Clinical Results of Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears

被引:575
作者
Mihata, Teruhisa [1 ,4 ,5 ]
Lee, Thay Q. [4 ,5 ]
Watanabe, Chisato [1 ]
Fukunishi, Kunimoto [1 ]
Ohue, Mutsumi [2 ]
Tsujimura, Tomoyuki [3 ]
Kinoshita, Mitsuo [1 ]
机构
[1] Osaka Med Coll, Dept Orthoped Surg, Takatsuki, Osaka 5698686, Japan
[2] Katsuragi Hosp, Osaka, Japan
[3] Veritas Hosp, Hyogo, Japan
[4] VA Healthcare Syst, Orthopaed Biomech Lab, Long Beach, CA USA
[5] Univ Calif Irvine, Irvine, CA USA
关键词
DORSI TENDON TRANSFER; DOUBLE-ROW; MASSIVE TEARS; REPAIR; SHOULDER; MUSCLE; DEBRIDEMENT; OUTCOMES; RUPTURES; LESIONS;
D O I
10.1016/j.arthro.2012.10.022
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Purpose: The objective of this study was to investigate the clinical outcome and radiographic findings after arthroscopic superior capsule reconstruction (ASCR) for symptomatic irreparable rotator cuff tears. Methods: From 2007 to 2009, 24 shoulders in 23 consecutive patients (mean, 65.1 years) with irreparable rotator cuff tears (11 large, 13 massive) underwent ASCR using fascia lata. We used suture anchors to attach the graft medially to the glenoid superior tubercle and laterally to the greater tuberosity. We added side-to-side sutures between the graft and infraspinatus tendon and between the graft and residual anterior supraspinatus/subscapularis tendon to improve force coupling. Physical examination, radiography, and magnetic resonance imaging (MRI) were performed before surgery; at 3, 6, and 12 months after surgery; and yearly thereafter. Average follow-up was 34.1 months (24 to 51 months) after surgery. Results: Mean active elevation increased significantly from 84 degrees to 148 degrees (P < .001) and external rotation increased from 26 degrees to 40 degrees (P < .01). Acromiohumeral distance (AHD) increased from 4.6 +/- 2.2 mm preoperatively to 8.7 +/- 2.6 mm postoperatively (P < .0001). There were no cases of progression of osteoarthritis or rotator cuff muscle atrophy. Twenty patients (83.3%) had no graft tear or tendon retear during follow-up (24 to 51 months). The American Shoulder and Elbow Surgeons (ASES) score improved from 23.5 to 92.9 points (P < .0001). Conclusions: ASCR restored superior glenohumeral stability and function of the shoulder joint with irreparable rotator cuff tears. Our results suggest that this reconstruction technique is a reliable and useful alternative treatment for irreparable rotator cuff tears. Level of Evidence: Level IV, therapeutic case series.
引用
收藏
页码:459 / 470
页数:12
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