Xiao Qi, Xu Zunying, Zhang Jingjie, Deng Huiyun, Wu Qingquan, Jiang Huixiang, Xie Wei, Zheng Jiapeng
Department of Sports Medicine, The 909th Hospital, School of Medicine, Xiamen University.
Department of Sports Medicine, The 909th Hospital, School of Medicine, Xiamen University;
J Vis Exp. 2025 Jun 6(220). doi: 10.3791/68098.
Massive irreparable rotator cuff tears (MIRCTs) are not uncommon in clinical practice, significantly impacting shoulder function and daily activities. Extensive tear size, tendon contracture, and fat infiltration within the rotator cuff pose significant challenges for both patients and clinicians. This type of tear is a key area of interest and a challenge in research and treatments. Current treatment options include conservative management, debridement, partial repair, superior capsule reconstruction (SCR), tendon transfers, and reverse total shoulder arthroplasty (RTSA). However, clinical outcomes vary widely. The rotator cable (RC) exhibits a perpendicular orientation with respect to the superior rotator cuffs, thereby forming an arc-shaped attachment to the proximal humerus, and it plays an essential role in maintaining the rotator cuff's force couple. The attachments of both anterior and posterior RC play a crucial role in facilitating overhead movements. When complete tension-free coverage of the footprint cannot be attained, whole rotator cable reconstruction (WRCR) presents as an alternative approach for MIRCTs. We utilized autologous tendon harvested from the proximal biceps tendon for arthroscopic WRCR. The proposed technique offers distinct advantages: autologous tissue utilization eliminates immunogenicity; simplified harvesting reduces operative complexity; and minimized anchor usage enhances cost-effectiveness. In this study, 12 patients underwent WRCR, with significant improvements in shoulder function and pain relief observed during a 1 year follow-up.
巨大不可修复性肩袖撕裂（MIRCTs）在临床实践中并不罕见，会显著影响肩部功能和日常活动。肩袖内广泛的撕裂大小、肌腱挛缩和脂肪浸润给患者和临床医生都带来了重大挑战。这种类型的撕裂是研究和治疗中一个关键的关注领域和挑战。目前的治疗选择包括保守治疗、清创术、部分修复、上盂唇重建（SCR）、肌腱转移和反式全肩关节置换术（RTSA）。然而，临床结果差异很大。肩袖索带（RC）相对于上肩袖呈垂直方向，从而在肱骨近端形成弧形附着，并且在维持肩袖的力偶中起重要作用。前、后RC的附着在促进过顶运动中起着关键作用。当无法实现足迹的完全无张力覆盖时，全肩袖索带重建（WRCR）是MIRCTs的一种替代方法。我们利用从肱二头肌近端肌腱获取的自体肌腱进行关节镜下WRCR。所提出的技术具有明显优势：使用自体组织消除了免疫原性；简化的取材减少了手术复杂性；最小化锚钉使用提高了成本效益。在本研究中，12例患者接受了WRCR，在1年随访期间观察到肩部功能显著改善和疼痛缓解。
