Department of Traumatology, Orthopaedics and Hand Surgery, University of Medical Sciences in Poznan, ul. 28 Czerwca 1956r 135, 61-545, Poznan, Poland,
Int Orthop. 2013 Dec;37(12):2395-401. doi: 10.1007/s00264-013-2024-0. Epub 2013 Aug 15.
The purpose of the study was clinical and advanced biomechanical evaluation of shoulder function with respect to rotator cuff (RC) integrity following repair.
This was a retrospective study of 111 cases with solid single row rotator cuff repair and a minimal one-year follow-up. The RC repair was performed as an open procedure in 42 patients, arthroscopically assisted in 34 and fully arthroscopic in 48 cases. Evaluation protocol included ultrasound evaluation of the RC integrity, clinical evaluation using shoulder scores and advanced biomechanical evaluation (isometric and the isokinetic strength testing).
Ultrasound evaluation revealed complete retear in 16%, partial retear in 10% and intact repair in 74% of the cases. Isometric testing of flexion and abduction had shown that shoulders with complete retear were weaker by 45% compared to those with full tendon healing. Isokinetic testing revealed 29-43% deficits in peak external rotation torque comparing complete retear vs. normal healing. Patients' ability to generate shoulder power and withstand a load proved to be lower in circumstances of a complete lack of healing (40-43% and 34-55%, respectively). Partial retears did not have a negative impact on the biomechanical properties of shoulders. Surprisingly, there were no significant differences in the shoulder scores related to the quality of healing. In terms of patient satisfaction the results were good and the patients declared themselves better in all cases, no matter what quality of healing had been recorded ultimately.
According to the results of this research rotator cuff integrity after open or arthroscopic repair does not seem to affect clinical scores. Recurrent tears may result in lower muscle performance in terms of active motion, strength and endurance. Advanced shoulder testing may be essential in assessing the patients' ability to return to sports or heavy labour.
本研究旨在对肩袖（RC）修复后肩功能进行临床和高级生物力学评估，以了解 RC 完整性。
这是一项回顾性研究，共纳入 111 例接受单排 RC 修复且随访时间至少 1 年的患者。42 例采用开放手术修复，34 例采用关节镜辅助修复，48 例采用全关节镜修复。评估方案包括 RC 完整性的超声评估、采用肩部评分的临床评估以及高级生物力学评估（等长和等速力量测试）。
超声评估显示，完全再撕裂的比例为 16%，部分再撕裂的比例为 10%，修复完整的比例为 74%。等长测试显示，完全再撕裂的肩部在屈曲和外展方面的力量比完全愈合的肩部弱 45%。等速测试显示，与正常愈合相比，完全再撕裂的肩部外旋峰值扭矩存在 29-43%的缺陷。在完全缺乏愈合的情况下（分别为 40-43%和 34-55%），患者产生肩部力量和承受负荷的能力较低。部分再撕裂对肩部生物力学特性没有负面影响。令人惊讶的是，与愈合质量相关的肩部评分没有显著差异。就患者满意度而言，结果是好的，所有患者都表示自己在各方面都更好，无论最终记录到何种愈合质量。
根据这项研究的结果，RC 在开放或关节镜修复后的完整性似乎不会影响临床评分。复发性撕裂可能导致主动运动、力量和耐力方面的肌肉性能下降。高级肩部测试可能对于评估患者重返运动或重体力劳动的能力至关重要。
