Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany.
Faculty of Medicine and University Hospital, Center for Orthopedic and Trauma Surgery, University of Cologne, Cologne, Germany.
J Shoulder Elbow Surg. 2024 Nov;33(11):2472-2481. doi: 10.1016/j.jse.2024.05.040. Epub 2024 Jul 19.
HYPOTHESIS AND/OR BACKGROUND: Extensive, irreparable rotator cuff tears remain a surgical challenge and multiple treatment options are proposed and currently in use. To biomechanically compare superior glenohumeral translation, subacromial contact pressures, and area in a box-shaped reconstruction using the long head of the biceps tendon (LHBT) in an irreparable supraspinatus tendon tear model.
Seven cadaveric shoulders (mean age 61 years; range 32-84 years; standard deviation 22.3) were tested with a custom testing rig used to evaluate superior translation; subacromial contact pressures; and areas at 0°, 30°, and 60° of glenohumeral abduction. Conditions tested included the native state; a complete tear of the supraspinatus tendon; a wide box-shaped, double-bundle LHBT superior capsular reconstruction (BS-SCR); and a narrow BS-SCR.
Compared with the wide BS-SCR, the narrow BS-SCR had statistically significantly lower median contact pressure at 30° and 60°. The subacromial contact area showed a statistically significant difference at 0° (P = .001) and 30° (P = .004) for the narrow BS-SCR compared with the wide BS-SCR. At an abduction angle of 0°, the narrow BS-SCR could restore superior translation significantly better compared with the wide construct. For all angles, the wide and narrow BS-SCR increased the median subacromial distance statistically significantly. The contact areas in 30° and 60° of abduction were higher for all scenarios, both peaking in the intact state in 30° with approximately 600 mm.
In comparison to a wide BS-SCR, a narrow BS-SCR using the LHBT has biomechanical advantages in regard to subacromial contact pressures, the subacromial contact areas, as well as the acromiohumeral distance. The width of the reconstruction, therefore, has a direct influence on the success of the technique.
假设和/或背景：广泛的、不可修复的肩袖撕裂仍然是一个手术挑战，目前提出并正在使用多种治疗方案。为了在不可修复的冈上肌腱撕裂模型中从生物力学角度比较使用肱二头肌长头肌腱（LHBT）的上盂肱关节平移、肩峰下接触压力和盒形重建的面积。
使用定制测试装置测试了 7 个尸体肩部（平均年龄 61 岁；范围 32-84 岁；标准差 22.3），该测试装置用于评估上盂肱关节平移；肩峰下接触压力；和在 0°、30°和 60°肩肱外展时的箱形面积。测试的条件包括自然状态；冈上肌腱完全撕裂；宽盒形双束 LHBT 上囊重建（BS-SCR）；和窄 BS-SCR。
与宽 BS-SCR 相比，窄 BS-SCR 在 30°和 60°时的中位接触压力统计学上显著降低。与宽 BS-SCR 相比，窄 BS-SCR 在 0°（P=.001）和 30°（P=.004）时的肩峰下接触面积有统计学显著差异。在 0°的外展角度下，与宽结构相比，窄 BS-SCR 可以显著更好地恢复上盂肱关节平移。在所有角度下，宽和窄 BS-SCR 都使中位肩峰下距离统计学显著增加。在所有情况下，30°和 60°外展时的接触面积更高，在 30°时均在完整状态下达到峰值，约为 600mm。
与宽 BS-SCR 相比，使用 LHBT 的窄 BS-SCR 在肩峰下接触压力、肩峰下接触面积以及肩肱距离方面具有生物力学优势。重建的宽度因此直接影响技术的成功。
