PDF(Pubmed)
Abstract：
BACKGROUND: Surgical management of a massive rotator cuff tear (RCT) is always challenging. This study describes the clinical and radiological outcomes of patients who underwent bridging grafts using a plantaris tendon for an irreparable RCT.
METHODS: Thirteen patients with a massive RCT were treated with arthroscopic interposition of a folded plantaris tendon autograft between June 2017 and January 2020. For clinical evaluation, a visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, Constant-Murley score, and range of motion values were collected. For radiographic evaluation, standardized magnetic resonance imaging and ultrasonography were performed to check the integrity of the interposed tendon.
RESULTS: A statistically significant improvement at the final follow-up was evident in scores for the VAS (-3.0, P=0.003), ASES (24.9, P=0.002), D ASH (-20.6, P=0.001), and Constant-Murley values (14.2, P=0.010). In addition, significant improvement was shown in postoperative flexion (17.3°, P=0.026) and external rotation (27.7°, P<0.001). In postoperative radiologic evaluations, the interposed tendons were intact at the last examination in 12 of the 13 patients. No complications related to donor sites were reported.
CONCLUSIONS: An arthroscopic bridging graft for irreparable RCTs using a modified Mason-Allen stitch and a plantaris autograft resulted in improved short-term radiological and clinical outcomes. Graft integrity was maintained for up to 2 years in most patients. Level of evidence: IV.
METHODS: Thirteen patients with a massive RCT were treated with arthroscopic interposition of a folded plantaris tendon autograft between June 2017 and January 2020. For clinical evaluation, a visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, Constant-Murley score, and range of motion values were collected. For radiographic evaluation, standardized magnetic resonance imaging and ultrasonography were performed to check the integrity of the interposed tendon.
RESULTS: A statistically significant improvement at the final follow-up was evident in scores for the VAS (-3.0, P=0.003), ASES (24.9, P=0.002), D ASH (-20.6, P=0.001), and Constant-Murley values (14.2, P=0.010). In addition, significant improvement was shown in postoperative flexion (17.3°, P=0.026) and external rotation (27.7°, P<0.001). In postoperative radiologic evaluations, the interposed tendons were intact at the last examination in 12 of the 13 patients. No complications related to donor sites were reported.
CONCLUSIONS: An arthroscopic bridging graft for irreparable RCTs using a modified Mason-Allen stitch and a plantaris autograft resulted in improved short-term radiological and clinical outcomes. Graft integrity was maintained for up to 2 years in most patients. Level of evidence: IV.
摘要：
■巨大的肩袖撕裂（RCT）的手术治疗始终具有挑战性。这项研究描述了使用the腱进行无法修复的RCT进行桥接移植的患者的临床和放射学结果。
■在2017年6月至2020年1月期间，对13例大量RCT患者进行了关节镜下交叉折叠的自体肌腱移植治疗。对于临床评估，视觉模拟量表(VAS)，美国肩肘外科医师（ASES）评分，手臂的残疾，肩膀,和手（DASH）得分，Constant-Murley得分,并收集运动范围值。对于射线照相评估，我们进行了标准化磁共振成像和超声检查,以检查介入肌腱的完整性.
■最终随访时，VAS评分明显有统计学意义的改善（-3.0，P=0.003），ASES（24.9，P=0.002），DASH（-20.6，P=0.001），和Constant-Murley值(14.2,P=0.010)。此外,术后屈曲显着改善（17.3°，P=0.026）和外部旋转（27.7°，P<0.001)。在术后放射学评估中，在13例患者中，有12例患者在最后一次检查中插入的肌腱完好无损。未报告与供体部位相关的并发症。
■使用改良的Mason-Allen针法和足底自体移植物对无法修复的RCT进行关节镜桥接移植物可改善短期放射学和临床结果。在大多数患者中,移植物完整性维持长达2年。
■在2017年6月至2020年1月期间，对13例大量RCT患者进行了关节镜下交叉折叠的自体肌腱移植治疗。对于临床评估，视觉模拟量表(VAS)，美国肩肘外科医师（ASES）评分，手臂的残疾，肩膀,和手（DASH）得分，Constant-Murley得分,并收集运动范围值。对于射线照相评估，我们进行了标准化磁共振成像和超声检查,以检查介入肌腱的完整性.
■最终随访时，VAS评分明显有统计学意义的改善（-3.0，P=0.003），ASES（24.9，P=0.002），DASH（-20.6，P=0.001），和Constant-Murley值(14.2,P=0.010)。此外,术后屈曲显着改善（17.3°，P=0.026）和外部旋转（27.7°，P<0.001)。在术后放射学评估中，在13例患者中，有12例患者在最后一次检查中插入的肌腱完好无损。未报告与供体部位相关的并发症。
■使用改良的Mason-Allen针法和足底自体移植物对无法修复的RCT进行关节镜桥接移植物可改善短期放射学和临床结果。在大多数患者中,移植物完整性维持长达2年。
