Alps Surgery Institute, Clinique Générale, Annecy, France.
Arthroscopy. 2013 Sep;29(9):1471-8. doi: 10.1016/j.arthro.2013.06.004. Epub 2013 Aug 2.
The purpose of this study was to evaluate outcome and structural integrity after arthroscopic repair of large subscapularis tendon (SSC) tears at 2 to 4 years' follow-up.
Between January 2006 and October 2008, 52 consecutive patients underwent arthroscopic repair of Lafosse type III and IV SSC ruptures. A total of 46 patients (38 men and 8 women) with a mean age of 62 years (range, 45 to 81 years) were available for final follow-up. Clinical findings were assessed for all patients preoperatively and postoperatively, including range of motion, the lift-off test, the belly-press test, the Constant score, and the modified University of California, Los Angeles score. Subscapularis muscle strength by use of the bear-hug test and external rotation were compared in both shoulders postoperatively. Patients were evaluated with plain radiographs and magnetic resonance imaging or computed tomographic arthrography before surgery. Postoperatively, radiographic examination was completed by use of magnetic resonance imaging or computed tomographic arthrography in 39 patients (85%). Patients completed the subjective shoulder value and rated their satisfaction at final follow-up.
The mean follow-up period was 35.3 ± 9.6 months (range, 23 to 57 months). An isolated lesion was detected in 13% of patients; a lesion of the SSC and supraspinatus tendon was found in 37%; and a lesion of the SSC, supraspinatus tendon, and infraspinatus tendon was detected in 50%. At latest follow-up, the mean Constant score significantly improved from 46.4 points to 79.9 points and the modified University of California, Los Angeles score improved from 15.1 points to 31.5 points (P < .001). Subscapularis strength was 92% and external rotation was 96% of the nonoperative shoulder. All outcome scores were similar between Lafosse type III and IV SSC ruptures. Radiographic evaluation showed a rerupture rate of 11%. The coracohumeral distance increased from 9.7 mm to 10.1 mm postoperatively (P = .086). The subjective shoulder value improved from 51% to 88% (P < .001), and 98% of patients were satisfied or very satisfied.
Arthroscopic treatment of large to massive SSC ruptures results in significant clinical improvements, excellent maintenance of muscle strength, and durable tendon integrity at 2 to 4 years' follow-up.
Level IV, therapeutic case series.
本研究旨在评估 2 至 4 年随访时关节镜下修复大型肩胛下肌腱（SSC）撕裂的结果和结构完整性。
2006 年 1 月至 2008 年 10 月期间，52 例连续患者接受了 Lafosse Ⅲ型和Ⅳ型 SSC 断裂的关节镜修复。共有 46 例患者（38 名男性和 8 名女性）可进行最终随访，平均年龄为 62 岁（范围，45 至 81 岁）。所有患者在术前和术后均进行了临床检查，包括活动范围、抬起测试、腹部按压测试、Constant 评分和改良加利福尼亚大学洛杉矶评分。术后比较了双侧肩部的抱熊试验和外旋的肩胛下肌力量。患者术前均接受了普通 X 线片和磁共振成像或计算机断层扫描关节造影检查。术后，39 例患者（85%）通过磁共振成像或计算机断层扫描关节造影进行了影像学检查。患者在最终随访时完成了主观肩部值和满意度的评估。
平均随访时间为 35.3 ± 9.6 个月（范围，23 至 57 个月）。13%的患者发现孤立性病变；37%的患者发现肩胛下肌腱和冈上肌腱病变；50%的患者发现肩胛下肌腱、冈上肌腱和冈下肌腱病变。在末次随访时，Constant 评分从 46.4 分显著提高至 79.9 分，改良加利福尼亚大学洛杉矶评分从 15.1 分提高至 31.5 分（P <.001）。肩胛下肌力量为非手术侧的 92%，外旋为 96%。Lafosse Ⅲ型和Ⅳ型 SSC 撕裂的所有结果评分均相似。影像学评估显示再撕裂率为 11%。术后喙肱距离从 9.7 毫米增加至 10.1 毫米（P =.086）。主观肩部值从 51%提高至 88%（P <.001），98%的患者满意或非常满意。
关节镜治疗大型至巨大型 SSC 撕裂在 2 至 4 年随访时可显著改善临床效果，维持肌肉力量和肌腱完整性。
Ⅳ级，治疗性病例系列。
