Ide Junji, Maeda Satoshi, Takagi Katsumasa
Department of Orthopaedic Surgery, Kumamoto University Hospital, Graduate School of Medical Sciences, Kumamoto University, Honjo 1-1-1, Kumamoto, 860-8556, Japan.
Am J Sports Med. 2005 Nov;33(11):1672-9. doi: 10.1177/0363546505277141. Epub 2005 Aug 10.
The precise results of arthroscopic transtendon repair of partial-thickness articular-side tears of the rotator cuff remain to be reported.
Arthroscopic transtendon repair is useful in patients with Ellman grade 3 (>6 mm) partial-thickness articular-side tears of the supraspinatus tendon.
Descriptive laboratory study and case series; Level of evidence, 4.
In 43 cadaveric shoulders (mean age, 80 years; range, 50-97 years), the authors measured the width of the supraspinatus insertion (medial-to-lateral direction) and the distance between the articular cartilage edge and the tendon insertion at a site 10 mm lateral to the anterior margin of the greater tuberosity. A clinical study group of 17 patients (mean age, 42 years; range, 17-51 years) was observed for a mean follow-up of 39 months (range, 25-57 months). University of California at Los Angeles and Japanese Orthopaedic Association shoulder scores and postoperative overhead athletic activities were evaluated.
The mean width of the supraspinatus insertion was 9.6 mm (SD, 1.6 mm; range, 7-13 mm; 95% confidence interval, 9.1-10.1 mm; 95% prediction interval, 6.4-12.8 mm). The mean distance between the articular cartilage edge and the tendon insertion was 0.3 mm (range, 0-2 mm). After the procedure, the mean University of California at Los Angeles and Japanese Orthopaedic Association scores significantly improved from 17.3 and 68.4 points to 32.9 and 94.8 points, respectively (P < .01). Rated on the Japanese Orthopaedic Association scale, results were excellent in 14, good in 2, and fair in 1 patient; there were no poor results. Of 6 overhead-throwing athletes, 2 returned to their previous sports at the same level, 3 returned at a lower level, and 1 was unable to return.
Arthroscopic transtendon repair is a safe, reliable procedure in patients with grade 3 partial-thickness articular-side tears. In the majority of patients, partial tears of more than 6 mm of the supraspinatus tendon thickness involved more than 50% of the entire tendon thickness.
肩袖部分厚度关节面侧撕裂的关节镜下经肌腱修复的确切结果仍有待报道。
关节镜下经肌腱修复对Ellman 3级（>6 mm）冈上肌腱部分厚度关节面侧撕裂的患者有用。
描述性实验室研究和病例系列；证据等级，4级。
在43具尸体肩部标本（平均年龄80岁；范围50 - 97岁）中，作者测量了冈上肌止点的宽度（内侧到外侧方向）以及在大结节前缘外侧10 mm处关节软骨边缘与肌腱止点之间的距离。对17例患者（平均年龄42岁；范围17 - 51岁）的临床研究组进行了平均39个月（范围25 - 57个月）的随访。评估了加州大学洛杉矶分校和日本骨科协会的肩部评分以及术后过头运动活动情况。
冈上肌止点的平均宽度为9.6 mm（标准差1.6 mm；范围7 - 13 mm；95%置信区间，9.1 - 10.1 mm；95%预测区间，6.4 - 12.8 mm）。关节软骨边缘与肌腱止点之间的平均距离为0.3 mm（范围0 - 2 mm）。手术后，加州大学洛杉矶分校和日本骨科协会的平均评分分别从17.3分和68.4分显著提高到32.9分和94.8分（P <.01）。根据日本骨科协会评分标准，14例结果为优，2例为良，1例为可；无差的结果。6名过头投掷运动员中，2名恢复到之前相同水平的运动，3名恢复到较低水平，1名无法恢复。
关节镜下经肌腱修复对于3级部分厚度关节面侧撕裂的患者是一种安全、可靠的手术方法。在大多数患者中，冈上肌腱厚度超过6 mm的部分撕裂累及整个肌腱厚度的50%以上。
