Huijsmans Pol E, Pritchard Mark P, Berghs Bart M, van Rooyen Karin S, Wallace Andrew L, de Beer Joe F
Cape Shoulder Institute, P.O. Box 15741, Panorama 7506, South Africa.
J Bone Joint Surg Am. 2007 Jun;89(6):1248-57. doi: 10.2106/JBJS.E.00743.
The treatment of rotator cuff tears has evolved from open surgical repairs to complete arthroscopic repairs over the past two decades. In this study, we reviewed the results of arthroscopic rotator cuff repairs with the so-called double-row, or footprint, reconstruction technique.
Between 1998 and 2002, 264 patients underwent an arthroscopic rotator cuff repair with double-row fixation. The average age at the time of the operation was fifty-nine years. Two hundred and thirty-eight patients (242 shoulders) were available for follow-up; 210 were evaluated with a full clinical examination and thirty-two, with a questionnaire only. Preoperative and postoperative examinations consisted of determination of a Constant score and a visual analogue score for pain as well as a full physical examination of the shoulder. Ultrasonography was done at a minimum of twelve months postoperatively to assess the integrity of the cuff.
The average score for pain improved from 7.4 points (range, 3 to 10 points) preoperatively to 0.7 point (range, 0 to 3 points) postoperatively. The subjective outcome was excellent or good in 220 (90.9%) of the 242 shoulders. The average increase in the Constant score after the operation was 25.4 points (range, 0 to 57 points). Ultrasonography demonstrated an intact rotator cuff in 83% (174) of the shoulders overall, 47% (fifteen) of the thirty-two with a repair of a massive tear, 78% (thirty-two) of the forty-one with a repair of a large tear, 93% (113) of the 121 with a repair of a medium tear, and 88% (fourteen) of the sixteen with a repair of a small tear. Strength and active elevation increased significantly more in the group with an intact repair at the time of follow-up than in the group with a failed repair; however, there was no difference in the pain scores.
Arthroscopic rotator cuff repair with double-row fixation can achieve a high percentage of excellent subjective and objective results. Integrity of the repair can be expected in the majority of shoulders treated for a large, medium, or small tear, and the strength and range of motion provided by an intact repair are significantly better than those following a failed repair.
Therapeutic Level IV.
在过去二十年中，肩袖撕裂的治疗方法已从开放手术修复发展为完全关节镜修复。在本研究中，我们回顾了采用所谓双排或足迹重建技术进行关节镜肩袖修复的结果。
1998年至2002年期间，264例患者接受了双排固定的关节镜肩袖修复术。手术时的平均年龄为59岁。238例患者（242个肩关节）可供随访；210例接受了全面的临床检查，32例仅通过问卷调查进行评估。术前和术后检查包括确定Constant评分、疼痛视觉模拟评分以及对肩部进行全面体格检查。术后至少12个月进行超声检查以评估肩袖的完整性。
疼痛平均评分从术前的7.4分（范围为3至10分）改善至术后的0.7分（范围为0至3分）。242个肩关节中有220个（90.9%）的主观结果为优或良。术后Constant评分的平均增加为25.4分（范围为0至57分）。超声检查显示，总体上83%（174个）肩关节的肩袖完整，32例巨大撕裂修复患者中有47%（15个），41例大撕裂修复患者中有78%（32个），121例中撕裂修复患者中有93%（113个），16例小撕裂修复患者中有88%（14个）。随访时修复完整组的力量和主动抬高增加幅度明显大于修复失败组；然而，疼痛评分没有差异。
采用双排固定的关节镜肩袖修复术可获得较高比例的优异主观和客观结果。对于大部分治疗大、中、小撕裂的肩关节，可预期修复的完整性，完整修复提供的力量和活动范围明显优于修复失败后的情况。
治疗性IV级。
