Chiu Joe Chih-Hao, Chen Yu-Cheng, Chen Poyu, Lu Yi, Yang Cheng-Pang, Cheng You-Hung, Chen Alvin Chao-Yu
Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
Clinics (Sao Paulo). 2025 Apr 2;80:100628. doi: 10.1016/j.clinsp.2025.100628. eCollection 2025.
A 2 mm-thick dermal allograft and autologous Long Head of the Biceps Tendon (LHBT) Superior Capsule Reconstruction (SCR) could provide improved clinical and radiographic outcomes for posterosuperior Massive Irreparable Rotator Cuff Tears (MIRCTs).
A retrospective study was conducted between April 2019 and October 2021. The LHBT was rerouted 5 mm posteriorly to the bicipital groove, and a 2 mm-thcick dermal allograft was used to cover the rerouted LHBT. Clinical assessment included Constant-Murley Shoulder score (CMS), American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), Visual Analog Scale (VAS) pain scores, and active ROM measurements. The radiological assessment included Acromiohumeral Distance (AHD), Superior Capsular Distance (SCD), muscle Fatty Infiltration (FI), and follow-up SCR integrity using ultrasound two years after surgery.
25 patients (7 male, 18 female) were included with a mean age of 64.2 ± 6.9 years. Active ROM, AHD, and SCD did not change significantly after the surgery. Patients' VAS (8.3 ± 0.7 to 1.3 ± 0.6, p < 0.001), SSV (22.4 ± 8.6 to 77.6 ± 12.7, p < 0.001), CMS (36.2 ± 6.8 to 79.9 ± 8.4, p < 0.001), and ASES (37.2 ± 10.0 to 80.5 ± 5.7, p < 0.001) improved significantly at final follow-up. The ultrasound examination of all patients demonstrated a healed dermal allograft on the supraspinatus footprint. One patient (4 %) had a postoperative trauma causing irreparable subscapularis tear, leading to reverse total shoulder arthroplasty during revision surgery.
The combined SCR technique using a 2 mm dermal allograft and autologous LHBT for posterosuperior MIRCTs significantly improved the patient-reported outcomes.
2毫米厚的同种异体真皮移植联合自体肱二头肌长头肌腱（LHBT）上盂唇重建（SCR）可为后上巨大不可修复性肩袖撕裂（MIRCT）提供更好的临床和影像学结果。
于2019年4月至2021年10月进行一项回顾性研究。将LHBT重新路由至肱二头肌沟后方5毫米处，并使用2毫米厚的同种异体真皮移植覆盖重新路由后的LHBT。临床评估包括Constant-Murley肩关节评分（CMS）、美国肩肘外科医师学会（ASES）评分、主观肩关节评价值（SSV）、视觉模拟量表（VAS）疼痛评分以及主动活动度测量。影像学评估包括肩峰下间隙距离（AHD）、上盂唇距离（SCD）、肌肉脂肪浸润（FI），并在术后两年使用超声检查随访SCR的完整性。
纳入25例患者（7例男性，18例女性），平均年龄64.2±6.9岁。术后主动活动度、AHD和SCD无显著变化。患者的VAS（从8.3±0.7降至1.3±0.6，p<0.001）、SSV（从22.4±8.6升至77.6±12.7，p<0.001）、CMS（从36.2±6.8升至79.9±8.4，p<0.001）和ASES（从37.2±10.0升至80.5±5.7，p<0.001）在末次随访时均显著改善。所有患者的超声检查均显示冈上肌足迹处的同种异体真皮移植已愈合。1例患者（4%）术后遭受创伤，导致不可修复的肩胛下肌撕裂，在翻修手术中接受了反式全肩关节置换术。
使用2毫米同种异体真皮移植联合自体LHBT的联合SCR技术显著改善了后上MIRCT患者的报告结局。
