Kuechly Henry A, Kurkowski Sarah C, Taleghani Eric R, Shah Nihar S, Kloby Michael A, Foster Timothy S, Grawe Brian M
Department of Orthopedic Surgery and Sports Medicine, University of Cincinnati, Cincinnati, OH, USA.
JSES Rev Rep Tech. 2024 Apr 15;4(3):413-418. doi: 10.1016/j.xrrt.2024.03.012. eCollection 2024 Aug.
Determine the effect of a novel acellular cannulated dermal allograft on tendon-to-bone healing, retear rates, and clinical outcomes over a 12-month period.
This was a single surgeon prospective nonrandomized case series. Patients with medium sized full-thickness superior and posterosuperior rotator cuff tears, as confirmed by magnetic resonance imaging, were consented. Patients were excluded if they had fatty atrophy indicative of Goutallier grade III or IV. The allograft is a cannulated rectangular prism that has a 5-year shelf life, does not require prehydration, and does not need to be trimmed to size. Outcome metrics included ultrasound assessment at 1-year as well as 6-month patient-reported outcomes (PROs) scores.
31 patients consented and enrolled in this consecutive cohort series. 9 patients were excluded, and statistical analysis was performed on the remaining 22 patients. There were 9 females and 13 males. The average age was 59.27 ± 7.48 year old. The average supraspinatus short axis measurement in males was 0.56 ± 0.12 cm and 0.52 ± 0.09 cm in females ( = .44). The average supraspinatus long axis measurement in males was 0.61 ± 0.18 cm and 0.55 ± 0.14 cm in females ( = .46). The average infraspinatus short axis measurement in males was 0.48 ± 0.10 cm and 0.50 ± 0.13 in females ( = .74). The average infraspinatus long axis measurement in males was 0.44 ± 0.12 cm and 0.43 ± 0.08 cm in females ( = .84). Of the 19 patients who completed baseline and 6-month PRO's, 17 achieved the minimal clinical important difference for American Shoulder and Elbow Surgeons and Patient-Reported Outcomes Measurement Information SystemUE 7a. Retear occurred in 2 cases. The remaining 20 cases have all demonstrated healing or fully healed repairs at their most recent clinical visits with no additional cases of retears.
This study is the first to report the results of a novel acellular dermal allograft for rotator cuff repair augmentation. Satisfactory PRO measures and robust tendon healing at 1 year, as measured by ultrasound, demonstrate the utility of a cannulated human acellular dermal allograft as a viable biologic augmentation device for rotator cuff repair.
确定一种新型脱细胞带孔真皮同种异体移植物在12个月期间对肌腱-骨愈合、再撕裂率和临床结果的影响。
这是一个由单一外科医生进行的前瞻性非随机病例系列研究。经磁共振成像证实为中等大小全层肩袖上表面和后上表面撕裂的患者签署了知情同意书。如果患者存在提示Goutallier III级或IV级的脂肪萎缩,则将其排除。同种异体移植物是一种带孔的长方体,保质期为5年,无需预水化,也无需修剪尺寸。结果指标包括1年时的超声评估以及6个月时患者报告的结局(PRO)评分。
31名患者签署知情同意书并纳入该连续队列系列研究。9名患者被排除,对其余22名患者进行了统计分析。其中有9名女性和13名男性。平均年龄为59.27±7.48岁。男性冈上肌短轴平均测量值为0.56±0.12 cm,女性为0.52±0.09 cm(P = 0.44)。男性冈上肌长轴平均测量值为0.61±0.18 cm,女性为0.55±0.14 cm(P = 0.46)。男性冈下肌短轴平均测量值为0.48±0.10 cm,女性为0.50±0.13 cm(P = 0.74)。男性冈下肌长轴平均测量值为0.44±0.12 cm,女性为0.43±0.08 cm(P = 0.84)。在完成基线和6个月PRO评估的19名患者中,17名患者达到了美国肩肘外科医生协会和患者报告结局测量信息系统UE 7a的最小临床重要差异。有2例发生再撕裂。其余20例在最近的临床随访中均显示愈合或完全愈合修复,无额外再撕裂病例。
本研究首次报告了一种新型脱细胞真皮同种异体移植物用于肩袖修复增强的结果。通过超声测量,1年时获得了令人满意的PRO指标和强劲的肌腱愈合,证明了带孔人脱细胞真皮同种异体移植物作为一种可行的生物增强装置用于肩袖修复的效用。