Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, CHS Room 76-143, Los Angeles, CA 90095, USA.
Clin Sports Med. 2012 Oct;31(4):693-712. doi: 10.1016/j.csm.2012.07.006. Epub 2012 Sep 1.
Rotator cuff repair is very likely to be clinically successful when performed well and rehabilitated properly, especially when judged with patient satisfaction outcome scores. A healed rotator cuff tendon will likely result in an improved and lasting clinical result. Recurrent tears will still be present despite optimal mobilization and fixation of the rotator cuff to bone, especially in large tears with retraction and atrophy. Failure of rotator cuff repairs is multifactorial with biologic factors, such as age, tear size, and fatty infiltration probably most critical. Other patient-related factors (ie, diabetes, smoking), recurrent trauma, and technical error at the time of surgery also contribute to rotator cuff repair failure. When managing a patient with a symptomatic re-tear, revision rotator cuff repair can be a very successful procedure, but patient selection is critical and managing patient expectations is paramount. Ideal candidates for revision rotator cuff repair have minimal muscle atrophy, minimal tendon retracted, preoperative forward elevation of greater than 90°, a functioning deltoid, and no evidence of cuff tear arthropathy.
当肩袖修复术操作得当且康复得当时，其在临床上极有可能取得成功，尤其是用患者满意度评分来评估时。肩袖肌腱愈合后，很可能会带来改善且持久的临床效果。尽管对肩袖进行了最佳的活动和固定，但仍会出现复发性撕裂，尤其是在伴有回缩和萎缩的大撕裂中。肩袖修复术的失败是多因素的，生物学因素（如年龄、撕裂大小和脂肪浸润）可能最为关键。其他与患者相关的因素（例如糖尿病、吸烟）、反复创伤以及手术时的技术错误也会导致肩袖修复失败。在处理有症状的复发性撕裂患者时，翻修肩袖修复术可能是一项非常成功的手术，但患者选择至关重要，管理患者的期望至关重要。翻修肩袖修复术的理想候选者具有最小的肌肉萎缩、最小的肌腱回缩、术前前屈大于 90°、功能正常的三角肌以及没有肩袖撕裂性关节炎的证据。
