Orthopaedic Research Institute, St George Hospital Campus, University of New South Wales, Sydney, Australia.
Orthop J Sports Med. 2015 Oct 1;3(10):2325967115605801. doi: 10.1177/2325967115605801. eCollection 2015 Oct.
Arthroscopic rotator cuff repair has traditionally been performed in the subacromial space from the bursal side of the tendon. The undersurface rotator cuff repair technique involves the arthroscope remaining in the glenohumeral joint, thus viewing the tendon from its undersurface during repair without a bursectomy or acromioplasty.
To compare the clinical and structural outcomes of undersurface rotator cuff repair with bursal-side repair.
Cohort study; Level of evidence, 3.
A retrospective analysis of prospectively collected data was conducted on 2 cohorts of patients who had undergone arthroscopic rotator cuff repair with knotless suture anchors configured in a single-row formation using inverted mattress-style sutures from either the bursal side (n = 100) or undersurface (n = 165) of the supraspinatus tendon. Data were collected preoperatively, intraoperatively, and at 1 week, 6 weeks, 3 months, 6 months, and 2 years postoperatively. At each time point, patients completed a modified L'Insalata questionnaire to assess patient-ranked pain scores and were clinically examined using standardized tests. Ultrasound examination was performed at 6 months and 2 years to assess the integrity of the repair.
At 2 years postoperatively, patients in both cohorts had significantly less pain and less difficulty with overhead activities compared with preoperative levels (P < .001). The type of repair performed (bursal or undersurface) did not affect the ability to perform overhead activities at 2 years. At 2 years, both groups also had similar retear rates (21% for bursal side, 23% for undersurface). The mean operative time for the arthroscopic rotator cuff repair was 32 minutes when performed from the bursal side and 20 minutes when performed from the undersurface (P < .001).
Arthroscopic rotator cuff repair, whether performed from the subacromial space or glenohumeral joint, resulted in decreased levels of pain and difficulty with overhead activities at 2 years. The major difference between the 2 techniques was operative time, with the undersurface technique being performed significantly faster than the bursal-side repair technique.
关节镜下肩袖修复术传统上是从肩峰下空间从肌腱的滑囊侧进行的。下表面肩袖修复技术包括关节镜保持在盂肱关节内，因此在修复过程中无需行肱二头肌长头腱切断术或肩峰成形术，即可从肌腱的下表面观察。
比较下表面肩袖修复与滑囊侧修复的临床和结构结果。
前瞻性收集数据的队列研究；证据水平，3 级。
对使用倒置褥式缝线以单排形式用无结缝线锚钉进行关节镜下肩袖修复的 2 个队列的前瞻性收集数据进行回顾性分析，其中一组从冈上肌腱的滑囊侧（n=100），另一组从下表面（n=165）进行修复。数据在术前、术中以及术后 1 周、6 周、3 个月、6 个月和 2 年采集。在每个时间点，患者使用改良的 L'Insalata 问卷评估患者自评疼痛评分，并使用标准化的检查进行临床检查。在术后 6 个月和 2 年进行超声检查以评估修复的完整性。
在术后 2 年，两组患者的疼痛和上肢活动困难均明显低于术前（P<0.001）。修复类型（滑囊侧或下表面）不影响术后 2 年的上肢活动能力。在 2 年时，两组的再撕裂率也相似（滑囊侧为 21%，下表面为 23%）。当从滑囊侧进行关节镜下肩袖修复时，手术时间平均为 32 分钟，而从下表面进行时为 20 分钟（P<0.001）。
无论是从肩峰下空间还是盂肱关节进行关节镜下肩袖修复，在术后 2 年均可降低疼痛水平和上肢活动困难。两种技术的主要区别是手术时间，下表面技术的手术时间明显快于滑囊侧修复技术。
