Langhans Mark T, Feroe Aliya G, Barlow Jonathan D, Camp Christopher L
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Video J Sports Med. 2024 Jan 22;4(1):26350254231188978. doi: 10.1177/26350254231188978. eCollection 2024 Jan-Feb.
Irreparable rotator cuff tears represent approximately 12% of all presenting cuff tears, and multiple surgical techniques have been described for treatment, including allograft/bridge augmentation, debridement, partial repair, subacromial balloon, tendon transfer, and superior capsule reconstruction (SCR). SCR has demonstrated durable improvement in range of motion (ROM) and outcome scores at 2 and 5 years.
Surgical indications for SCR include an irreparable tear of the supraspinatus and/or infraspinatus with a preserved or reparable subscapularis and preserved glenohumeral joint cartilage.
Diagnostic arthroscopy is performed to identify and characterize the rotator cuff tear. Thorough debridement of the greater tuberosity is performed. Two all-suture FiberTak anchors are placed in the superior aspect of the glenoid. Two 2.6-mm FiberTak suture anchors are placed in the humeral head at the chondral margin. After measuring, the dermal allograft is cut to size with 15-mm overhang left on the far lateral edge. A 12-mm passport cannula is inserted laterally and the sutures from the glenoid and humeral head anchors are brought out through the cannula maintaining their position and orientation. The sutures are passed through the graft outside the cannula. The graft is introduced into the shoulder via the passport cannula with a back grasper. A cannula-in-cannula technique is used to tie the glenoid anchors first and then the medial row anchors. Two lateral row swivel lock anchors are used to complete a standard double row repair. Margin convergence is performed between the dermal allograft and remaining rotator cuff anterior and posterior. Postoperatively, patients are kept in a sling for 6 weeks, with no shoulder ROM. From weeks 6 to 12, patients discontinue sling and begin passive progression to active ROM. Strengthening is initiated at 12 weeks, and return-to-sport or work is at approximately 6 months.
Irreparable rotator cuff tears treated with arthroscopic rotator cuff repair and SCR show durable improvement in patient-reported outcomes at 2 and 5 years. Re-tear rates did not differ between athletes and non-athletes.
DISCUSSION/CONCLUSION: Arthroscopic rotator cuff repair with SCR is a durable and reliable surgical option for patients presenting with preserved glenohumeral joint and irreparable supraspinatus and/or infraspinatus tear.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
不可修复的肩袖撕裂约占所有肩袖撕裂病例的12%，目前已有多种手术技术用于治疗，包括同种异体移植/桥接增强、清创、部分修复、肩峰下球囊扩张、肌腱转移和上盂唇重建（SCR）。SCR已证明在2年和5年时可持久改善活动范围（ROM）和预后评分。
SCR的手术适应症包括冈上肌和/或冈下肌不可修复的撕裂，同时肩胛下肌保留或可修复，且盂肱关节软骨保留。
进行诊断性关节镜检查以识别和表征肩袖撕裂。对大结节进行彻底清创。在肩胛盂上缘放置两个全缝线FiberTak锚钉。在肱骨头软骨边缘放置两个2.6毫米的FiberTak缝线锚钉。测量后，将真皮同种异体移植物裁剪至合适尺寸，在最外侧边缘留出15毫米的边缘。在外侧插入一个12毫米的通道套管，将肩胛盂和肱骨头锚钉的缝线通过套管引出，保持其位置和方向。缝线在套管外穿过移植物。使用反向抓钳通过通道套管将移植物引入肩部。采用套管内套管技术先系紧肩胛盂锚钉然后系紧内侧排锚钉。使用两个外侧排旋转锁定锚钉完成标准的双排修复。在真皮同种异体移植物与剩余肩袖的前后缘之间进行边缘对合。术后，患者用吊带固定6周，并避免肩部进行ROM活动。从第6周开始到第12周，患者停止使用吊带，开始从被动活动逐渐过渡到主动ROM活动。在12周时开始进行强化训练，并在大约6个月时恢复运动或工作。
采用关节镜下肩袖修复和SCR治疗不可修复的肩袖撕裂，在2年和5年时患者报告的预后有持久改善。运动员和非运动员的再撕裂率无差异。
讨论/结论：对于盂肱关节保留且冈上肌和/或冈下肌不可修复撕裂的患者，关节镜下肩袖修复联合SCR是一种持久且可靠的手术选择。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本提交内容附上患者的豁免声明或其他书面批准形式以供发表。
