Background:

In recent years, superior capsular reconstruction (SCR) has emerged as a promising treatment for massive rotator cuff tears and has been performed with an array of graft options, most commonly dermal allograft and tensor fascia lata (TFL) autograft.

Purpose:

To compare the clinical outcomes, functional outcomes, and complication rates after SCR performed with dermal allograft, TFL autograft, long head of the biceps tendon (LHBT) autograft, and porcine xenograft.

Study Design:

Meta-analysis; Level of evidence, 4.

Methods:

PubMed, Cochrane Library, and Embase were systematically reviewed for studies that enrolled ≥10 patients who underwent SCR and presented clinical outcome data at a minimum follow-up of 12 months. When available, pre- and postoperative patient-reported outcome scores and clinical examination data were extracted. Outcome data were then compared by graft type. A meta-analysis was also conducted of graft tear and reoperation rates after SCR with dermal allograft and TFL autograft.

Results:

Human dermal allograft and TFL autograft were each utilized in 7 studies, LHBT autograft in 2 studies, and porcine xenograft in 1 study. Dermal allograft, TFL autograft, and LHBT autograft demonstrated comparable median (range) postoperative American Shoulder and Elbow Surgeons scores of 85.3 (77.5-89), 88.6 (73.7-94.3), and 82.7 (80-85.4), respectively. The median postoperative pain scores per visual analog scale for dermal allograft, TFL autograft, and LHBT autograft were 0.8, 2.5, and 1.4. Median postoperative forward elevation was 159.0°, 147.0°, 163.8°, and 151.4° for dermal allograft, TFL autograft, LHBT autograft, and porcine xenograft. Meta-analysis demonstrated a comparable pooled graft tear rate between TFL autograft (9%; 95% CI, 4%-16%) and dermal allograft (7%; 95% CI, 2%-13%). Similarly, the pooled reoperation rate was similar for TFL autograft (3%; 95% CI, 0%-7%) and dermal allograft (6%; 95% CI, 2%-12%). Among the 3 studies with pre- and postoperative information on pseudoparalysis, 73 of 76 (96%) patients with an intact/repairable subscapularis had a reversal of their pseudoparalysis after SCR.

Conclusion:

Dermal allograft, TFL autograft, and LHBT autograft are all suitable options for SCR and demonstrate significant improvements in American Shoulder and Elbow Surgeons score, pain score per visual analog scale, and forward elevation. Moreover, dermal allograft and TFL autograft have comparable rates of graft tear and reoperation.

中文翻译：

---

上囊重建中移植物类型的临床和功能结果：系统回顾和荟萃分析

 背景：

近年来，上皮囊重建 (SCR) 已成为治疗大面积肩袖撕裂的一种有前途的治疗方法，并已采用一系列移植方案进行，最常见的是同种异体真皮移植和自体阔筋膜张肌 (TFL) 移植。

 目的：

比较同种异体真皮移植物、自体 TFL 移植物、自体二头肌腱长头 (LHBT) 移植物和猪异种移植物进行 SCR 后的临床结果、功能结果和并发症发生率。

 学习规划：

荟萃分析；证据级别，4。

 方法：

对 PubMed、Cochrane 图书馆和 Embase 的研究进行了系统审查，这些研究纳入了 ≥10 名接受 SCR 的患者，并在至少 12 个月的随访中提供了临床结果数据。如果有的话，提取术前和术后患者报告的结果评分和临床检查数据。然后按移植物类型比较结果数据。还对同种异体真皮移植和自体 TFL 移植 SCR 后移植物撕裂和再手术率进行了荟萃分析。

 结果：

7 项研究中分别使用了人同种异体真皮移植物和 TFL 自体移植物，2 项研究中使用了 LHBT 自体移植物，1 项研究中使用了猪异种移植物。同种异体真皮移植、自体 TFL 移植和自体 LHBT 移植的美国肩肘外科医生术后评分中位数（范围）相当，分别为 85.3 (77.5-89)、88.6 (73.7-94.3) 和 82.7 (80-85.4)。同种异体真皮移植、自体 TFL 移植和自体 LHBT 移植的根据视觉模拟量表的术后疼痛评分中位数分别为 0.8、2.5 和 1.4。真皮同种异体移植、TFL 自体移植、LHBT 自体移植和猪异种移植的术后前向中位抬高分别为 159.0°、147.0°、163.8° 和 151.4°。荟萃分析表明，TFL 自体移植物（9%；95% CI，4%-16%）和同种异体真皮移植物（7%；95% CI，2%-13%）之间的合并移植物撕裂率相当。同样，TFL 自体移植（3%；95% CI，0%-7%）和同种异体真皮移植（6%；95% CI，2%-12%）的合并再手术率相似。在 3 项包含假性麻痹术前和术后信息的研究中，76 名肩胛下肌完整/可修复的患者中，有 73 名 (96%) 在 SCR 后假性麻痹得到了逆转。

 结论：

同种异体真皮移植、TFL 自体移植和 LHBT 自体移植都是 SCR 的合适选择，并且在美国肩肘外科医生评分、每个视觉模拟量表的疼痛评分和前抬高方面表现出显着改善。此外，同种异体真皮移植和自体 TFL 移植的移植物撕裂和再次手术率相当。