Department of Sports Medicine, First Affiliated Hospital of Hospital of Army Medical University, Chongqing, China.
Department of Sports Medicine, Second Affiliated Hospital of Hospital of Chongqing Medical University, Chongqing, China.
Am J Sports Med. 2024 Aug;52(10):2628-2638. doi: 10.1177/03635465241264805. Epub 2024 Aug 13.
Massive irreparable rotator cuff tears (MIRCTs) are among the most challenging shoulder conditions to treat surgically. Supraspinatus tendon reconstruction (STR) is a recently introduced technique for MIRCTs based on fascia lata-muscle interface healing, which completely differs from the classic bridging technique with fascia lata-tendon interface healing. However, histological and biomechanical comparisons of the fascia-muscle and fascia-tendon interfaces have not been performed.
To investigate the histological and biomechanical healing of the fascia-bone interface and fascia-muscle interface after chronic MIRCTs in a rat model using different surgical methods.
Controlled laboratory study.
The authors established a chronic MIRCT model in the right shoulder of rats and then repaired it using the STR or bridging repair technique. Evaluations were performed at 2, 4, 8, and 12 weeks, including histological, imaging, biomechanical, and functional analyses.
Both techniques resulted in good fascia-bone interface healing based on the histological results. The STR group had significantly more cartilage formation at 8 and 12 weeks and higher Modified Tendon Maturity Score after 12 weeks at the fascia-bone interface compared with the bridging repair group and formed the typical 4-layered structure. Collagen fibers in the fascia-muscle and fascia-tendon interfaces exhibited normal muscle-tendon interface characteristics at 12 weeks. However, the STR group had more improvement in fatty infiltration compared with the bridging repair group. The ultimate failure load and stiffness did not differ between the STR and bridging repair groups 4 weeks postoperatively in both the fascia-bone interface and supraspinatus muscle-fascia-bone integrity. Movement distance and grasp time were significantly longer in the STR group than in the bridging repair group at 12 weeks and attached the level in the normal control groups.
These results suggest that the fascia-muscle interface from the STR technique is histologically and functionally better than the fascia-tendon interface. Moreover, this study provides a theoretical basis for the clinical use of the STR technique.
The fascia-muscle interface and fascia-tendon interface were the key points of the STR and bridging techniques, respectively. The fascia-muscle interface is histologically and functionally superior to the bridging technique, and the STR technique might be a better choice for the treatment of MIRCTs.
巨大不可修复的肩袖撕裂（MIRCT）是最具挑战性的肩部疾病之一，需要手术治疗。冈上肌肌腱重建术（STR）是一种最近引入的治疗 MIRCT 的技术，基于阔筋膜-肌肉界面愈合，这与经典的阔筋膜-肌腱界面愈合的桥接技术完全不同。然而，尚未对筋膜-肌肉和筋膜-肌腱界面进行组织学和生物力学比较。
使用不同的手术方法，在大鼠慢性 MIRCT 模型中研究慢性 MIRCT 后筋膜-骨界面和筋膜-肌肉界面的组织学和生物力学愈合情况。
对照实验室研究。
作者在大鼠右侧建立慢性 MIRCT 模型，然后使用 STR 或桥接修复技术进行修复。在 2、4、8 和 12 周时进行评估，包括组织学、影像学、生物力学和功能分析。
两种技术均能很好地实现筋膜-骨界面的愈合，组织学结果良好。与桥接修复组相比，STR 组在 8 周和 12 周时在筋膜-骨界面处有更多的软骨形成，12 周时改良肌腱成熟评分更高，并形成了典型的 4 层结构。12 周时，筋膜-肌肉和筋膜-肌腱界面处的胶原纤维呈现出正常的肌腱-肌肉界面特征。然而，与桥接修复组相比，STR 组的脂肪浸润改善更为明显。在筋膜-骨界面和冈上肌筋膜-骨完整性中，STR 和桥接修复组术后 4 周时的最终失效负荷和刚度没有差异。12 周时，STR 组的运动距离和抓握时间明显长于桥接修复组，并与正常对照组的水平相吻合。
这些结果表明，从 STR 技术获得的筋膜-肌肉界面在组织学和功能上优于筋膜-肌腱界面。此外，这项研究为 STR 技术的临床应用提供了理论依据。
STR 技术和桥接技术的关键分别是筋膜-肌肉界面和筋膜-肌腱界面。筋膜-肌肉界面在组织学和功能上优于桥接技术，STR 技术可能是治疗 MIRCT 的更好选择。
