ヒト脱細胞コラーゲンマトリックスを用いた関節鏡視下上方関節包再建術：後上方広範修復不能回旋筋腱板断裂に対する2年間の追跡調査

This study aimed to assess clinical and radiological outcomes of arthroscopic superior capsular reconstruction (SCR) using human-derived acellular collagen matrix (hACM) in patients with posterosuperior massive irreparable rotator cuff tears (MIRCTs).

This retrospective study analyzed patients who underwent arthroscopic SCR using hACM between April 2018 and December 2021. Inclusion criteria were intact or repairable subscapularis tendon, failure of nonoperative treatment, age under 80 years, Goutallier grade ≤2 for the infraspinatus and minimum clinical follow-up of 2 years. Patients lost to follow-up or who underwent revision SCR were excluded. Primary outcome was Constant-Murley score (CMS). Radiographic evaluation included acromio-humeral interval (AHI) measurements and assessment of graft integrity 2 years after surgery.

Forty-eight patients met inclusion criteria at mean of 26 months postoperatively, including 20 (41.7%) women and 28 (58.3%) men, with a mean ± standard deviation (SD) age of 63.5 ± 7.1. CMS increased from preoperative median values of 39.5-73.0 at 1 year (p < 0.0001) and 76.04 at 2 years (p < 0.0001). Two patients (4.2%) did not achieve the minimal clinically important difference at 2 years. Improvement was consistent across all subdomains: pain, activities of daily living, range of motion, and strength. Mean ± SD AHI before surgery was 0.58 ± 0.21 cm, changing to 0.51 ± 0.21 cm after SCR (p = 0.031). Graft integrity at 2 years was observed in 20 (41.7%) cases. No significant differences in pre- versus post-variation in clinical outcomes were observed between patients with or without graft integration, but the variation in AHI differed significantly between groups (p = 0.030): AHI remained stable in patients with graft integration, whereas it decreased significantly in those without integration.

SCR using hACM achieved significant clinical improvement and may represent a viable non-prosthetic approach for posterosuperior MIRCTs in middle-aged patients, though further studies are needed to confirm effectiveness.

Level IV, case series with no comparison group.