Barth Johannes, Fotiadis Elias, Barthelemy Renaud, Genna Sophie, Saffarini Mo
Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France.
Knee Surg Sports Traumatol Arthrosc. 2015 Feb;23(2):376-85. doi: 10.1007/s00167-015-3505-z. Epub 2015 Jan 20.
Despite proven accuracy of US for the evaluation of rotator cuff integrity, there is no US-based classification for this purpose. This study aimed to assess US for the evaluation of rotator cuff repair integrity in accordance with a well-established MRI classification.
The authors retrospectively reviewed 257 patients who underwent arthroscopic double-row suture anchor repair for rotator cuff tears. Post-operative function was rated using the Constant score, the UCLA rating and the SSV, whereas repair integrity was assessed using US as described in the MRI classification of Sugaya et al.
A total of 212 patients aged 55.6 ± 9.8 years had complete functional and radiographic assessments at a mean follow-up of 36.8 ± 11.6 months. Using all three ratings, repairs of Type I had highest scores, repairs of Type II had discernibly lower scores, whereas repairs of Types III, IV and V had similar intermediate scores.
Comparison of the UCLA scores with those of Sugaya et al. revealed similar scores for repairs of Type I and of Type V. The scores are less comparable for repairs of Types II, III and IV, because US does not allow identification of partial tears if shielded by bony structures and because partial tears correspond to minimal impairment. The study reveals that US is an adequate imaging modality to classify rotator cuff repair integrity, which could reduce economic and practical burdens of CTA, MRI or MRA. The results also confirm that post-operative repair integrity and functional outcome depend on pre-operative tear size and fatty infiltration, which provides clinicians with reasoning for early surgical repair and warning of the risks of strenuous activity for patients with larger tears.
Prognostic study, Level IV.
尽管超声在评估肩袖完整性方面已被证明具有准确性，但尚无基于超声的此类评估分类方法。本研究旨在根据一种成熟的MRI分类方法，评估超声在评估肩袖修复完整性方面的作用。
作者回顾性分析了257例行关节镜下双排缝线锚钉修复肩袖撕裂的患者。术后功能采用Constant评分、UCLA评分和SSV进行评定，而修复完整性则按照Sugaya等人的MRI分类中所述的方法用超声进行评估。
共有212例年龄为55.6±9.8岁的患者在平均随访36.8±11.6个月时进行了完整的功能和影像学评估。使用所有三种评分方法，I型修复的得分最高，II型修复的得分明显较低，而III型、IV型和V型修复的得分相近，处于中等水平。
将UCLA评分与Sugaya等人的评分进行比较发现，I型和V型修复的得分相似。II型、III型和IV型修复的得分可比性较差，这是因为如果部分撕裂被骨质结构遮挡，超声无法识别，而且部分撕裂对应的功能损害最小。该研究表明，超声是一种用于对肩袖修复完整性进行分类的合适成像方式，这可以减轻CTA、MRI或MRA的经济和实际负担。结果还证实，术后修复完整性和功能结果取决于术前撕裂大小和脂肪浸润情况，这为临床医生提供了早期手术修复的依据，并为大撕裂患者剧烈活动的风险提供了警示。
预后研究，IV级。
