OrthoCarolina Sports Medicine Division, Charlotte, North Carolina, USA.
Am J Sports Med. 2010 Jan;38(1):40-6. doi: 10.1177/0363546509346401. Epub 2009 Nov 25.
Although a number of reports have documented outcomes after open revision rotator cuff repair, there are few studies reporting results after arthroscopic revision.
Arthroscopic repair of failed rotator cuff results in significant improvement in shoulder functional outcome and pain relief.
Case series; Level of evidence, 4.
Multiple variables including demographic data, the number of prior ipsilateral shoulder surgeries, and tear size were recorded from chart review. An independent examiner then measured shoulder strength, range of motion, and shoulder functional outcome scores including American Shoulder and Elbow Surgeons score, Simple Shoulder Test, and visual analog pain scale. Paired t tests were performed to compare preoperative and postoperative measures. Additionally, contingency table analysis was performed to identify prognostic factors for failure of repair requiring further surgery and American Shoulder and Elbow Surgeons score less than 50.
Fifty-four patients (88.5%) were available for follow-up evaluation with a mean age of 54.9 +/- 10.1 years (range, 22.7-82.5 years) and a mean follow-up of 31.1 +/- 11.9 months. American Shoulder and Elbow Surgeons scores improved from 43.8 +/- 5.7 (mean +/- 95% confidence interval) before revision to 68.1 +/- 7.2 at final follow-up (P = .0039). The Simple Shoulder Test improved significantly from 3.56 +/- 0.8 before surgery to 7.5 +/- 1.1 at most recent follow-up (P < .0001). Visual analog pain scale scores improved from 5.17 +/- 0.8 to 2.75 +/- 0.8 (P = .03), and forward elevation increased from 121.0 degrees +/- 12.3 degrees to 136 degrees +/- 11.8 degrees postoperatively (P = .025). Greater than 1 prior shoulder surgery was associated with cases that required additional surgery (P = .031). Female gender (P = .007) and preoperative abduction less than 90 masculine (P = .009) were associated with American Shoulder and Elbow Surgeons scores less than 50.
Arthroscopic revision rotator cuff repair may be a reasonable treatment option even after prior open repairs and provides both improved pain relief and shoulder function. Nonetheless, results are not completely optimal. Female patients and those who have undergone more than 1 ipsilateral shoulder surgery are at increased risk for poorer results.
尽管已有许多报告记录了开放式修复肩袖撕裂后的结果，但很少有研究报告关节镜下修复后的结果。
关节镜下修复失败的肩袖可显著改善肩部功能和缓解疼痛。
病例系列；证据水平，4 级。
从图表回顾中记录了多个变量，包括人口统计学数据、同侧肩部手术的数量和撕裂大小。然后，一位独立的检查者测量了肩部力量、活动范围和肩部功能结果评分，包括美国肩肘外科医生评分、简单肩部测试和视觉模拟疼痛量表。进行配对 t 检验以比较术前和术后测量值。此外，进行列联表分析以确定需要进一步手术修复和美国肩肘外科医生评分低于 50 的修复失败的预后因素。
54 例患者（88.5%）可进行随访评估，平均年龄为 54.9±10.1 岁（范围为 22.7-82.5 岁），平均随访 31.1±11.9 个月。美国肩肘外科医生评分从修复前的 43.8±5.7（平均值±95%置信区间）提高到最终随访时的 68.1±7.2（P=.0039）。简单肩部测试从术前的 3.56±0.8 显著提高到最近随访时的 7.5±1.1（P<.0001）。视觉模拟疼痛量表评分从 5.17±0.8 改善至 2.75±0.8（P=.03），外展角度从术前的 121.0°±12.3°增加至术后的 136°±11.8°（P=.025）。超过 1 次同侧肩部手术与需要进一步手术的病例相关（P=.031）。女性（P=.007）和术前外展小于 90 度（P=.009）与美国肩肘外科医生评分低于 50 相关。
即使在先前的开放性修复后，关节镜下修复肩袖撕裂也可能是一种合理的治疗选择，可同时提供更好的疼痛缓解和肩部功能。尽管如此，结果并非完全理想。女性患者和接受过 1 次以上同侧肩部手术的患者结果风险增加。
