Dykhouse Gabrielle, Marigi Erick, Finocchiaro Anthony, Dines Joshua S, Fu Michael C
Weill Cornell Medical College, Weill Cornell Medicine, New York, NY, USA.
Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA.
JSES Int. 2024 Dec 2;9(2):385-389. doi: 10.1016/j.jseint.2024.11.007. eCollection 2025 Mar.
Management of posterosuperior irreparable rotator cuff tears (IRCTs) remains challenging without clear consensus among shoulder surgeons. Arthroscopic superior capsular reconstruction (SCR) with dermal allograft has been proposed as a promising treatment option. However, current investigations are limited to short term studies and recent data has suggested variable clinical outcomes. Therefore, the purpose of this investigation was to report intermediate-term clinical outcomes in patients who underwent arthroscopic SCR with a dermal allograft for IRCTs.
Over a 4-year period (2016-2020), all patients who underwent an arthroscopic dermal allograft SCR with a minimum 2-year follow-up period were identified. SCR with dermal allograft was performed for patients with an IRCT utilizing a 3-mm acellular dermal allograft. Collected clinical outcomes included range of motion, strength, Numeric Rating Scale for pain, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, Single-Assessment Numeric Evaluation score, complications, and reoperations.
The final cohort included 41 dermal allograft SCR performed in 40 patients (1 bilateral) with a majority male cohort (n = 29; 72%), a mean age of 67 ± 7 years, body mass index of 28.4 ± 5.0, and follow-up of 5.3 ± 1.4 years. Clinically, there was a significant improvement in preoperative and postoperative Numeric Rating Scale pain scores from 5.0 to 1.8 ( < .001), but no differences in preoperative and postoperative forward flexion ( = .268), abduction ( = .822), external rotation ( = .323), or internal rotation ( = .995). The final postoperative American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form and Single-Assessment Numeric Evaluation scores were 66 ± 28 and 59 ± 30, respectively. There were 8 (19.5%) complications, which consisted primarily of symptomatic graft failure in 6 (14.6%) shoulders and progression of rotator cuff arthropathy in 2 (4.9%) shoulders. Reoperations occurred in 6 (14.3%) shoulders: 4 (9.8%) were conversion to reverse total shoulder arthroplasty and 2 (4.9%) were arthroscopic revision dermal allograft SCR with partial repair and reattachment of the torn graft.
At a cohort mean of 5 years after arthroscopic SCR with dermal allograft for IRCTs, patients experienced sustained pain relief but no significant improvement in shoulder function. Additionally, 20% sustained a postoperative complication with a 14% reoperation rate. These findings should be considered when counseling patients about the challenges of managing IRCTs and the possible outcomes of utilizing dermal allograft SCR as a surgical modality.
对于后上不可修复性肩袖撕裂（IRCT）的治疗，目前尚无明确共识，这仍然是一个具有挑战性的问题。关节镜下使用同种异体真皮进行上盂唇重建（SCR）已被提出作为一种有前景的治疗选择。然而，目前的研究仅限于短期研究，且近期数据显示临床结果存在差异。因此，本研究的目的是报告接受关节镜下使用同种异体真皮进行SCR治疗IRCT患者的中期临床结果。
在4年期间（2016 - 2020年），确定了所有接受关节镜下同种异体真皮SCR且随访期至少为2年的患者。对患有IRCT的患者使用3毫米无细胞同种异体真皮进行SCR。收集的临床结果包括活动范围、力量、疼痛数字评分量表、美国肩肘外科医师协会标准化肩部评估表评分、单评估数字评价评分、并发症和再次手术情况。
最终队列包括40例患者（1例双侧）接受的41次同种异体真皮SCR，大多数为男性队列（n = 29；72%），平均年龄67±7岁，体重指数28.4±5.0，随访时间5.3±1.4年。临床上，术前和术后疼痛数字评分量表疼痛评分从5.0显著改善至1.8（P <.001），但术前和术后前屈（P =.268）、外展（P =.822）、外旋（P =.323）或内旋（P =.995）无差异。最终术后美国肩肘外科医师协会标准化肩部评估表和单评估数字评价评分分别为66±28和59±30。有8例（19.5%）并发症，主要包括6例（14.6%）肩部有症状的移植物失败和2例（4.9%）肩部肩袖关节病进展。6例（14.3%）肩部进行了再次手术：4例（9.8%）转换为反式全肩关节置换术，2例（4.9%）为关节镜下同种异体真皮SCR翻修术，包括部分修复和重新附着撕裂的移植物。
对于接受关节镜下使用同种异体真皮进行SCR治疗IRCT的患者，在队列平均5年后，患者疼痛持续缓解，但肩部功能无显著改善。此外，20%的患者出现术后并发症，再次手术率为14%。在向患者咨询管理IRCT的挑战以及使用同种异体真皮SCR作为手术方式可能的结果时，应考虑这些发现。
