ORTON Research Institute and ORTON Hospital, Invalid Foundation, Tenholantie 10, 00280, Helsinki, Finland.
Clin Orthop Relat Res. 2013 Feb;471(2):554-61. doi: 10.1007/s11999-012-2494-1. Epub 2012 Aug 16.
Recurrent or persistent defects in the rotator cuff after its repair are common. Short- and medium-term surveys have revealed, after open repair, patients with an intact rotator cuff have increased function and ROM. However, no long-term studies have verified cuff integrity on MR arthrography or correlated it with clinical and functional outcomes.
QUESTIONS/PURPOSES: We evaluated long-term cuff integrity and fatty infiltration after open repair using MR arthrography and determined whether these findings correlated with clinical and functional results.
Using MR arthrography, we retrospectively evaluated 67 patients (48 men, 19 women) who underwent open rotator cuff repair between 1980 and 1989. Their mean age at surgery was 52 years. Minimum followup was 16 years (mean, 20 years; range, 16-25 years).
The retear rate was 94%, and mean size of rerupture was 3.5 × 3.6 cm (ranges, 0.5-5.0 cm × 0.5-5.2 cm; median, 4 × 4 cm). The remaining four patients had a partial supraspinatus tendon tear. Fatty infiltration was marked in the supraspinatus and infraspinatus tendons. Cuff integrity correlated with clinical results: active external rotation and forward flexion, and flexion, abduction, and external rotation strengths, were better in patients with an intact rotator cuff or a small retear of 4 cm(2) or less than in patients with larger tears. Cuff integrity also correlated with functional results.
Rotator cuff integrity was lost in 94% of patients after a minimum followup of 16 years. Cuff integrity correlates well with clinical and functional results even several years postoperatively. A large retear seems to be the most important factor in deteriorating long-term clinical and functional results after open rotator cuff repair.
Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
肩袖修复后出现复发性或持续性缺陷较为常见。短期和中期研究表明，在开放性修复后，肩袖完整的患者功能和 ROM 增加。然而，尚无长期研究通过 MRI 关节造影术证实肩袖的完整性，并将其与临床和功能结果相关联。
问题/目的：我们通过 MRI 关节造影术评估开放性肩袖修复后肩袖的长期完整性和脂肪浸润，并确定这些发现是否与临床和功能结果相关。
我们回顾性评估了 1980 年至 1989 年间接受开放性肩袖修复的 67 例患者（48 名男性，19 名女性）。手术时的平均年龄为 52 岁。最小随访时间为 16 年（平均 20 年；范围，16-25 年）。
再撕裂率为 94%，再撕裂的平均大小为 3.5×3.6cm（范围，0.5-5.0cm×0.5-5.2cm；中位数为 4×4cm）。其余 4 例患者存在部分冈上肌腱撕裂。冈上肌和冈下肌肌腱内脂肪浸润明显。肩袖完整性与临床结果相关：肩袖完整或撕裂面积小于 4cm²的患者主动外旋和前屈以及屈、外展和外旋肌力均较好，而撕裂面积较大的患者则较差。肩袖完整性也与功能结果相关。
在至少 16 年的随访后，94%的患者失去了肩袖的完整性。肩袖的完整性与临床和功能结果密切相关，即使在手术后数年也是如此。较大的再撕裂似乎是开放性肩袖修复后长期临床和功能结果恶化的最重要因素。
IV 级，治疗性研究。请参阅作者说明以获取完整的证据等级描述。
