Ilg Ansgar, Kaiser René, Schneider Stefan, Hollander Karsten, Holz Johannes
OrthoCentrum Hamburg, Hamburg, Germany.
MSH Medical School, Hamburg, Germany.
Orthop J Sports Med. 2024 Oct 22;12(10):23259671241264499. doi: 10.1177/23259671241264499. eCollection 2024 Oct.
Currently, there is no consensus on the adequate management of irreparable rotator cuff tears. Arthroscopic superior capsule reconstruction (SCR) seems to be an alternative treatment option.
PURPOSE/HYPOTHESIS: The purpose of this study was to evaluate patient-reported outcomes up to 2 years after the treatment of irreparable rotator cuff tears with SCR using an acellular porcine dermal xenograft. It was hypothesized that SCR treatment with an acellular porcine dermal xenograft would not result in a significant clinical improvement or pain relief in patients with irreparable rotator cuff tears if the xenograft fails.
Case series; Level of evidence, 4.
A total of 26 consecutive patients with irreparable rotator cuff tears were enrolled in the study between 2015 and 2019. All patients underwent SCR with acellular porcine dermal xenograft. Patient-reported outcome measures including visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, the Veterans RAND 12- Item Health Survey (VR-12), and the Single Assessment Numeric Evaluation (SANE) were followed up for 2 years. For statistical analysis, the 1-way analysis of variance was used to compare means for VAS, ASES, VR-12, and SANE results between pre- and posttreatment. Magnetic resonance imaging (MRI) records were obtained at 1 year postoperatively to evaluate graft integrity.
In total, 22 patients were included in the patient-reported outcomes with 4 being lost at final follow-up. The mean VAS score decreased from 4.2 ± 2.5 to 1.0 ± 1.4 ( < .001) from pretreatment to 2 years postoperatively. The mean ASES - index score improved significantly from 47.7 ± 15.3 to 86.4 ± 12.9 ( < .001) and the SANE score improved from 34.0 ± 20.4 to 77.3 ± 20.2 ( < .001). In addition, a clinically important difference in the patients' quality of life was achieved, as shown by the mean changes in the VR-12 physical (+4.3) and mental scores (+9.3). Based on postoperative MRI, the dermal graft on the humeral side was intact in 15 (68.2%) patients after surgery.
Our arthroscopic SCR with an acellular porcine dermal matrix showed significant and continuous improvement in pain and clinical scores up to a 2-year follow-up in patients with irreparable rotator cuff tears, even with structural graft failure. However, further studies and evaluation of larger patient groups are needed to evaluate the long-term effect of this procedure.
目前，对于不可修复的肩袖撕裂的适当治疗尚无共识。关节镜下上盂唇重建术（SCR）似乎是一种替代治疗选择。
目的/假设：本研究的目的是评估使用脱细胞猪真皮异种移植物对不可修复的肩袖撕裂进行SCR治疗后长达2年的患者报告结局。假设如果异种移植物失败，使用脱细胞猪真皮异种移植物进行SCR治疗不会使不可修复的肩袖撕裂患者的临床有显著改善或疼痛缓解。
病例系列；证据等级，4级。
2015年至2019年期间，共有26例连续的不可修复肩袖撕裂患者纳入本研究。所有患者均接受了脱细胞猪真皮异种移植物的SCR治疗。对患者报告的结局指标进行随访2年，包括疼痛视觉模拟量表（VAS）、美国肩肘外科医师（ASES）评分、退伍军人兰德12项健康调查（VR-12）和单项评估数字评价（SANE）。为进行统计分析，采用单因素方差分析比较治疗前后VAS、ASES、VR-12和SANE结果的均值。术后1年获取磁共振成像（MRI）记录以评估移植物完整性。
共有22例患者纳入患者报告结局分析，4例在最终随访时失访。从术前到术后2年，平均VAS评分从4.2±2.5降至1.0±1.4（P<.001）。平均ASES指数评分从47.7±15.3显著提高到86.4±12.9（P<.001），SANE评分从34.0±20.4提高到77.3±20.2（P<.001）。此外，VR-12身体评分（+4.3）和精神评分（+9.3）的平均变化表明患者的生活质量有了临床上的重要差异。根据术后MRI，术后15例（68.2%）患者肱骨侧的真皮移植物完整。
我们使用脱细胞猪真皮基质进行的关节镜下SCR显示，即使存在结构性移植物失败，不可修复肩袖撕裂患者在长达2年的随访中疼痛和临床评分仍有显著且持续的改善。然而，需要进一步研究和评估更大的患者群体以评估该手术的长期效果。
