Arthroscopic superior capsular reconstruction of irreparable massive rotator cuff tearsras using "Sandwich" patch graft / 中华骨科杂志

ABSTRACT

Objective:To investigate the effect of arthroscopic superior capsular reconstruction (ASCR) of irreparable massive rotator cuff tears (RCTs) using the "Sandwich" patch graft (autologous fascia lata + LARS artificial ligament + autologous fascia lata).Methods:The patients with irreparable massive RCTs who underwent ASCR by using "Sandwich" patch graft were retrospectively evaluated between December 2016 and October 2018. All cases were followed up more than two years. The pain and function of the shoulder were evaluated by visual analogue scale (VAS), active forward elevation (aFE), American Shoulder & Elbow Surgeons score (ASES), University of California Los Angeles (UCLA) score, and Constant-Murley score. The acromiohumeral distance (AHD) and patch healing were assessed by shoulder X-ray and MRI scan.Results:Twenty-nine patients (12 males and 17 females) were enrolled for final analysis. The average age was 66.0±5.88 years (range 55-77 years). The average length of follow-up was 35.3±7.20 months (range 24-46 months). The tendon of the subscapularis muscle was intacted in 13 cases and repairable in 16 cases. All patients' teres minor muscles were intact and the function of deltoid muscles was all complete. Based on Hamada classification of massive RCTs, 11 cases with type 2, 14 cases with type 3, and 4 cases with type 4. At the last follow-up visit, the AFE of the surgical shoulder was 158.45°±23.87° (range 70°-180°), which was significantly higher than before the surgery 92.59°±45.99° (range 20°-160°, t=6.190, P<0.001). The ASES score was 92.92±9.08 (range 64-100), UCLA score was 31.62±3.93 (range 19-35), and Constant-Murley score was 85.8±8.44 (range 68-94), which were higher than those before the operation 30.69±12.99 (range 68-95), 10.93±3.43 (range 4-17), 39.62±12.68 (range 14-55). There were significant differences between them, respectively ( t=21.145, P<0.001; t=21.348, P<0.001; t=16.333, P<0.001). The VAS was 0.41±0.57 (range 0-2 points), which was significantly lower than that of 4.90±1.05 (range 3-7 points) before operation ( t=20.267, P<0.001). At the last follow-up visit, MRI showed that the AHD increased from 3.31±1.57 mm (range 1.1-6.6 mm) to 6.94±1.76 mm (range 3.0-10.8 mm) significantly ( t=12.195, P<0.001). Radiological outcomes were evaluated according to MRI, the total healing rate was 89.7% (26/29). There were two cases of complete tears, which including one case of infection and 1 partial tears. Conclusion:ASCR of irreparable massive RCTs using "Sandwich" patch graft showed the high healing rate in the short-term follow-up, which is possible to restore the shoulder functions early. It is an effective method for the treatment of irreparable massive RCTs.