Comparative study of enhanced repair of huge rotator cuff tear with allograft acellular dermal patch

doi:10.3877/ cma.j.issn.1674-134X.2024.06.002

Abstract

Abstract:

Objective

To compare the efficacy of allograft acellular dermal patch enhancement repair and arthroscopic single row suture in the treatment of large rotator cuff tears.

Methods

A retrospective analysis was conducted on the data of 70 patients with giant rotator cuff tears treated in the Orthopedics Department of Guangzhou Red Cross Hospital affiliated to Jinan University from July 2019 to December 2022. All the patients had rotator cuff tears over five cetimeters or more than two tendons injuries， no local bone lesions， ineffective conservative treatment or poor results， good tolerance to patch repair and good cognitive function. Osteoarthritis，patients who needed complete resection of the distal clavicle， instability in front of the shoulder joint，unauthorized use of drugs or other treatment plans during treatment， end-stage malignant tumors were excluded.According to the treatment method used， the patients were divided into the control group of 35 cases and an observation group of 35 cases. The control group was treated with simple arthroscopic double row suturing， while the observation group was treated with arthroscopic double row suturing combined with allogeneic decellularized dermal patches for enhanced repair. The differences in shoulder joint range of motion， excellent shoulder joint function rate， and total incidence of complications between the two groups were compared by t test and chi square test.

Results

There was no statistically significant difference in shoulder joint range of motion between the two groups before treatment （P＞0.05）. After treatment， shoulder joint range of motion increased and the observation group were higher than the control group （t=6.820， 5.942， 8.082， 6.624， 7.006， all P＜0.05）. The excellent rate of shoulder joint function in the observation group was higher than that in the control group （χ²=9.875，P＜0.05）， and the total incidence of complications was lower than that in the control group （χ²=5.385， P＜0.05）.

Conclusion

In the treatment of giant rotator cuff tear， allograft acellular dermal patch can improve shoulder joint function and reduce the risk of complications， which is worthy of promotion.

Key words: Rotator cuff injuries, Allogeneic cells, Acellular dermis, Shoulder joint, Range of motion， articular

Min Wang, Tao Cheng, Menghu Han, Shaohua Liang, Wen Wang. Comparative study of enhanced repair of huge rotator cuff tear with allograft acellular dermal patch[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(06): 702-708.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgjwkzz.cma-cmc.com.cn/EN/10.3877/ cma.j.issn.1674-134X.2024.06.002

https://zhgjwkzz.cma-cmc.com.cn/EN/Y2024/V18/I06/702

Figures/Tables 10

Table 1 Ggeneral information of the two groups before operation

组别 Groups	例数 Number of cases	年龄［岁，（ $\overset{ˉ}{x}$ ±s）］ Age（year）	性别（男/女） Gender （male/female）	侧别（左/右） Side（left/right）	外伤史（有/无） History of trauma（yes/no）
观察组 Observation group	35	60.0±8.9	22/13	17/18	35/0
对照组 Control group	35	59.0±9.9	23/12	18/17	35/0
统计值 Statistical value		t=0.578	χ²=0.062	χ²=0.057	χ²＜0.0001
P值		＞0.05	＞0.05	＞0.05	＞0.05
组别 Groups	例数 Number of cases	吸烟史（有/无） Smoking history（yes/no）	撕裂大小［cm，（ $\overset{ˉ}{x}$ ±s）］ Size of tear	病程［个月，（ $\overset{ˉ}{x}$ ±s）］ Course of disease（month）	随访时间［个月，（ $\overset{ˉ}{x}$ ±s）］ Follow-up time （month）
观察组 Observation group	35	6/29	6.5±1.9	23.6±11.2	17.9±4.7
对照组 Control group	35	7/28	5.7±1.6	25.4±12.3	18.6±5.4
统计值 Statistical value		χ²=0.094	t=1.905	t=0.640	t=0.578
P值		＞0.05	＞0.05	＞0.05	＞0.05

Table 1 Ggeneral information of the two groups before operation

组别 Groups	例数 Number of cases	年龄［岁，（ $\overset{ˉ}{x}$ ±s）］ Age（year）	性别（男/女） Gender （male/female）	侧别（左/右） Side（left/right）	外伤史（有/无） History of trauma（yes/no）
观察组 Observation group	35	60.0±8.9	22/13	17/18	35/0
对照组 Control group	35	59.0±9.9	23/12	18/17	35/0
统计值 Statistical value		t=0.578	χ²=0.062	χ²=0.057	χ²＜0.0001
P值		＞0.05	＞0.05	＞0.05	＞0.05
组别 Groups	例数 Number of cases	吸烟史（有/无） Smoking history（yes/no）	撕裂大小［cm，（ $\overset{ˉ}{x}$ ±s）］ Size of tear	病程［个月，（ $\overset{ˉ}{x}$ ±s）］ Course of disease（month）	随访时间［个月，（ $\overset{ˉ}{x}$ ±s）］ Follow-up time （month）
观察组 Observation group	35	6/29	6.5±1.9	23.6±11.2	17.9±4.7
对照组 Control group	35	7/28	5.7±1.6	25.4±12.3	18.6±5.4
统计值 Statistical value		χ²=0.094	t=1.905	t=0.640	t=0.578
P值		＞0.05	＞0.05	＞0.05	＞0.05

Table 2 Comparison of shoulder joint range of motion between two groups

组别 Groups	例数 Number of cases	外展Abduction		前屈上举Flexion and overhead lift		内收Adduction
组别 Groups	例数 Number of cases	治疗前 Before treatment	治疗后 After treatment	治疗前 Before treatment	治疗后 After treatment	治疗前 Before treatment	治疗后 After treatment
观察组 Observation group	35	20.4±1.3	72.18±3.0^*	60.3±2.6	153.1±5.5^*	11.2±1.1	34.6±2.5^*
对照组 Control group	35	20.4±1.3	67.7±2.5^*	60.3±2.5	145.7±5.0^*	11.2±1.0	30.2±2.1^*
t值		0.097	6.820	0.049	5.942	0.120	8.082
P值		＞0.05	＜0.001	＞0.05	＜0.001	＞0.05	＜0.001
组别 Groups	例数 Number of cases	后伸 Posterior extension		内旋/外旋 Internal/external rotations		-		-
组别 Groups	例数 Number of cases	治疗前 Before treatment	治疗后 After treatment	治疗前 Before treatment	治疗后 After treatment
观察组 Observation group	35	10.9±1.0	33.3±2.4^*	23.6±1.6	62.2±2.7^*	-	-
对照组 Control group	35	10.9±1.1	29.8±2.1^*	23.6±1.5	57.9±2.4^*	-	-
t值		0.119	6.624	0.081	7.006	-	-
P值		＞0.05	＜0.001	0.936	＜0.001	-	-

Table 3 Comparison of excellent and good shoulder joint function rates between two groups

组别 Groups	例数 Number of cases	优 Excellent	良 Good	可 Fair	差 Poor	优良率 Excellent rate
观察组 Observation group	35	27（77.1）	8（22.9）	0	0	35（100.0）
对照组 Control group	35	18（51.4）	9（25.7）	5（14.3）	3（8.6）	27（77.1）
χ²值						9.032
P值						0.003

Table 4 Comparison of total incidence of complications between the two groups［ Example （%）］

组别 Groups	例数 Number of cases	感染 Infection	关节黏连 Joint adhesion	异物反应 Foreign object reaction	总发生率 Total incidence rate
观察组 Observation group	35	0	0	0	0
对照组 Control group	35	2（5.7）	2（5.7）	1（2.9）	5（14.3）
χ²值					5.385
P值					0.020

Figure 1 Arthroscopic view showed a huge tear in the left supraspinatus tendon

Figure 2 Freshness enhancement of surgical termination points with allogeneic decellularized dermal patches in arthroscopic rotator cuff repair

Figure 3 Allogeneic decellularized dermal patch with enhanced insertion point during arthroscopic rotator cuff repair

Figure 4 Preoperative MRI oblique coronal T2WI image of left shoulder， shows a continuous interruption of the left supraspinatus tendon， with the broken end retracted to the level of the glenoid joint （the red arrow）

Figure 5 On the third day after surgery， MRI oblique coronal T2WI image shows good bridging and fixation between the patch and the left supraspinatus muscle

Figure 6 Three months after surgery， MRI oblique coronal T2WI image shows good healing between the fascia lata patch and the residual end of the left supraspinatus tendon suture， and good healing of the autologous fascia lata patch in the footprint area

References 20

［1］	于承浩，张益，陈进利，等. 肩袖补片在巨大肩袖损伤治疗中的研究进展［J/CD］. 中华关节外科杂志（电子版）， 2021， 15（ 2 ）：225-230.
［2］	张耀南，乾皓明，驹井正彦，等. 肩袖撕裂与肩峰骨棘之间关系的临床研究［J/CD］. 中华关节外科杂志（电子版）， 2010， 4（ 1 ）：4-11.
［3］	王铭，李海滨，苗军. 肱二头肌长头腱“L” 形转位上关节囊与肩袖索联合增强重建术治疗巨大肩袖撕裂［J］. 天津医药， 2023，51（ 2 ）： 180-185.
［4］	宫宵男，吕东维，宁波，等. 关节镜下改良压配式双排缝合技术对巨大肩袖撕裂患者肩关节功能、活动度及疼痛的影响［J］. 实用医学杂志， 2023， 39（ 8 ）： 953-957.
［5］	张博，林源，任世祥，等. “Chinese way”在关节镜下处理巨大肩袖损伤中的作用及临床疗效［J］. 首都医科大学学报， 2022， 43（ 5 ）： 792-798.
［6］	Virk MS， Cole BJ. Proximal biceps tendon and rotator cuff tears［J］.Clin Sports Med， 2016， 35（ 1 ）： 153-161.
［7］	Ryösä A， Laimi K， Äärimaa V， et al. Surgery or conservative treatment for rotator cuff tear： a meta-analysis［J/OL］. Disabil Rehabil， 2017， 39（ 14 ）： 1357-1363.
［8］	张玉富，米萌，张健，等. 肱骨近端骨折合并肩袖损伤情况初步调查［J］. 中华创伤骨科杂志， 2018， 20（ 11 ）： 975-979.
［9］	Ranade AV， Rai R， Rai AR， et al. Variants of latissimus dorsi with a perspective on tendon transfer surgery： an anatomic study［J］.JShoulderElbow Surg， 2018， 27（ 1 ）： 167-171.
［10］	Patel S， Gualtieri AP， Lu HH， et al. Advances in biologic augmentation for rotator cuff repair［J］. Ann N Y Acad Sci， 2016，1383（ 1 ）： 97-114.
［11］	Wang A， McCann P， Colliver J， et al. Do postoperative platelet-rich plasma injections accelerate early tendon healing and functional recovery after arthroscopic supraspinatus repair？ A randomized controlled trial［J］. Am J Sports Med， 2015， 43（ 6 ）： 1430-1437.
［12］	Shin SJ， Lee S， Hwang JY， et al. Tear pattern after superior capsular reconstruction using an acellular dermal matrix allograft［J/OL］. J Shoulder Elbow Surg， 2022， 31（ 6 ）： e279-e288. DOI： 10.1016/j.jse.2021.12.009.
［13］	Shin SJ， Lee S， Hwang JY， et al. Superior capsular reconstruction using acellular dermal allograft combined with remaining rotator cuff augmentation improved shoulder pain and function at 1 year after the surgery［J］. Arthroscopy， 2022， 38（ 4 ）： 1089-1098.
［14］	Lee S， Koh KH， Shin SJ. Superior capsule reconstruction using an acellular dermal matrix allograft combined with remnant tendon augmentation for irreparable rotator cuff tear［J/OL］.Arthrosc Tech，2023， 12（ 2 ）： e241-e246. DOI： 10. 1016/j.eats. 2022. 10. 013.
［15］	辛鹏飞，孙友强，李杰，等. 生物材料修复肩袖损伤的最新研究热点［J］. 中国组织工程研究， 2020， 24（ 28 ）： 4459-4464.
［16］	王文，王敏，秦胜男，等. 巨大肩袖撕裂同种异体脱细胞真皮补片修补的早中期疗效［J/OL］. 中华肩肘外科电子杂志， 2021， 9（ 3 ）： 208-211.
［17］	Lawrence RL， Moutzouros V， Bey MJ. Asymptomatic rotator cuff tears［J/OL］. JBJS Rev， 2019， 7（ 6 ）： e9. DOI： 10.2106/JBJS.RVW. 18. 00149.
［18］	Hohmann E. Editorial commentary： if the massive rotator cuff tear is irreparable， just fix the rotator cable［J］. Arthroscopy， 2021， 37（ 5 ）：1411-1413.
［19］	Rhee SM， Youn SM， Park JH， et al. Biceps rerouting for semirigid large-to-massive rotator cuff tears［J］. Arthroscopy， 2021， 37（ 9 ）：2769-2779.
［20］	王敏，戴天明，孟庆奇，等. 补片技术在巨大肩袖撕裂中的应用［J］. 中华创伤骨科杂志， 2020， 22（ 11 ）： 989-992.

[1]	Xiaomeng Ji, Fan Liu, Xiaobo Tang, Weiwei Bian, Peilong Dong, Zhenlu Liu. Two surgical methods in treatment of rotator cuff tear with adhesive shoulder capsitis [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(05): 561-567.
[2]	Cheng Li, Liang Zhu, Yong Pang, Guochun Zha, Shang Qiu, Wei Sun, Shuo Feng. Lateral suture combined with knotless suture bridge technique for treatment of large L-shaped rotator cuff tears [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(03): 301-306.
[3]	Yan Yan, Dedong Cui, Xinhao Li, Yi Long, Cheng Li, Jingyi Hou, Rui Yang. Clinical efficacy evaluation of compound Danshen tablets combined with routine treatment for frozen shoulder [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(02): 271-276.
[4]	Yanhong Han, Jianke Pan, Minghui Luo, Hetao Huang, Houran Cao, Xiang Li, Lingfeng Zeng, Guihong Liang, Hongyun Chen, Jun Liu, Weiyi Yang. Research progress on influencing factors of tendon bone healing after rotator cuff injury repair surgery [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(02): 239-244.
[5]	Jun Zhang, Qiang Li, Baiyi Meng, Chengyu Li. Arthroscopic release combined with rotator cuff repair for treatment of rotator cuff injury with secondary frozen shoulder [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(01): 1-7.
[6]	Dijun Li, Bin Wang. Application of biomaterials in rotator cuff injury based on animal models [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2024, 18(01): 118-124.
[7]	Cheng Li, Liang Zhu, Yong Pang, Xingchen Zhang, Guochun Zha, Kaijin Guo. Modified load sharing rip-stop and knotless suture bridge technique for rotator cuff tear repair in frozen shoulder [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(03): 424-429.
[8]	Qingpei Xue. Arthroscopic meniscus plasty combined with injection of sodium hyaluronate in treatment of meniscus tear [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(02): 288-291.
[9]	Xin Zhou, Xiaohua Zhang, Shuqing Zhou, Bowen Yang, Ji Luo, Zhongzu Zhang, Yating Yu. Network meta-analysis on various surgical procedures in treatment of irreparable rotator cuff tears [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(02): 232-242.
[10]	Pu Wang, Jianghui Qin, Dongyang Chen, Xianfeng Yang, Qing Jiang. Evaluation of supraspinatus tendon tear and changes in MRI shoulder parameters [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(02): 173-178.
[11]	Renrui Yang, Yongqing Xu, Junfeng Chen, Pengju He, Tao Jin. Clinical characteristics analysis of recurrent dislocation of shoulder joint among servicemen in Southwest China [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2023, 17(01): 119-122.
[12]	Lei Shan, Junlin Zhou. Characteristics and efficacy of simultaneous repair of rotator cuff tear combined with locking plate in the treatment of elderly proximal humeral fractures [J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2024, 12(03): 211-215.
[13]	Peng Xie, Guoqiang Ding, Han Zheng, Youkang Wei, Han Liu, Bing Lu. Application of 3D guide plate technology in reverse shoulder joint replacement [J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2024, 12(01): 21-26.
[14]	Changbing Wang, Lilian Zhao, Ting Xu, Yanjin Li, Chaoming Zhang, Yongjian Liu. Clinical study on the treatment of recurrent anterior dislocation of shoulder joint with precise iliac osteotomy and shoulder pelvis bone grafting [J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2023, 11(04): 313-320.
[15]	Han Zheng, Guoqiang Ding, Peng Xie, Bing Lu. Follow-up study of open latarjet for recurrent anterior dislocation of shoulder joint [J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2023, 11(03): 204-211.

Please choose a citation manager

Content to export