Ben Hui, Wang Changbing, Jeon In-Ho
Beijing Jishuitan Hospital, Beijing, China.
Foshan Hospital of TCM, Foshan, China.
Int Orthop. 2025 Jun 18. doi: 10.1007/s00264-025-06568-3.
This study aimed to investigate the effect of failed rotator cuff repair (RCR) on surgical outcomes after superior capsular reconstruction (SCR) using a fascia lata autograft.
We included 79 patients with irreparable massive rotator cuff tears who underwent SCR using fascia lata autografts between 2018 and 2023, with a minimum follow-up of ≥ one year. Of them, 66 patients underwent primary SCR (primary SCR group) and 13 underwent SCR after structural failure of previous RCR (revision SCR group). Clinical outcomes, including American Shoulder and Elbow Surgeons (ASES) score, Constant score, visual analogue scale (VAS) score, and range of motion, were assessed. Radiological outcomes were evaluated using radiographs and magnetic resonance imaging (MRI) scans. The minimal clinically important difference (MCID) values determined the clinical relevance of the difference in functional outcomes. Graft tears were recorded if graft discontinuity was found on MRI.
The revision SCR group showed worse VAS (2.1 vs. 1.1, P = 0.025), ASES (69.7 vs. 82.4, P = 0.008), Constant (57.1 vs. 64.3, P = 0.016) scores and higher graft tear rates (61.5% vs. 21.2%; P = 0.049) than the primary SCR group. The differences in VAS, ASES, and Constant scores exceeded the MCID threshold in the primary SCR group at a mean final follow-up of 2.1 ± 1.0 years. Conversely, in the revision SCR group, only the difference in Constant score exceeded the MCID threshold at a mean final follow-up of 2.2 ± 1.6 years, and patients with intact grafts showed significantly better VAS score and acromiohumeral distance (both P = 0.030) than those with torn grafts.
SCR using fascia lata autograft improved surgical outcomes for primary and revision SCRs. However, revision SCR showed worse outcomes and higher graft tear rates compared to primary SCR.
本研究旨在探讨使用阔筋膜自体移植进行上盂唇重建（SCR）时，肩袖修复（RCR）失败对手术效果的影响。
我们纳入了79例患有不可修复的巨大肩袖撕裂的患者，这些患者在2018年至2023年间接受了阔筋膜自体移植的SCR手术，且最短随访时间≥1年。其中，66例患者接受了初次SCR（初次SCR组），13例在先前RCR结构失败后接受了SCR（翻修SCR组）。评估了包括美国肩肘外科医师（ASES）评分、Constant评分、视觉模拟量表（VAS）评分和活动范围在内的临床结果。使用X线片和磁共振成像（MRI）扫描评估放射学结果。最小临床重要差异（MCID）值确定了功能结果差异的临床相关性。如果在MRI上发现移植组织连续性中断，则记录移植组织撕裂情况。
与初次SCR组相比，翻修SCR组的VAS评分（2.1对1.1，P = 0.025）、ASES评分（69.7对82.4，P = 0.008）、Constant评分（57.1对64.3，P = 0.016）更差，移植组织撕裂率更高（61.5%对21.2%；P = 0.049）。在平均最终随访2.1±1.0年时，初次SCR组的VAS、ASES和Constant评分差异超过了MCID阈值。相反，在翻修SCR组中，在平均最终随访2.2±1.6年时，只有Constant评分差异超过了MCID阈值，且移植组织完整的患者的VAS评分和肩峰下间隙明显优于移植组织撕裂的患者（P均 = 0.030）。
使用阔筋膜自体移植进行SCR可改善初次和翻修SCR的手术效果。然而，与初次SCR相比，翻修SCR的效果更差，移植组织撕裂率更高。
