Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Avenue J.-D.-Maillard 3, CH-1217 Meyrin, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
Orthop Traumatol Surg Res. 2024 Feb;110(1S):103758. doi: 10.1016/j.otsr.2023.103758. Epub 2023 Nov 14.
Although the superior portion of the shoulder joint capsule is a clearly distinct structure, its ability to prevent vertical humeral head translation in irreparable rotator cuff tears remains controversial. The clinical results of superior capsule reconstruction (SCR) in this context are satisfactory but the radiological outcomes are poor in up to two-thirds of patients. Moreover, there is no proof that SCR is more beneficial than simply doing a subacromial debridement, a partial repair or a tenotomy of the long head of biceps. Furthermore, graft healing is not predictive of success. Given the lack of comparative studies with high level of evidence (level 1 or 2), we cannot conclude that this surgical technique (and its many variants) has a place in our treatment paradigm. Also, it seems that xenografts are no longer being used given the high rate of structural failure seen on MRI and the large number of complications. If the long head of biceps tendon is still intact at the time of surgery, it is a feasible option for SCR given the reasonable cost and minimal complications. If it is not - but the subscapularis tendon is intact or repairable - an allograft or a non-local autograft should be considered, despite its unpredictable clinical results. Surgeons should inform patients of the high rate of radiological repair failure and the worse results if a reverse shoulder arthroplasty should be needed subsequently. Level of evidence: 4.
尽管肩关节囊的上部是一个明显不同的结构，但在不可修复的肩袖撕裂中，它防止肱骨头垂直移位的能力仍存在争议。在这种情况下，进行上关节囊重建（SCR）的临床效果令人满意，但多达三分之二的患者的放射学结果较差。此外，没有证据表明 SCR 比单纯进行肩峰下减压术、部分修复或肱二头肌长头肌腱切断术更有益。此外，移植物愈合并不能预测手术成功。鉴于缺乏具有高级别证据（1 级或 2 级）的比较研究，我们不能得出结论认为这种手术技术（及其多种变体）在我们的治疗方案中有一席之地。此外，似乎由于 MRI 上看到的结构失败率高和并发症多，异种移植物已不再使用。如果在手术时肱二头肌长头肌腱仍然完整，那么对于 SCR 来说，它是一种可行的选择，因为其具有合理的成本和最小的并发症。如果它不完整——但肩胛下肌腱完整或可修复——则应考虑使用同种异体移植物或非局部自体移植物，尽管其临床结果不可预测。外科医生应告知患者放射学修复失败的高发生率，如果随后需要进行反向肩关节置换术，结果会更差。证据等级：4 级。
