Shoulder and Elbow Center, Knoxville Orthopaedic Clinic, 260 Fort Sanders West Blvd, Knoxville, TN 37922, USA.
Clin Orthop Relat Res. 2010 Jun;468(6):1514-20. doi: 10.1007/s11999-009-1215-x.
Treatment of partial-thickness articular surface rotator cuff tears varies from simple débridement with or without an acromioplasty to various repair techniques. These repair techniques have included in situ transtendinous methods, as well as completion of the tear and repairing the full-thickness defect. The transtendinous techniques can be associated with stiffness and completing the tear takes down normal intact tissue. Therefore, a technique was developed that repairs the articular-side partial- thickness rotator cuff tears with an all-inside approach that does not violate the intact bursal tissue and does not complete the tear.
QUESTIONS/PURPOSES: To compare the preoperative and postoperative Penn shoulder scores (PSS) associated with an in situ all-inside repair technique and the effects of such a repair on postoperative stiffness.
Twenty patients with partial-thickness articular rotator cuff tears greater than 50% of the width of the tendon repaired with an all-inside repair technique were retrospectively reviewed. Two of the patients were high school athletes and the rest self-described as recreational athletes. The minimum followup was 16 months (average, 29 months; range, 16-41 months). A validated outcome measure (PSS) was used to assess clinical outcome, and postoperative ROM was measured.
The average PSS score improved from 74 (range, 56-84) to 92 (range, 86-99). All but one patient was able to return to the same level of play or higher.
In situ repairs of partial-thickness articular surface tears using an all-inside approach resulted in a substantial increase in PSS with no cases of major postoperative clinical stiffness.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
治疗部分厚度关节面肩袖撕裂的方法各不相同，从简单的清创术，伴或不伴肩峰成形术，到各种修复技术。这些修复技术包括原位腱内方法，以及完成撕裂并修复全层缺陷。腱内技术可能会导致僵硬，而完成撕裂会破坏正常完整的组织。因此，开发了一种使用全内入路修复关节侧部分厚度肩袖撕裂的技术，该技术不会侵犯完整的滑囊组织，也不会完成撕裂。
问题/目的：比较原位全内修复技术的术前和术后宾夕法尼亚肩部评分（PSS），以及这种修复对术后僵硬的影响。
回顾性分析了 20 例采用全内修复技术治疗的部分厚度关节旋转袖撕裂大于肌腱宽度 50%的患者。其中 2 例患者为高中生运动员，其余患者自述为娱乐运动员。最小随访时间为 16 个月（平均 29 个月；范围 16-41 个月）。使用经过验证的结果测量（PSS）评估临床结果，并测量术后关节活动度。
平均 PSS 评分从 74（范围 56-84）提高到 92（范围 86-99）。除 1 例患者外，所有患者均能恢复到相同或更高的运动水平。
使用全内入路对部分厚度关节表面撕裂进行原位修复可显著提高 PSS，且无术后严重临床僵硬的病例。
IV 级，治疗研究。请参阅作者指南，以获取完整的证据水平描述。
