Human dermal allograft augmentation in primary and revision arthroscopic rotator cuff repair: a retrospective controlled study including patient outcomes and ultrasound evaluation of tendon healing.
Giovanni Merolla, Rocco Bonfatti, Francesco Marra, Andrea Pellegrini, Giacomo Cataldo, Marco Saporito, Paolo Paladini, Giuseppe Porcellini
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Abstract
Purpose: Rotator cuff (RC) tears are common in older adults, often leading to muscle atrophy. Standard arthroscopic repair has high re-tear rates, prompting the use of biological patches for augmentation. This study assessed differences in range of motion, strength, and tendon healing using ultrasound in primary and revision RC repairs using acellular dermal allograft augmentation.
Methods: Forty-eight patients undergoing arthroscopic RC repair with dermal allograft augmentation were assessed, with 42 completing a median follow-up of 32.4 months. Twenty patients had primary repairs and 22 had revision procedures. A control group of 26 patients, matched for age, sex, BMI, and RC injury type, underwent RC repair without patch augmentation. Active range of motion, Constant-Murley socre (CS), Simple Shoulder Test (SST), Subjective Shoulder value (SSV) and isometric strength were measured. Tendon healing was assessed via dynamic US.
Results: Both primary and revision groups showed significant improvements in clinical scores and shoulder mobility. However, the primary group had significantly higher postoperative CS, SST and SSV scores. Strength tests indicated lower values in the revision group compared to primary and control groups. Ultrasound outcomes showed reduced tendon thickness in 23 patients, with similar repair integrity across groups. Five cases of RC re-tears were noted, with higher but not significantly different re-tear rates in the revision group.
Conclusion: Dermal allograft augmentation in RC repair leads to significant clinical improvement in both primary and revision cases, but strength recovery is less pronounced in revision repairs. Long-term follow-up is necessary to validate these findings and assess the durability of tendon healing.
Level of evidence: Level III, Retrospective cohort design, Treatment study.
目的：肩袖（RC）撕裂在老年人中很常见，经常导致肌肉萎缩。标准关节镜修复具有较高的再撕裂率，促使使用生物补片进行增强。本研究评估了超声在脱细胞异体真皮增强术的初级和改良RC修复中的运动范围、力量和肌腱愈合的差异。方法：对48例接受关节镜下真皮异体移植修复的患者进行评估，其中42例完成了中位32.4个月的随访。20例患者进行了初步修复，22例进行了翻修。对照组26例患者，年龄、性别、BMI和RC损伤类型相匹配，行无补片的RC修复。测量主动活动度、Constant-Murley score （CS）、Simple Shoulder Test （SST）、Subjective Shoulder value （SSV）和等长肌力。通过动态US评估肌腱愈合情况。结果：初级组和翻修组的临床评分和肩部活动度均有显著改善。然而，原发性组术后CS、SST和SSV评分明显较高。强度测试显示复习组的强度值低于初级组和对照组。超声结果显示23例患者肌腱厚度减少，各组修复完整性相似。5例RC再撕裂，翻修组再撕裂率较高，但差异无统计学意义。结论：同种异体真皮增强术在原发性和改型修复中均能显著改善临床效果，但在改型修复中力量恢复不明显。需要长期随访来验证这些发现并评估肌腱愈合的持久性。证据等级：III级，回顾性队列设计，治疗研究。
期刊介绍：
International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters.
Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted.
Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable.
The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.
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