Bi Mingguang, Sun Zheng, Wei Liyong, Ding Wei, Zheng Minzhe, Li Jin, Ding Shaohua
Department of Joint and Sports Medicine, The Affiliated Lihuili Hospital, Ningbo University, Ningbo, Zhejiang, China.
Health Science Center, Ningbo University, Ningbo, Zhejiang, China.
Am J Sports Med. 2025 Jun;53(7):1721-1730. doi: 10.1177/03635465251336190. Epub 2025 May 16.
Arthroscopic superior capsule reconstruction (ASCR) with combined fascia lata autograft and synthetic scaffold patch graft has been reported to improve graft healing and treat irreparable rotator cuff tears (RCTs). Information about the surgical outcomes of using different synthetic scaffold materials is limited.
To compare the clinical outcomes of the ASCR technique using LARS ligament with polyethylene terephthalate (PET) material versus polypropylene (PP) mesh scaffold augmentation to treat irreparable RCTs.
Case series; Level of evidence, 4.
The data of 92 patients with irreparable RCTs who underwent ASCR between 2016 and 2022 were retrospectively evaluated. Among them, 82 of 92 patients who met the inclusion and exclusion criteria were available for follow-up. Fascia lata autografts augmented with LARS ligament (LARS with PET; Corin Group) were used in 43 patients (LARS group), and fascia lata autografts with PP mesh augmentation were used in 39 patients (mesh group). Clinical outcomes were evaluated preoperatively and at a final follow-up by a visual analog scale for pain score and range of motion along with the American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score, and Constant-Murley score (CMS). Radiological outcomes were assessed according to the rotator cuff arthropathy and acromiohumeral distance stages. Graft integrity and muscle fatty infiltration were evaluated by magnetic resonance imaging.
Both groups showed significant improvement in clinical and radiological outcomes at the final follow-up. The LARS group showed significantly better outcomes in mean ASES score (92.6 ± 8.0 vs 77.8 ± 21.3; < .001), UCLA score (31.5 ± 3.9 vs 24.4 ± 7.5; < .001), and CMS (86.6 ± 7.2 vs 67.9 ± 18.9; < .001) compared with the mesh group. The mean active elevation was significantly higher in the LARS group (161.4 ± 19.7) than in the mesh group (124.2 ± 31.3) ( < .001). The graft healing rate was also significantly higher in the LARS group (91%) than in the mesh group (72%) ( = .027), and acromiohumeral distance was significantly greater in the LARS group (7.0 ± 1.5 mm) than in the mesh group (6.3 ± 1.5 mm) at the final follow-up ( = .036). Subgroup analysis revealed that patients with intact grafts demonstrated a more substantial improvement in functional outcomes and active elevation.
Compared with combining ASCR with a synthetic PP mesh scaffold graft, augmenting autogenous fascia lata ASCR with a synthetic LARS ligament scaffold graft achieved better functional outcomes and graft healing rate.
据报道，采用阔筋膜自体移植联合合成支架补片移植的关节镜下上盂唇重建术（ASCR）可促进移植物愈合，并治疗不可修复的肩袖撕裂（RCT）。关于使用不同合成支架材料的手术效果的信息有限。
比较使用聚对苯二甲酸乙二酯（PET）材料的LARS韧带进行ASCR技术与聚丙烯（PP）网片支架增强术治疗不可修复的RCT的临床效果。
病例系列；证据等级，4级。
回顾性评估2016年至2022年间接受ASCR的92例不可修复RCT患者的数据。其中，92例符合纳入和排除标准的患者中有82例可供随访。43例患者（LARS组）使用LARS韧带（含PET的LARS；Corin集团）增强的阔筋膜自体移植，39例患者（网片组）使用PP网片增强的阔筋膜自体移植。术前和末次随访时通过视觉模拟评分法评估疼痛评分和活动范围，并采用美国肩肘外科医师（ASES）评分、加利福尼亚大学洛杉矶分校（UCLA）评分和Constant-Murley评分（CMS）评估临床效果。根据肩袖关节病和肩峰下间隙阶段评估影像学效果。通过磁共振成像评估移植物完整性和肌肉脂肪浸润情况。
两组在末次随访时临床和影像学效果均有显著改善。与网片组相比，LARS组在平均ASES评分（92.6±8.0对77.8±21.3；P<0.001）、UCLA评分（31.5±3.9对24.4±7.5；P<0.001）和CMS（86.6±7.2对67.9±18.9；P<0.001）方面表现出显著更好的效果。LARS组的平均主动抬高（161.4±19.7）显著高于网片组（124.2±31.3）（P<0.001）。LARS组的移植物愈合率（91%）也显著高于网片组（72%）（P=0.027），末次随访时LARS组的肩峰下间隙（7.0±1.5mm）显著大于网片组（6.3±1.5mm）（P=0.036）。亚组分析显示，移植物完整的患者在功能结局和主动抬高方面有更显著的改善。
与ASCR联合合成PP网片支架移植相比，自体阔筋膜ASCR联合合成LARS韧带支架移植可获得更好的功能结局和移植物愈合率。
