Kim Hyun Gon, Kim Su Cheol, Park Jong Hun, Kim Jae Soo, Kim Dae Yeung, Lee Sang Min, Yoo Jae Chul
Department of Orthopedic Surgery, Korea University Ansan Hospital, Ansan, Republic of Korea.
Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Arthroscopy. 2024 Nov;40(11):2669-2677. doi: 10.1016/j.arthro.2024.02.046. Epub 2024 Mar 19.
To evaluate the clinical and structural outcomes of using injectable atelocollagen during arthroscopic rotator cuff repair (ARCR) for small- to medium-sized rotator cuff tears.
This retrospective study reviewed patients with small- to medium-sized full-thickness tears who underwent ARCR from 2016 to 2022 with a minimum 1-year follow-up. Propensity score (PS) matching was used to reduce bias. Tendon integrity was evaluated using magnetic resonance imaging (MRI) at postoperative 6 months. Clinical and structural outcomes were compared between the 2 groups.
After PS matching, this study included 181 pairs of patients comparing ARCR with atelocollagen injection and without atelocollagen injection. Range of motion, muscle strength, and functional outcomes were significantly improved in both the atelocollagen group and the control group. Forward elevation and external rotation were significantly worse in the atelocollagen group compared with the control group at 2, 6, and 12 months postoperatively and at the final follow-up. In total, 125 patients (69.1%) in the atelocollagen group and 130 patients (71.8%) in the control group exceeded the minimal clinically important difference in the American Shoulder and Elbow Surgeons score without a significant difference between the 2 groups (P = .509). The mean value of Sugaya grade on postoperative MRI evaluation was 2.03 ± 0.81 for the atelocollagen group and 2.24 ± 0.97 for the control group, with a significant difference between the 2 groups (P = .027). Tendon healing failure was observed in 12 patients (6.6%) in the atelocollagen group and 19 patients (10.5%) in the control group, with no statistical difference between the 2 groups (P = .189).
Atelocollagen injection during ARCR for small- to medium-sized subacute or chronic rotator cuff tears did not show a benefit in clinical outcomes. However, postoperative MRI showed significantly lower Sugaya grade compared with the control group, with no significant difference in retear rate.
Level III, retrospective case-control study.
评估在关节镜下修复中小型肩袖撕裂（ARCR）时使用注射用去细胞胶原蛋白的临床和结构结果。
这项回顾性研究纳入了2016年至2022年接受ARCR且至少随访1年的中小型全层撕裂患者。采用倾向评分（PS）匹配以减少偏倚。术后6个月使用磁共振成像（MRI）评估肌腱完整性。比较两组的临床和结构结果。
经过PS匹配后，本研究纳入了181对患者，比较了ARCR联合注射去细胞胶原蛋白与未注射去细胞胶原蛋白的情况。去细胞胶原蛋白组和对照组的活动范围、肌肉力量和功能结果均有显著改善。术后2个月、6个月、12个月及末次随访时，去细胞胶原蛋白组的前屈和外旋明显比对照组差。总体而言，去细胞胶原蛋白组125例患者（69.1%）和对照组130例患者（71.8%）的美国肩肘外科医生评分超过最小临床重要差异，两组间无显著差异（P = 0.509）。术后MRI评估的Sugaya分级平均值，去细胞胶原蛋白组为2.03±0.81，对照组为2.24±0.97，两组间有显著差异（P = 0.027）。去细胞胶原蛋白组有12例患者（6.6%）出现肌腱愈合失败，对照组有19例患者（10.5%）出现肌腱愈合失败，两组间无统计学差异（P = 0.189）。
在ARCR治疗中小型亚急性或慢性肩袖撕裂时注射去细胞胶原蛋白在临床结果方面未显示出益处。然而，术后MRI显示与对照组相比Sugaya分级显著更低，再撕裂率无显著差异。
III级，回顾性病例对照研究。
