian, Fal Milad Farkhondeh, Kircher Jörn
Department of Shoulder and Elbow Surgery, ATOS Klinik Fleetinsel Hamburg, Hamburg, Germany.
Hokkaido Shoulder Clinic, Obihiro, Hokkaido, Japan.
J Shoulder Elbow Surg. 2024 Feb;33(2):312-320. doi: 10.1016/j.jse.2023.06.024. Epub 2023 Jul 22.
Large and massive rotator cuff tears and tears after failed surgical repair are a challenging clinical problem with different treatment options. The purpose of the study was to evaluate the midterm outcomes after rotator cuff repair (RCR) with autologous hamstring tendon graft bridging (tissue-enhanced autologous rotator cuff repair [TEAR] patch) with the hypothesis that outcomes would be reasonable and complication rates would be low.
This is a retrospective case series study of patients who underwent open RCR using a TEAR patch from June 2015 to March 2019. The exclusion criteria included evidence of cuff tear arthropathy, advanced fatty infiltration, moderate-to-severe arthropathy, and workers compensation board or litigation involved. Clinical outcome measures were Constant score; Disabilities of the Arm, Shoulder and Hand score; Simple Shoulder Test; Subjective Shoulder Value; range of motion (ROM); and manual muscle test for forward elevation, abduction, external and internal rotation, patient satisfaction, and willingness to perform the operation again. Radiographic outcome measures were magnetic resonance imaging, ultrasound, and radiographs: graft integrity and acromiohumeral distance (AHD).
A total of 44 patients were followed (89%) for ≥2 years (45 shoulders, mean age 60.3 years [48-76 years], mean follow-up 4.3 years [2-6 years]). All clinical outcome measures (Constant score, Disabilities of the Arm, Shoulder and Hand score, Simple Shoulder Test, Subjective Shoulder Value, ROM, and manual muscle test) demonstrated significant improvement except active external and internal rotation. At 2 years of follow-up, the mean patient satisfaction was high (12.2 of 15 points), and 33 of 38 patients (73.3%) would perform the operation again. A perfect graft integration was observed in 30 (66.7%), a small gap in 7 (15.6%), a retear in 3 (7%), and a complete failure of the tendon patch in 5 (11%) patients. Graft integrity was strongly correlated with the postoperative AHD (r = 0.599, P = .001) and the gain in AHD (r = 0.599, P = .001) but not with ROM or patient-reported outcome measures or patient satisfaction. Four patients required revision surgeries (3 due to deep infection and 1 for poor function and pain).
Midterm clinical and radiographic outcomes after RCR with graft bridging using a TEAR patch were reasonable. The procedure resulted in improved shoulder function and a high level of patient satisfaction. The revision rate is acceptable in view of the specific patient group and treatment alternatives. The described technique of the TEAR patch can be a valuable alternative to existing methods and a new autograft source for rotator cuff surgeries that need bridging of a tendon defect.
巨大和大规模的肩袖撕裂以及手术修复失败后的撕裂是一个具有挑战性的临床问题，存在不同的治疗选择。本研究的目的是评估采用自体腘绳肌腱移植桥接（组织增强自体肩袖修复[TEAR]补片）进行肩袖修复（RCR）后的中期结果，假设结果将是合理的且并发症发生率较低。
这是一项回顾性病例系列研究，研究对象为2015年6月至2019年3月期间接受使用TEAR补片的开放性RCR手术的患者。排除标准包括肩袖撕裂性关节病的证据、严重脂肪浸润、中度至重度关节病以及涉及工人赔偿委员会或诉讼的情况。临床结果指标包括Constant评分；手臂、肩部和手部功能障碍评分；简易肩部测试；主观肩部评分；活动范围（ROM）；以及前屈、外展、外旋和内旋的徒手肌力测试、患者满意度和再次接受手术的意愿。影像学结果指标包括磁共振成像、超声和X线片：移植物完整性和肩峰下间隙（AHD）。
共对44例患者（89%）进行了≥2年的随访（45个肩部，平均年龄60.3岁[48 - 76岁]，平均随访4.3年[2 - 6年]）。除主动外旋和内旋外，所有临床结果指标（Constant评分、手臂、肩部和手部功能障碍评分、简易肩部测试、主观肩部评分、ROM和徒手肌力测试）均显示出显著改善。在随访2年时，患者平均满意度较高（15分制中的12.2分），38例患者中有33例（73.3%）愿意再次接受手术。在30例（66.7%）患者中观察到移植物完美整合，7例（15.6%）有小间隙，3例（7%）有再撕裂，5例（11%）患者的肌腱补片完全失败。移植物完整性与术后AHD（r = 0.599，P = 0.001）和AHD的增加（r = 0.599，P = 0.001）密切相关，但与ROM、患者报告的结果指标或患者满意度无关。4例患者需要进行翻修手术（3例因深部感染，1例因功能差和疼痛）。
使用TEAR补片进行移植物桥接的RCR术后中期临床和影像学结果是合理的。该手术改善了肩部功能并提高了患者满意度。鉴于特定的患者群体和治疗选择，翻修率是可以接受的。所描述的TEAR补片技术可以成为现有方法的有价值替代方案，以及肩袖手术中需要桥接肌腱缺损时的一种新的自体移植物来源。
