Background:

Massive rotator cuff tears have a high incidence of postoperative retear that can reach 90%. It is still unclear which intervention may reduce the incidence of retear and improve the functional and clinical outcomes.

Purpose/Hypothesis:

The purpose of this study was to investigate the clinical and structural outcomes at 2 years after repair of reparable massive rotator cuff tears with and without the use of partial superior capsular reconstruction (pSCR), using the autologous long head of the biceps tendon (LHBT) as a graft. It was hypothesized that augmentation with a pSCR would decrease retear rates.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

The authors compared arthroscopic repair of massive posterosuperior rotator cuff tears with and without augmentation using the LHBT for pSCR between 2015 and 2017. After applying the selection criteria, 106 patients were included in the study and distributed into 2 groups of 50 and 56 patients. Patients in the first group (50 patients) underwent arthroscopic repair without use of the LHBT (AR group), and patients in the second group (56 patients) underwent arthroscopic repair with use of the LHBT for pSCR (AR-LHBT group). The structural outcome was evaluated by ultrasound at 2 years of follow-up. Function and pain were evaluated preoperatively and at the 2-year follow-up using the American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS). Pre- and postoperative active range of motion, including forward elevation, external rotation, and abduction, were also documented.

Results:

No significant differences were found between groups regarding the baseline characteristics. After 24 months, both groups showed significant improvement from preoperative ASES scores, VAS score, and active range of motion (P < .01 for all). Patients in the AR-LHBT group showed significant improvements in postoperative functional and pain scores compared with the AR group in all measurements at the 2-year follow-up (ASES score: 77.23 ± 7.45 vs 71.04 ± 9.28, P < .01; VAS score: 1.64 ± 1.03 vs 2.12 ± 1.06, P < .01). Final range of motion was significantly increased for the AR-LHBT group for forward elevation (155 [interquartile range {IQR}, 150-160] vs 150 [IQR, 140-170]; P < .01) and abduction (150 [IQR, 140-157.5] vs 120 [IQR, 100-140]; P < .01), but external rotation was significantly greater for the AR group (54.43 ± 10.55 vs 59.5 ± 10.55; P < .01). Postoperative ultrasonography at the 2-year follow-up revealed a higher retear rate in the AR group than in the AR-LHBT group (46% vs 14%; P < .01).

Conclusion:

Use of the LHBT for pSCR to augment massive rotator cuff tears resulted in markedly lower retear rates and modestly improved pain and function outcomes compared with repair alone.

中文翻译：

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使用自体二头肌腱进行部分上囊重建以增强关节镜下修复大面积肩袖撕裂：对再撕裂率的影响

背景：

大面积肩袖撕裂术后再撕裂发生率高达90%。目前尚不清楚哪种干预措施可以降低再撕裂的发生率并改善功能和临床结果。

目的/假设：

本研究的目的是使用自体肱二头肌长头肌腱 (LHBT) 研究使用和不使用部分上囊重建 (pSCR) 修复可修复的大肩袖撕裂后 2 年的临床和结构结果作为嫁接。假设使用 pSCR 增强会降低再撕裂率。

学习规划：

队列研究；证据水平，3。

方法：

作者比较了 2015 年至 2017 年间使用 LHBT 对 pSCR 进行的大量后上肩袖撕裂的关节镜修复。在应用选择标准后，106 名患者被纳入研究，并分为 2 组，每组 50 名和 56 名患者。第一组患者（50 例）接受了不使用 LHBT 的关节镜修复（AR 组），第二组患者（56 例）接受了使用 LHBT 进行 pSCR 的关节镜修复（AR-LHBT 组）。在 2 年的随访中通过超声评估结构结果。使用美国肩肘外科医生 (ASES) 评分和视觉模拟量表 (VAS) 在术前和 2 年随访时评估功能和疼痛。术前和术后主动活动范围，包括向前抬高，

结果：

在基线特征方面，各组之间没有发现显着差异。24 个月后，两组均较术前 ASES 评分、VAS 评分和主动活动范围有显着改善（均P < .01）。在 2 年的随访中，与 AR 组相比，AR-LHBT 组患者的术后功能和疼痛评分显着改善（ASES 评分：77.23 ± 7.45 vs 71.04 ± 9.28，P < .01；VAS得分：1.64 ± 1.03 vs 2.12 ± 1.06，P < .01）。AR-LHBT 组向前抬高的最终运动范围显着增加（155 [四分位距 {IQR}，150-160] vs 150 [IQR，140-170]；P< .01）和外展（150 [IQR，140-157.5] vs 120 [IQR，100-140]；P < .01），但 AR 组的外旋显着更大（54.43 ± 10.55 vs 59.5 ± 10.55；P < .01)。2 年随访的术后超声检查显示，AR 组的再撕裂率高于 AR-LHBT 组（46% vs 14%；P < .01）。

结论：

与单独修复相比，使用 LHBT 进行 pSCR 以增加大量肩袖撕裂导致再撕裂率显着降低，并适度改善疼痛和功能结果。