Ben Hui, Kholinne Erica, Guo Jia, Park Ji Yeon, Jeon In-Ho
Department of Orthopaedic Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China.
Faculty of Medicine, Universitas Trisakti, Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia.
Arthroscopy. 2025 Jul;41(7):2248-2258. doi: 10.1016/j.arthro.2024.11.096. Epub 2024 Dec 11.
To evaluate the minimum 12-month clinical and radiologic outcomes of combined superior capsular reconstruction (SCR) and lower trapezius transfer (LTT) for posterosuperior irreparable massive rotator cuff tears (IMRCTs).
Patients with posterosuperior IMRCTs and severe fatty infiltration (Goutallier grade ≥3) of the infraspinatus who underwent combined SCR and LTT were retrospectively reviewed. A double-folded fascia lata autograft with 1 layer of polypropylene mesh inside was used for SCR, and an Achilles tendon allograft was used to connect the tendon of the lower trapezius to the greater tuberosity. A thorough preoperative assessment with clinical history, physical examination, and imaging studies was critical for identifying tear patterns that were reparable or irreparable and to guide further treatment. American Shoulder and Elbow Surgeons (ASES), visual analog scale (VAS), Constant, Single Assessment Numeric Evaluation (SANE) scores, and range of motion were collected at a minimum 12-month follow-up postoperatively. Radiologic evaluation included graft integrity and the acromiohumeral distance at the final follow-up. Postoperative magnetic resonance imaging was used to assess graft integrity. The minimal clinically important difference was calculated as one-half of the standard deviation of the score change between the preoperative baseline and the latest follow-up.
Fifteen patients were included in this study, with a mean follow-up period of 20.6 months (range, 12.2-31.2 months). Significant improvements in clinical and radiologic outcomes were found after surgery. The VAS score decreased from 4.1 to 0.7 (P = .001). The ASES, Constant, and SANE scores improved from 54.5 to 83.7 (P = .001), from 61.1 to 76.7 (P = .001), and from 48.7 to 74.0 (P = .001), respectively. External rotation improved from 26.0° to 45.7° (P = .009). Postoperative magnetic resonance imaging scans were obtained at a mean final follow-up of 14.2 months (range, 11.9-23.2). The acromiohumeral distance improved significantly from 4.9 mm to 8.1 mm after surgery (P = .003). In 2 patients (13.3%), both fascia lata and Achilles tendon graft tears developed during follow-up. The minimal clinically important difference was obtained in 80.0%, 66.7%, 53.3%, and 46.7% of patients for the ASES score, VAS score, Constant score, and SANE score, respectively.
SCR-LTT contributes to significant pain relief and functional improvements with a graft healing rate of 86.7% at a minimum 12-month follow-up in patients with posterosuperior IMRCTs and high-grade fatty infiltration of the infraspinatus.
Level IV, retrospective case series.
评估联合上盂唇重建术（SCR）和下斜方肌转移术（LTT）治疗后上盂唇不可修复性巨大肩袖撕裂（IMRCT）的至少12个月的临床和影像学结果。
回顾性分析接受联合SCR和LTT治疗的后上盂唇IMRCT且冈下肌严重脂肪浸润（Goutallier分级≥3）的患者。SCR采用双层阔筋膜自体移植，内有一层聚丙烯网片，采用跟腱同种异体移植将下斜方肌肌腱连接至大结节。通过临床病史、体格检查和影像学检查进行全面的术前评估，对于识别可修复或不可修复的撕裂模式以及指导进一步治疗至关重要。术后至少12个月随访时收集美国肩肘外科医师学会（ASES）、视觉模拟评分（VAS）、Constant评分、单项评估数字评价（SANE）评分及活动范围。影像学评估包括末次随访时移植物完整性和肩峰下间隙距离。术后磁共振成像用于评估移植物完整性。将最小临床重要差异计算为术前基线与最新随访之间评分变化标准差的一半。
本研究纳入15例患者，平均随访时间为20.6个月（范围12.2 - 31.2个月）。术后临床和影像学结果有显著改善。VAS评分从4.1降至0.7（P = 0.001）。ASES、Constant和SANE评分分别从54.5提高至83.7（P = 0.001）、从61.1提高至76.7（P = 0.001）、从48.7提高至74.0（P = 0.001）。外旋从26.0°改善至45.7°（P = 0.009）。平均末次随访14.2个月（范围11.9 - 23.2个月）时进行术后磁共振成像扫描。术后肩峰下间隙距离从4.9 mm显著改善至8.1 mm（P = 0.003）。2例患者（13.3%）在随访期间出现阔筋膜和跟腱移植物撕裂。ASES评分、VAS评分、Constant评分和SANE评分分别在80.0%、66.7%、53.3%和46.7%的患者中达到最小临床重要差异。
对于后上盂唇IMRCT且冈下肌高级别脂肪浸润的患者，SCR - LTT在至少12个月随访时可显著缓解疼痛并改善功能，移植物愈合率为86.7%。
IV级，回顾性病例系列。
