Ryu Keun Jung, Kim Bang Hyun, Lee Yohan, Lee Yoon Seok, Kim Jae Hwa
Department of Orthopaedic Surgery, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam-si, Kyeonggi-do, Korea.
Department of Orthopaedic Surgery, CHA Gumi Medical Center, School of Medicine, CHA University, Gumi-si, Kyungsangbuk-do, Korea.
Am J Sports Med. 2015 Mar;43(3):597-605. doi: 10.1177/0363546514562175. Epub 2014 Dec 24.
The arthroscopic suture-bridge technique has proved to provide biomechanically firm fixation of the torn rotator cuff to the tuberosity by increasing the footprint contact area and pressure. However, a marginal dog-ear deformity is encountered not infrequently when this technique is used, impeding full restoration of the torn cuff.
To evaluate the structural and functional outcomes of the use of a modified suture-bridge technique to prevent a marginal dog-ear deformity compared with a conventional suture-bridge method in rotator cuff repair.
Cohort study; Level of evidence 2.
A consecutive series of 71 patients aged 50 to 65 years who underwent arthroscopic rotator cuff repair for full-thickness medium-sized to massive tears was evaluated. Patients were divided into 2 groups according to repair technique: a conventional suture-bridge technique (34 patients; group A) versus a modified suture-bridge technique to prevent a marginal dog-ear deformity (37 patients; group B). Radiographic evaluations included postoperative cuff integrity using MRI. Functional evaluations included pre- and postoperative range of motion (ROM), pain visual analog scale (VAS), the University of California, Los Angeles (UCLA) shoulder rating scale, the Constant score, and the American Shoulder and Elbow Surgeons (ASES) score. All patients were followed up clinically at a minimum of 1 year.
When the 2 surgical techniques were compared, postoperative structural integrity by Sugaya classification showed the distribution of types I:II:III:IV:V to be 4:20:2:4:4 in group A and 20:12:4:0:1 in group B. More subjects in group B had a favorable Sugaya type compared with group A (P < .001). The postoperative healed:retear rate was 26:8 in group A and 36:1 in group B, with a significantly lower retear rate in group B (P = .011). However, there were no significant differences in ROM and all functional outcome scores between the 2 groups postoperatively. When surgical techniques were compared across healed (n = 62) and retear (n = 9) groups, significantly fewer modified suture-bridge technique repairs were found in the retear group (P = .03). There were significant differences between healed and retear groups in functional outcome scores, with worse results in the retear group.
A modified suture-bridge technique to prevent a marginal dog-ear deformity provided better structural outcomes than a conventional suture-bridge technique for medium-sized to massive rotator cuff tears. This technique may ultimately provide better functional outcomes by decreasing the retear rate.
关节镜下缝合桥技术已被证明可通过增加接触面积和压力，为撕裂的肩袖提供生物力学上稳固的结节固定。然而，使用该技术时，边缘“狗耳”畸形并不少见，这妨碍了撕裂肩袖的完全修复。
评估与传统缝合桥技术相比，使用改良缝合桥技术预防边缘“狗耳”畸形在肩袖修复中的结构和功能结果。
队列研究；证据等级2。
对71例年龄在50至65岁之间、因全层中型至大型撕裂接受关节镜下肩袖修复的患者进行连续评估。根据修复技术将患者分为两组：传统缝合桥技术组（34例；A组）和预防边缘“狗耳”畸形的改良缝合桥技术组（37例；B组）。影像学评估包括使用MRI评估术后肩袖完整性。功能评估包括术前和术后的活动范围（ROM）、疼痛视觉模拟量表（VAS）、加利福尼亚大学洛杉矶分校（UCLA）肩评分量表、Constant评分和美国肩肘外科医师（ASES）评分。所有患者至少随访1年。
比较两种手术技术时，根据Sugaya分类法，术后结构完整性显示A组I:II:III:IV:V型的分布为4:20:2:4:4，B组为20:12:4:0:1。与A组相比，B组更多患者的Sugaya分型较好（P <.001）。A组术后愈合:再撕裂率为26:8，B组为36:1，B组再撕裂率显著更低（P =.011）。然而，两组术后ROM和所有功能结果评分无显著差异。比较愈合组（n = 62）和再撕裂组（n = 9）的手术技术时，再撕裂组中改良缝合桥技术修复明显更少（P =.03）。愈合组和再撕裂组在功能结果评分上存在显著差异，再撕裂组结果更差。
对于中型至大型肩袖撕裂，预防边缘“狗耳”畸形的改良缝合桥技术比传统缝合桥技术提供了更好的结构结果。该技术最终可能通过降低再撕裂率提供更好的功能结果。
