The treatment of giant rotator cuff tear with enhanced reconstruction of the superior capsule and rotator cable by

doi:10.11958/20221135

Abstract

Abstract:

Objective To investigate the clinical effect of arthroscopic reconstruction of the superior capsule and rotator cable with "L" shape transposition of long head of biceps tendon in the treatment of giant rotator cuff tear. Methods Thirty-six patients with giant rotator cuff tears were included. All patients were treated by shoulder arthroscopy, in which the long head of the biceps tendon was "L" shaped transposed for joint reconstruction of the superior capsule and rotator cable, followed by repairing the remaining rotator cuff tissue. The patient's surgical condition and complications were recorded. The active shoulder mobility, visual analogue score of pain (VAS), American Shoulder and Elbow Surgery (ASES) score, Constant-Murley score and Fudan University Shoulder Function Score (FUSS) were used for evaluating shoulder joint function and pain before and after surgery. Anteroposterior X-ray and three-dimensional CT were used to evaluate the degree of shoulder degeneration and proximal humeral displacement distance (PHM). MRI was used to assess the structural integrity of the reconstructed tissue. Results The operation was successful in all patients. Twenty-one patients (58%) underwent full rotator cuff repair with single- or double-row suture bridge fixation. Fifteen patients (42%) underwent partial rotator cuff repair. Subscapularis tendon tears were repaired using a single-row technique in 25 patients. Two to five anchor nails were used during surgery, with a mean of (3.8±1.4). Fourteen patients underwent limited acromioplasty. Twelve cases underwent humeral megacartilage, and 10 cases underwent both acromioplasty and humeral megacartilage. The operative times ranged from 50 to 110 min, with a mean of (83.21±21.57) min. The puncture openings healed grade A, and no complications such as infection, fat liquefaction or vascular nerve injury were found. At 6 and 12 months after surgery, the active shoulder mobility and shoulder VAS, ASES, Constant-Murley, and FUSS scores were significantly improved at the last follow-up compared with the preoperation. The joint mobility and scores showed continuous improvement with the extension of the follow-up time (P<0.01). 3D CT showed a significant reduction in PHM at the last postoperative follow-up compared with the preoperative period (P<0.01). MRI follow-up evaluation showed that the reconstructed tissue was structurally intact in 34 cases, with a healing rate of 94.4%. Conclusion The treatment of giant rotator cuff tears by combined augmented reconstruction of the long head of biceps tendon with the rotator cable under shoulder arthroscopy can significantly relieve pain and improve shoulder joint function, and the re-tear rate is low, which is worthy of clinical promotion.

Key words: arthroscopy, rotator cuff injuries, shoulder joint, giant rotator cuff tears, long head of biceps tendon, superior capsular reconstruction, rotator cable, pulley system

CLC Number:

R686.5

Figures/Tables 5

References 15

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时间	站立位前屈（°）	体侧外旋（°）	体侧内旋（分）
术前	86.19±6.15	33.28±3.93	6.78±1.12
术后6个月	118.94±8.40^a	45.17±4.95^a	7.56±0.77^a
术后12个月	139.78±4.28^ab	61.42±3.26^ab	8.92±1.00^ab
末次随访	149.03±4.59^abc	72.81±5.06^abc	10.00±0.96^abc
F	1 164.892^＊＊	1 220.194^＊＊	123.460^＊＊

时间	站立位前屈（°）	体侧外旋（°）	体侧内旋（分）
术前	86.19±6.15	33.28±3.93	6.78±1.12
术后6个月	118.94±8.40^a	45.17±4.95^a	7.56±0.77^a
术后12个月	139.78±4.28^ab	61.42±3.26^ab	8.92±1.00^ab
末次随访	149.03±4.59^abc	72.81±5.06^abc	10.00±0.96^abc
F	1 164.892^＊＊	1 220.194^＊＊	123.460^＊＊

时间	VAS	ASES	Constant-Murley	FUSS
术前	7.78±1.10	13.56±1.73	39.97±2.78	30.42±3.06
术后6个月	4.75±0.94^a	19.67±2.26^a	57.50±3.81^a	50.44±3.36^a
术后12个月	1.92±0.84^ab	25.06±3.06^ab	76.78±3.99^ab	70.22±3.68^ab
末次随访	0.81±0.58^abc	31.97±1.81^abc	89.58±2.85^abc	81.17±2.70^abc
F	780.949^＊＊	1 059.876^＊＊	3 398.648^＊＊	3 946.542^＊＊

时间	VAS	ASES	Constant-Murley	FUSS
术前	7.78±1.10	13.56±1.73	39.97±2.78	30.42±3.06
术后6个月	4.75±0.94^a	19.67±2.26^a	57.50±3.81^a	50.44±3.36^a
术后12个月	1.92±0.84^ab	25.06±3.06^ab	76.78±3.99^ab	70.22±3.68^ab
末次随访	0.81±0.58^abc	31.97±1.81^abc	89.58±2.85^abc	81.17±2.70^abc
F	780.949^＊＊	1 059.876^＊＊	3 398.648^＊＊	3 946.542^＊＊