Park Yong Bok, Ryu Ho Young, Hong Jin Ho, Ko Young Hoo, Yoo Jae Chul
Department of Orthopaedic Surgery, Soonchunhyang University Hospital Bucheon, Soonchunhyang University School of Medicine, Bucheon, Korea.
Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Am J Sports Med. 2016 Apr;44(4):981-8. doi: 10.1177/0363546515625211. Epub 2016 Feb 10.
To date, there are few reports of the definite reversibility of rotator cuff muscle atrophy after repair.
To evaluate the reversibility of rotator cuff muscle atrophy after successful arthroscopic repair.
Case series; Level of evidence, 4.
Included in this study were 47 patients (mean age, 61.2 ± 7.3 years; range, 49-73 years) who underwent arthroscopic rotator cuff repair as well as magnetic resonance imaging (MRI) preoperatively and at 6-month and last follow-up. Patients who had confirmed rotator cuff healing (grades 1-3 according to the Sugaya classification) on both series of postoperative MRI were enrolled in the study. The mean time from the onset of symptoms to surgery was 24.7 ± 25.6 months (range, 3-120 months). The minimum follow-up was 2 years, and the mean follow-up duration was 41.8 ± 14.4 months. Serial changes in the supraspinatus muscle area on the most matching MRI scans (sagittal-oblique view) were evaluated. The area was measured by 2 independent observers.
Both independent observers reported no significant difference in the area of the supraspinatus muscle between the preoperative time point and 6-month follow-up (observer 1: P = .135; observer 2: P = .189). However, there was a significant difference between the 6-month and last follow-up (mean, 41.8 months; observers 1 and 2: P < .001). The serial changes in the area preoperatively and at 6-month and last follow-up were 419.41 ± 122.97 mm(2), 431.76 ± 104.27 mm(2), and 466.73 ± 121.42 mm(2), respectively (observer 1), and 421.01 ± 116.61 mm(2), 432.56 ± 100.78 mm(2), and 469.84 ± 113.80 mm(2), respectively (observer 2). The intraclass correlation coefficient between the 2 observers was 0.988. At final follow-up, the area increase on the medial and lateral aspects of the sagittal-oblique view compared with preoperatively was 13.9% (P < .001) and 11.3% (P < .001), respectively. Fatty infiltration did not change from preoperatively to 6-month follow-up (P > .999) or from 6-month to final follow-up (P = .077).
After successful arthroscopic rotator cuff repair, there was a slight (11.3%-13.9%) increase in muscle volume from preoperatively to final follow-up, as seen on serial MRI. Fatty infiltration according to the Goutallier grade was not reversed (P = .077). Some reversibility of supraspinatus muscle atrophy may exist in tendon-bone healing after arthroscopic rotator cuff repair; further follow-up is needed to better elucidate this result.
迄今为止，关于肩袖肌萎缩在修复后明确可逆的报道较少。
评估成功的关节镜修复术后肩袖肌萎缩的可逆性。
病例系列；证据等级，4级。
本研究纳入47例患者（平均年龄61.2±7.3岁；范围49 - 73岁），这些患者接受了关节镜下肩袖修复术，并在术前、术后6个月及末次随访时进行了磁共振成像（MRI）检查。纳入研究的患者在术后两组MRI上均证实肩袖愈合（根据Sugaya分类为1 - 3级）。从症状出现到手术的平均时间为24.7±25.6个月（范围3 - 120个月）。最小随访时间为2年，平均随访时长为41.8±14.4个月。对最匹配的MRI扫描（矢状斜位视图）上的冈上肌面积的系列变化进行评估。该面积由2名独立观察者测量。
两名独立观察者均报告术前时间点与术后6个月随访时冈上肌面积无显著差异（观察者1：P = 0.135；观察者2：P = 0.189）。然而，6个月随访与末次随访（平均41.8个月）之间存在显著差异（观察者1和2：P < 0.001）。术前、术后6个月及末次随访时面积的系列变化分别为419.41±122.97mm²、431.76±104.27mm²和4,66.73±121.42mm²（观察者1），以及421.01±116.61mm²、432.56±100.78mm²和4,69.84±113.80mm²（观察者2）。两名观察者之间的组内相关系数为0.988。在末次随访时，矢状斜位视图内侧和外侧的面积较术前分别增加了13.9%（P < 0.001）和11.3%（P < 0.001）。脂肪浸润从术前到术后6个月随访未改变（P > 0.999），从术后6个月到最终随访也未改变（P = 0.077）。
成功的关节镜下肩袖修复术后，如系列MRI所示，从术前到最终随访肌肉体积有轻微增加（11.3% - 13.9%）。根据Goutallier分级的脂肪浸润未逆转（P = 0.077）。关节镜下肩袖修复术后肌腱 - 骨愈合过程中可能存在冈上肌萎缩的一定可逆性；需要进一步随访以更好地阐明这一结果。
