PDF(Pubmed)
Abstract：
Introduction Arthroscopic advancements have notably improved rotator cuff repair, yet the healing of tendons and retear risks still pose significant challenges, especially with massive and large tears. These larger tears have shown a quadruple increase in retear rate when the tear size grows from 1-3 cm. The prevalent cause of failure, particularly in tears with fatty degeneration, is suture tearing. As such, techniques that enhance tendon healing are pivotal due to their correlation with improved functional outcomes. Dermal allograft augmentation (DAA) is one method that has demonstrated improvements in rotator cuff repair biomechanics, as well as the promotion of vascularization and neotendon formation. This study evaluates the efficacy of DAA in the postoperative healing of large and massive rotator cuff tears, assessed through patient-reported outcomes and functional range of motion. Methods This retrospective study reviewed a single surgeon\'s database, selecting patients who underwent arthroscopic surgery for full-thickness rotator cuff tears measuring at least 3 cm, or those with maximum stage II fatty infiltration of the supraspinatus or infraspinatus muscle on MRI. We used three validated patient-reported outcome (PRO) measures, American Shoulder and Elbow Surgeon Score (ASES), Single Assessment Numeric Evaluation (SANE), and Simple Shoulder Test (SST), alongside a range of motion metrics, external rotation (ER), and forward flexion (FF). These were recorded pre-operatively and, at minimum, one year post-operatively, with a standard student t-test employed for comparative analysis. Results Out of 18 total patients, the average age was 61 years, and 83% were male. The cause of injury was mostly traumatic in nature (n=11), with the remainder being chronic (n=7). All three PROs (n=11) demonstrated a statistically significant increase in score including ASES (p=0.003), SANE (p=0.004), and SST (p=0.039). External rotation also significantly improved pre- to post-operative function (46 vs 58, p=0.049). Three patients (17%) suffered from a retear within three months of their rotator cuff repair. Two patients (11%) required a reverse shoulder arthroplasty within a year. Conclusion Our study demonstrated that DAA in rotator cuff repair yielded notable functional and clinical advancements, with a moderately low retear rate as confirmed by ultrasound. These outcomes suggest that DAA is a promising intervention for large and historically difficult rotator cuff tears, offering significant implications for future treatment protocols.
摘要：
介绍关节镜的进步显著改善了肩袖修复，然而，肌腱的愈合和撕裂风险仍然构成重大挑战，尤其是巨大而巨大的眼泪。当泪液大小从1-3厘米增加时，这些较大的泪液显示出再泪液速率的四倍增加。失败的主要原因,特别是在脂肪变性的眼泪中，是缝线撕裂。因此，增强肌腱愈合的技术是关键的，因为它们与改善的功能结果相关。真皮同种异体移植（DAA）是一种已证明改善肩袖修复生物力学的方法，以及促进血管化和新腱形成。这项研究评估了DAA在巨大和巨大的肩袖撕裂术后愈合中的疗效，通过患者报告的结果和运动功能范围进行评估。方法这项回顾性研究回顾了一名外科医生的数据库，选择接受关节镜手术治疗至少3厘米的全厚度肩袖撕裂的患者，或MRI显示冈上肌或冈下肌具有最大II期脂肪浸润的那些。我们使用了三个经过验证的患者报告结果(PRO)指标，美国肩肘外科评分（ASES），单一评估数字评估(SANE)，和简单肩部测试（SST），除了一系列的运动指标，外部旋转(ER),和向前弯曲（FF）。这些都在术前记录，至少,术后一年,采用标准学生t检验进行比较分析。结果18例患者中,平均年龄61岁,83%为男性。损伤的原因主要是创伤性的（n=11），其余为慢性（n=7）。所有三个PRO（n=11）均显示出包括ASES在内的得分统计学上的显着增加（p=0.003），SANE（p=0.004），和SST(p=0.039)。外部旋转也显着改善了手术前后的功能（46vs58，p=0.049）。三名患者（17％）在肩袖修复后的三个月内遭受了再撕裂。两名患者（11％）在一年内需要进行反向肩关节置换术。结论我们的研究表明，DAA在肩袖修复中产生了显著的功能和临床进步，与适度低的再撕裂率由超声证实。这些结果表明，DAA是一个有希望的干预大型和历史上困难的肩袖撕裂，为未来的治疗方案提供了重要的意义。
