University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A.
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A.
Arthroscopy. 2024 Apr;40(4):1279-1287. doi: 10.1016/j.arthro.2023.08.025. Epub 2023 Aug 26.
To review cadaveric studies evaluating the biomechanical outcomes of superior capsular reconstruction (SCR) with different graft types for the treatment of irreparable rotator cuff (RTC) tears.
PubMed, Cochrane, and Embase were queried in January 2022 to conduct this meta-analysis using the following key words: "superior capsule reconstruction," "superior capsular reconstruction," and "biomechanics." Articles were included if they reported glenohumeral superior translation or subacromial contact pressure following SCR in cadaveric RTC tears. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. Number of shoulders, graft types, and biomechanical outcomes were recorded and analyzed with forest plots.
Twelve studies (95 shoulders) were included in the statistical analysis. There was a significant reduction in glenohumeral superior translation following SCR compared with RTC tear across 10 studies (79 shoulders) with standardized mean difference (SMD) -2.48 mm; confidence interval (CI) -3.28 mm, -1.69 mm. The SMD between fascia lata graft and RTC tear was -3.84 mm (CI -4.82 mm, -2.86 mm) and between dermal allograft and RTC tear was -2.05 mm (CI -3.10 mm, -1.00 mm). There was a significant reduction in subacromial contact pressure following SCR compared with RTC tear across 5 studies (55 shoulders) with SMD -3.49 MPa (CI -4.54 MPa, -2.44 MPa). The SMD between fascia lata graft and RTC tear was -3.21 MPa (CI -5.08 MPa, -1.34 MPa) and between dermal allograft and RTC tear was -3.89 MPa (CI -5.91 MPa, -1.87 MPa).
Independent of graft type, biomechanical studies suggest that SCR improves glenohumeral superior translation and subacromial contact pressure in comparison with RTC tear at time zero. There was no definitive evidence identified in this study to suggest a biomechanically superior SCR graft option.
Investigating the biomechanical outcomes of several graft types for superior capsular reconstruction will help surgeons better understand the efficacies of different graft types for use in superior capsule reconstruction surgery.
回顾评估不同移植物类型用于治疗不可修复性肩袖撕裂（RTC）的上囊重建（SCR）的生物力学结果的尸体研究。
2022 年 1 月，通过以下关键词在 PubMed、Cochrane 和 Embase 中进行了这项荟萃分析：“上囊重建”、“上囊重建”和“生物力学”。如果文章报告了在 RTC 撕裂的尸体肩袖中 SCR 后肩峰下间隙的盂肱关节上移位或肩峰下接触压力，则将其纳入。该综述符合系统评价和荟萃分析的首选报告项目标准。记录了研究数量、移植物类型和生物力学结果，并使用森林图进行分析。
共有 12 项研究（95 个肩膀）纳入统计分析。与 RTC 撕裂相比，10 项研究（79 个肩膀）中 SCR 后盂肱关节上移明显减少，标准化均数差（SMD）为-2.48mm；置信区间（CI）为-3.28mm，-1.69mm。阔筋膜移植物与 RTC 撕裂之间的 SMD 为-3.84mm（CI -4.82mm，-2.86mm），真皮移植物与 RTC 撕裂之间的 SMD 为-2.05mm（CI -3.10mm，-1.00mm）。与 RTC 撕裂相比，5 项研究（55 个肩膀）中 SCR 后肩峰下接触压力明显降低，SMD 为-3.49MPa（CI -4.54MPa，-2.44MPa）。阔筋膜移植物与 RTC 撕裂之间的 SMD 为-3.21MPa（CI -5.08MPa，-1.34MPa），真皮移植物与 RTC 撕裂之间的 SMD 为-3.89MPa（CI -5.91MPa，-1.87MPa）。
无论移植物类型如何，生物力学研究均表明，与 RTC 撕裂相比，SCR 在时间为零时可改善盂肱关节的上移位和肩峰下接触压力。本研究未确定有明确证据表明 SCR 移植物有更优越的生物力学选择。
研究几种移植物类型对上囊重建的生物力学结果将有助于外科医生更好地了解不同移植物类型在上囊重建手术中的功效。
