Shamsudin Aminudin, Lam Patrick H, Peters Karin, Rubenis Imants, Hackett Lisa, Murrell George A C
Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, New South Wales, Australia.
Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, New South Wales, Australia
Am J Sports Med. 2015 Mar;43(3):557-64. doi: 10.1177/0363546514560729. Epub 2014 Dec 19.
Symptomatic rotator cuff tears are often treated surgically. However, there is a paucity of information regarding the outcomes of revision arthroscopic rotator cuff repairs.
To evaluate the outcome of revision arthroscopic rotator cuff surgery when compared with primary arthroscopic rotator cuff surgery in a large cohort of patients.
Cohort study; Level of evidence, 3.
A consecutive series of 50 revision arthroscopic rotator cuff repairs performed by a single surgeon, with minimum 2-year follow-up, were retrospectively reviewed using prospectively collected data. As a comparison, 3 primary arthroscopic rotator cuff repair cases (primary group; n = 310) were chosen immediately before each revision case, and 3 were chosen after. Standardized patient-ranked outcomes, examiner-determined assessments, and ultrasound-determined rotator cuff integrity were assessed preoperatively at 6 months and at a minimum of 2 years after surgery.
The revision group was older (mean age, 63 years; range, 43-80 years) compared with the primary group (mean age, 60 years; range, 18-88 years) (P < .05) and had larger tear size (mean ± SEM) (4.1 ± 0.5 cm(2)) compared with the primary group (3.0 ± 0.2 cm(2)) (P < .05). Two years after surgery, the primary group reported less pain at rest (P < .02), during sleep (P < .05), and with overhead activity (P < .01) compared with the revision group. The primary group had better passive forward flexion (+13°; P < .05), abduction (+18°; P < .01), internal rotation (+2 vertebral levels; P < .001) and also significantly greater supraspinatus strength (+15 N; P < .001), lift-off strength (+9.3 N; P < .05), and adduction strength (+20 N; P < .01) compared with the revision group at 2 years. When compared with the primary group, the revision group was more satisfied with the overall shoulder function before surgery but was less satisfied with their shoulder function than the primary group at 2 years (P < .005). The retear rate for primary rotator cuff repair was 16% at 6 months and 21% at 2 years, while the retear rate for revision rotator cuff repair was 28% at 6 months and deteriorated to 40% at 2 years (P < .05).
The short-term clinical outcomes of patients undergoing revision rotator cuff repair were similar to those after primary rotator cuff repair. However, these results did not persist, and by 2 years patients who had revision rotator cuff repair were twice as likely to have retorn compared with those undergoing primary repair. The increase in retear rate in the revision group at 2 years was associated with increased pain, impaired overhead function, less passive motion, weaker strength, and less overall satisfaction with shoulder function.
有症状的肩袖撕裂通常采用手术治疗。然而，关于关节镜下肩袖修复翻修手术的结果，相关信息较少。
在一大群患者中，评估关节镜下肩袖翻修手术与初次关节镜下肩袖手术相比的结果。
队列研究；证据等级，3级。
回顾性分析由一名外科医生连续进行的50例关节镜下肩袖修复翻修手术，采用前瞻性收集的数据，随访时间至少2年。作为对照，在每例翻修病例之前立即选择3例初次关节镜下肩袖修复病例（初次组；n = 310），并在之后选择3例。在术前、术后6个月和至少2年时，评估标准化的患者排名结局、检查者确定的评估以及超声确定的肩袖完整性。
与初次组（平均年龄60岁；范围18 - 88岁）相比，翻修组年龄更大（平均年龄63岁；范围43 - 80岁）（P <.05），撕裂尺寸更大（平均±标准误）（4.1±0.5 cm²），而初次组为（3.0±0.2 cm²）（P <.05）。术后2年，与翻修组相比，初次组在静息时（P <.02）、睡眠时（P <.05）和进行过头活动时（P <.01）疼痛更少。初次组在术后2年时，被动前屈（+13°；P <.05）、外展（+18°；P <.01）、内旋（+2个椎体水平；P <.001）更好，并且冈上肌力量（+15 N；P <.001）、抬起力量（+9.3 N；P <.05）和内收力量（+20 N；P <.01）也显著更强。与初次组相比，翻修组术前对整体肩部功能更满意，但在术后2年时对肩部功能的满意度低于初次组（P <.005）。初次肩袖修复的再撕裂率在6个月时为16%，在2年时为21%，而肩袖修复翻修的再撕裂率在6个月时为28%，在2年时恶化至40%（P <.05）。
接受肩袖修复翻修手术患者的短期临床结果与初次肩袖修复术后相似。然而，这些结果并未持续，到2年时，接受肩袖修复翻修手术的患者再撕裂的可能性是接受初次修复患者 的两倍。翻修组在2年时再撕裂率的增加与疼痛加剧、过头功能受损、被动活动减少、力量减弱以及对肩部功能的总体满意度降低有关。
