Kim Jae Hwa, Hong In Tae, Ryu Keun Jung, Bong Sun Tae, Lee Yoon Seok, Kim Jang Hwan
Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
Am J Sports Med. 2014 Nov;42(11):2606-13. doi: 10.1177/0363546514547177. Epub 2014 Sep 3.
Few clinical studies have evaluated the integrity of repaired tendons and identified the timing of retears through the use of serial imaging.
Retears after arthroscopic rotator cuff repair are uncommon in the late postoperative period (after 3 months).
Case series; Level of evidence, 4.
Among 221 arthroscopic rotator cuff repairs that were performed at a single hospital between May 2010 and February 2012, 61 were involved in this study. Rotator cuff tears consisted of 12 small, 31 medium, 8 large, and 6 massive rotator cuff tears. Additionally, 4 isolated subscapularis tears were included. For clinical evaluation, all patients were assessed both preoperatively and postoperatively by use of the University of California-Los Angeles Shoulder Rating Scale, absolute and relative Constant scores, and American Shoulder and Elbow Surgeons score; active range of motion was assessed as well. For radiological evaluation, all 61 patients had a magnetic resonance imaging (MRI) evaluation at 3 months postoperatively. Among them, 23 patients were evaluated for repaired tendon integrity on postoperative MRI at a minimum of 1 year after surgery (mean, 14.1 months; range, 12-19 months), and results were classified according to the Sugaya classification: type I, sufficient thickness with homogeneously low intensity on each image; type II, sufficient thickness, partial high-intensity area; type III, less than half the thickness without discontinuity; type IV, minor discontinuity; and type V, major discontinuity. The remaining 38 patients, who refused to undergo MRI again for financial reasons, were evaluated through ultrasound.
Statistically significant clinical improvements were observed after surgery. The MRI conducted at 3 months postoperatively identified 9 patients with Sugaya type I, 28 patients with type II, and 24 patients with type III repairs. No patients showed Sugaya type IV or V repairs at postoperative 3 months. Thirty-seven patients who had shown Sugaya type I or II repairs on 3-month postoperative MRI had no retear on imaging study at a minimum of 1 year. Of 24 patients who had shown type III repairs on 3-month postoperative MRI, 1 patient exhibited retear (Sugaya type IV) on 1-year postoperative MRI and 3 patients showed full-thickness retear on 1-year postoperative ultrasonography. All 4 of these patients had had large to massive tears preoperatively.
Retears occurred infrequently in the late postoperative period (after 3 months) in well-healed tendons that had shown intact cuff repair integrity with sufficient mechanical and biological healing within the first 3 postoperative months.
很少有临床研究通过系列成像评估修复肌腱的完整性并确定再撕裂的时间。
关节镜下肩袖修复术后的再撕裂在术后晚期（3个月后）并不常见。
病例系列；证据等级，4级。
在2010年5月至2012年2月于一家医院进行的221例关节镜下肩袖修复手术中，本研究纳入了61例。肩袖撕裂包括12例小撕裂、31例中等撕裂、8例大撕裂和6例巨大肩袖撕裂。此外，还纳入了4例孤立的肩胛下肌撕裂。对于临床评估，所有患者术前和术后均采用加利福尼亚大学洛杉矶分校肩评分量表、绝对和相对Constant评分以及美国肩肘外科医师评分进行评估；同时评估主动活动范围。对于影像学评估，所有61例患者术后3个月均进行了磁共振成像（MRI）评估。其中，23例患者在术后至少1年（平均14.1个月；范围12 - 19个月）进行了术后MRI修复肌腱完整性评估，结果根据Sugaya分类进行分类：I型，各图像上厚度足够且强度均匀低；II型，厚度足够，部分高强度区域；III型，厚度小于一半且无连续性中断；IV型，轻微连续性中断；V型，严重连续性中断。其余38例因经济原因拒绝再次进行MRI检查的患者通过超声进行评估。
术后观察到有统计学意义的临床改善。术后3个月进行的MRI检查发现9例Sugaya I型、28例II型和24例III型修复患者。术后3个月无患者表现为Sugaya IV型或V型修复。术后3个月MRI显示为Sugaya I型或II型修复的37例患者在至少1年的影像学检查中无再撕裂。术后3个月MRI显示为III型修复的24例患者中，1例在术后1年MRI出现再撕裂（Sugaya IV型），3例在术后1年超声检查显示全层再撕裂。所有这4例患者术前均为大到巨大撕裂。
在术后3个月内机械和生物学愈合充分、肩袖修复完整性良好且愈合的肌腱中，术后晚期（3个月后）再撕裂很少发生。
