Centre Orthopédique Santy, 24 Avenue Paul Santy, F-69008 Lyon, France.
J Bone Joint Surg Am. 2012 Sep 5;94(17):e125. doi: 10.2106/JBJS.K.00008.
Even though the frequency of arthroscopic repair of isolated lesions of the subscapularis tendon has increased, few studies have presented clinical and anatomical outcomes of this treatment. We hypothesized that, after an arthroscopic repair, structural outcomes in the muscle have an influence on functional results.
A retrospective study was performed on twenty-two patients who had undergone arthroscopic repair of an isolated tear of the subscapularis tendon and had a mean follow-up of thirty-six months. Patients were evaluated preoperatively and postoperatively with use of the Constant-Murley score, a subjective shoulder value, the lift-off test, the belly-press test, and magnetic resonance imaging or computed tomography arthrography. The results were compared with those of a cohort of thirteen patients who underwent open repair of the subscapularis tendon tear.
In the arthroscopic group, the Constant-Murley score improved from a mean of 66 points preoperatively to a mean of 85 points postoperatively (p < 0.05). The subscapularis tendon was healed in 86% of the patients. Three patients (14%) had a partial rupture limited to the superior tendon. Postoperatively, progression of fatty infiltration of the subscapularis muscle was observed in 55% of the patients. Ten patients (45%) had a severe but localized fatty infiltration area of the subscapularis muscle related to the larger tears. Subjective and functional outcomes were not influenced by tendon-healing or postoperative fatty infiltration (p > 0.05). Clinical testing was significantly improved, but incomplete corrections remained frequent. Although open repair resulted in higher subjective shoulder scores and better strength scores, most other clinical parameters, postoperative subscapularis testing results, and structural outcomes were comparable between the arthroscopic repair and the open repair group.
Arthroscopic repair of isolated subscapularis tears was associated with improved shoulder function and improved results on clinical testing. The tendon-healing rate was high but resulted in incomplete correction of the results of clinical testing. Progression of fatty infiltration in the subscapularis muscle was observed on magnetic resonance imaging but did not influence the clinical outcomes.
尽管关节镜下修复肩胛下肌腱孤立性病变的频率有所增加，但很少有研究报道这种治疗的临床和解剖学结果。我们假设，在关节镜下修复后，肌肉的结构结果会对功能结果产生影响。
对 22 例肩胛下肌腱孤立性撕裂行关节镜下修复的患者进行回顾性研究，平均随访 36 个月。患者术前和术后采用 Constant-Murley 评分、主观肩部值、抬离试验、腹部按压试验和磁共振成像或计算机断层扫描关节造影进行评估。结果与 13 例接受肩胛下肌腱撕裂开放修复的患者进行比较。
在关节镜组，Constant-Murley 评分从术前的 66 分平均提高到术后的 85 分（p < 0.05）。肩胛下肌腱愈合率为 86%。3 例（14%）患者存在局限于肌腱上部的部分撕裂。术后，55%的患者肩胛下肌脂肪浸润进展。10 例（45%）患者肩胛下肌脂肪浸润面积严重但局限，与较大撕裂有关。肌腱愈合或术后脂肪浸润对主观和功能结果无影响（p > 0.05）。临床检查明显改善，但不完全纠正仍很常见。虽然开放修复导致更高的主观肩部评分和更好的力量评分，但大多数其他临床参数、术后肩胛下肌检查结果和结构结果在关节镜修复组和开放修复组之间是可比的。
关节镜下修复肩胛下肌腱孤立性撕裂与肩关节功能改善和临床检查结果改善有关。肌腱愈合率高，但导致临床检查结果不完全纠正。磁共振成像显示肩胛下肌脂肪浸润进展，但不影响临床结果。
