Background:Studies to date of superior capsular reconstruction (SCR) comparing outcomes of healed grafts versus torn grafts do not separate graft tears based on location of the tear, rather they combine and report all tears as a single group.Purpose/Hypothesis:The purpose of this study was to correlate functional outcome with graft integrity and graft tear location after SCR with a dermal allograft. It was hypothesized that the functional outcomes of patients with an intact graft would be equivalent to those with graft tears leaving the tuberosity covered.Study Design:Cohort study; Level of evidence, 3.Methods:Patients who underwent SCR with an acellular dermal allograft at a single institution were included. Pre- and postoperative American Shoulder and Elbow Surgeons (ASES), Oxford Shoulder Score, visual analog scale (VAS) for pain, and postoperative Single Assessment Numeric Evaluation (SANE) scores were recorded. A magnetic resonance imaging scan was performed postoperatively to assess graft integrity.Results:A total of 39 patients met inclusion criteria. Mean age of patients was 60.4 ± 8.7 years; mean follow-up was 53.3 ± 25 months (range, 14-98 months). Magnetic resonance imaging performed at a mean of 17.5 months (range, 6-66 months) demonstrated an intact graft in 14 (36%); tear from the glenoid in 11 (28%), from midsubstance in 4 (10%), and from the tuberosity in 8 (21%); and complete graft absence in 2 (5%). Patients were divided into group 1 (intact graft), group 2 (tuberosity covered: tears from glenoid and midsubstance tears), and group 3 (tuberosity bare: tears from the tuberosity and dissolved or absent grafts). In group 1, there was significant improvement in ASES (37.9 to 88.5; P < .001), Oxford (25.2 to 46.2; P < .001), and VAS (6.8 to 0.9; P < .001). In group 2, there was significant improvement in ASES (32.2 to 86.1; P < .001), Oxford (23.4 to 44.2; P < .001), and VAS (7.3 to 1.3; P < .001). In group 3, there was no significant improvement in ASES (40.3 to 45.8; P = .50) or Oxford (33.5 to 31.4; P = .81), but there was a significant reduction in VAS (7.1 to 5.4; P = .03). There was no significant difference between group 1 and 2 in postoperative ASES (88.5 vs 86.1; P = .59), Oxford (46.2 vs 44.2; P = .07), VAS (0.9 vs 1.3, P = .42) and SANE (85.4 vs 83.2; P = .92) scores. However, group 3 had significantly lower ASES (45.8; P < .001), lower Oxford (31.4; P < .001), lower SANE (45.4; P < .001), and higher VAS (5.4; P < .001) scores than groups 1 and 2. There were no differences in outcomes based on sex ( P = .72), previous surgery ( P = .06), preoperative acromiohumeral distance ( P = .57), and preoperative Goutallier stage of the supraspinatus ( P = .16).Conclusion:Patients who underwent SCR with a dermal allograft and developed a graft tear leaving the tuberosity covered had equivalent functional outcomes to those with an intact graft.

中文翻译：

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覆盖粗隆部的移植物撕裂患者与上囊重建后移植物完整的患者具有相似的功能结果


背景： 迄今为止，比较愈合移植物与撕裂移植物结局的上囊重建 （SCR） 的研究没有根据撕裂的位置分离移植物撕裂，而是将它们合并并报告为一组所有撕裂。目的/假设： 本研究的目的是将功能结果与真皮同种异体移植物 SCR 后移植物完整性和移植物撕裂位置相关联。据推测，移植物完整患者的功能结果与移植物撕裂而结节覆盖的患者相当。研究设计： 队列研究;证据水平， 3.方法： 纳入在单个机构接受 SCR 和无细胞皮肤同种异体移植物的患者。记录术前和术后美国肩肘外科医生 （ASES） 、牛津肩评分、疼痛视觉模拟量表 （VAS） 和术后单次评估数字评估 （SANE） 评分。术后进行磁共振成像扫描以评估移植物的完整性。结果： 共有 39 例患者符合纳入标准。患者的平均年龄为 60.4 ± 8.7 岁;平均随访时间为 53.3 ± 25 个月 （范围，14-98 个月）。平均 17.5 个月 （范围，6-66 个月） 进行的磁共振成像显示 14 例 （36%） 移植物完整;11 例 （28%） 从关节盂撕裂，4 例 （10%） 从中质撕裂，8 例 （21%） 从结节撕裂;和 2 例 （5%） 完全缺失移植物。将患者分为第 1 组 （完整移植物）、第 2 组 （覆盖结节：关节盂和中质撕裂撕裂）和第 3 组 （裸露的结节：结节撕裂和溶解或不存在移植物）。在第 1 组中，ASES 有显着改善 （37.9 至 88.5;P < .001）、牛津（25.2 至 46.2;P < .001） 和 VAS （6.8 至 0.9;P < .在第 2 组中，ASES 有显着改善 （32.2 至 86.1;P < .001）、牛津（23.4 至 44.2;P < .001） 和 VAS （7.3 至 1.3;P < .001）.在第 3 组中，ASES 没有显着改善 （40.3 至 45.8;P = .50）或牛津（33.5 至 31.4;P = .81），但 VAS 显著降低 （7.1 至 5.4;P = .03）。术后 ASES 第 1 组和第 2 组之间无显著差异 （88.5 vs 86.1;P = .59）、牛津 （46.2 对 44.2;P = .07）、VAS（0.9 对 1.3，P = .42）和 SANE（85.4 对 83.2;P = .92） 分数。然而，第 3 组的 ASES 显著降低 （45.8;P < .001），下牛津 （31.4;P < .001），较低的 SANE （45.4;P < .001） 和更高的 VAS （5.4;P < .001） 分数高于第 1 组和第 2 组。基于性别 （ P = .72 ）、既往手术 （ P = .06 ）、术前肩峰肱距离 （ P = .57） 和术前冈上肌 Goutallier 分期 （ P = .16） 的结果没有差异。结论： 接受真皮同种异体移植物 SCR 并发生移植物撕裂而覆盖结节的患者与完整移植物患者具有相当的功能结局。