変形性関節症の術前所見は、上関節包再建術の転帰に影響を与えるか？システマティックレビュー

The optimal indications for superior capsular reconstruction (SCR) in cases of massive irreparable rotator cuff tears (RCTs) accompanied by degenerative arthritis remain controversial.

A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, searching PubMed, Embase (Elsevier), and Google Scholar. Studies were included if they documented Hamada grade and reported clinical and radiographic outcomes after SCR for irreparable RCTs. American Shoulder and Elbow Surgeons (ASES) score, visual analog scale for pain (pVAS), active range of motion, and acromiohumeral distance (AHD) were analyzed.

In all 7 studies, there was no consistent trend observed regarding the influence of arthritis on the improvement of ASES scores, and none of the studies showed statistically significant correlations (p > 0.05). All 5 studies regarding pVAS showed a trend that the pVAS improvement after surgery decreased as the severity of arthritis increased (beta coefficient < 0). Out of the 7 studies regarding forward flexion (FF), 6 demonstrated a trend where the improvement after surgery decreased as the severity of arthritis increased (beta coefficient < 0). There was a tendency for the improvement in AHD to increase as the Hamada grade progressed.

There was no consistent trend observed regarding the impact of the severity of arthritis on the improvement of ASES score. However, there was a trend of decreasing improvement in pVAS and FF after surgery as arthritis progressed. SCR could be a viable option even in cases of Hamada grades 3 and 4.