大腿筋膜移植による腱板再建後に再鏡視評価をした一例

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We described the case of a massive rotator cuff tear treated by a reconstruction with fascia lata grafting and evaluated by a second-look arthroscopy. Case: A 56-year-old man who had been a manual laborer and lifted heavy objects for 30 years was referred to our clinic. He presented himself with a history of discomfort in the right shoulder associated with progressive pain and with a loss of motion. A physical examination confirmed that active motion was restricted to 90 degrees flexion and 60 degrees abduction. A Hawkins impingement was present; a supraspinatus (SSP) test indicated weakness of the SSP. An MRI scan showed massive rotator cuff tears. Clinical results were evaluated using a Japanese Orthopaedic Association shoulder scoring system (JOA score) and the preoperative score was 41 points. Surgical treatment was performed with arthroscopic debridement for a partially torn long head of the biceps brachii, inflammatory synovial tissue and degenerative rotator cuff torn end with subacromial decompression. Arthroscopic evaluation revealed massive rotator cuff tears measured 40mm in width and 50mm in length; rotator cuff defect measured 20mm in width and 15mm in length and remained after sufficient debridement of the surrounding tissue around the torn tendon. Rotator cuff reconstruction with double folded fascia lata grafting for the defect was performed with 2 suture anchors. The JOA score had improved 81 and 87 points at 3 and 6 months follow up respectively. Active motion was recovered to 170 degrees flexion and 160 degrees abduction. A second-look arthroscopy evaluation revealed good continuity and integration between rotator cuff tendons and grafted fascia lata as well as fascia lata and the greater tuberosity with almost normal shoulder articulation. Our current second look evaluation indicated that fasia lata grafting might be one of the useful options for the reconstruction of massive rotator cuff tears.
日本肩関節学会の論文

大腿筋膜移植による腱板再建後に再鏡視評価をした一例

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