Arthroskopische superiore Kapselrekonstruktion mit einem 6 mm dicken azellulären dermalen Allograft bei irreparablen posterosuperioren Rotatorenmanschettenrupturen

Abstract

Implantation of an acellular dermal allograft between glenoid and humerus to restore astable glenohumeral center of rotation in cases of irreparable posterosuperior rotator cuff tears. Irreparable posterosuperior rotator cuff tears with low-grade cuff tear arthropathy (Hamada grade1 and2) and isolated pseudoparesis for flexion. Absolute: Infection, nerve lesions (brachial plexus, axillary nerve), concomitant irreparable subscapularis tendon tear, anterosuperior subluxation of the humeral head ("anterosuperior escape"). Relative: Cuff tear arthropathy ≥ Hamada grade3, fatty infiltration of the infraspinatus muscle ≥ Goutallier grade2, deficiency of the deltoid muscle, inability to adhere to the rehabilitation program, poor compliance. Arthroscopic fixation of a6 mm thick acellular dermal allograft with three suture anchors at the superior glenoid rim and adouble-row construct at the greater tuberosity. Dorsal and ventral interval closure with side-to-side sutures. Abduction brace for 6weeks with passive mobilization. Active motion exercises are commenced at 6weeks with progression to strengthening exercises after 12weeks. Between April 2019 and September 2020, 15patients (5women and 10men) underwent arthroscopic superior capsule reconstruction using a6 mm thick acellular dermal allograft for treatment of irreparable posterosuperior rotator cuff tears. After amean follow-up of 15.4 ± 5.5months, there was asignificant improvement in active flexion (102° ± 37°preop vs. 143° ± 24°postop; P = 0.001; 95%CI 19.6-63.7), ASES score (45.5 ± 16.1preop vs. 68.2 ± 17.4postop; P < 0.001; 95% CI; 12.9-33.7) and DASH score (57.2 ± 18.6preop vs. 22.0 ± 17.4postop; P < 0.001; 95% CI; -46.0 to 24.7), along with significant pain reduction (4.5 ± 2.0preop vs. 2.5 ± 2.1postop; P = 0.001; 95% CI; -3.2 to 1.1). There were no complications requiring revision surgery.