Gasbarro Gregory, Ye Jason, Newsome Hillary, Jiang Kevin, Wright Vonda, Vyas Dharmesh, Irrgang James J, Musahl Volker
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A..
Arthroscopy. 2016 Oct;32(10):1947-1952. doi: 10.1016/j.arthro.2016.01.067. Epub 2016 Apr 27.
To evaluate whether morphologic characteristics of rotator cuff tear have prognostic value in determining symptomatic structural failure of arthroscopic rotator cuff repair independent of age or gender.
Arthroscopic rotator cuff repair cases performed by five fellowship-trained surgeons at our institution from 2006 to 2013 were retrospectively reviewed. Data extraction included demographics, comorbidities, repair technique, clinical examination, and radiographic findings. Failure in symptomatic patients was defined as structural defect on postoperative magnetic resonance imaging or pseudoparalysis on examination. Failures were age and gender matched with successful repairs in a 1:2 ratio.
A total of 30 failures and 60 controls were identified. Supraspinatus atrophy (P = .03) and tear size (18.3 mm failures v 13.9 mm controls; P = .02) were significant risk factors for failure, as was the presence of an infraspinatus tear greater than 10 mm (62% v 17%, P < .01). Single-row repair (P = .06) and simple suture configuration (P = .17) were more common but similar between groups. Diabetes mellitus and active tobacco use were not significantly associated with increased failure risk but psychiatric medication use was more frequent in the failure group.
This study confirms previous suspicions that tear size and fatty infiltration are associated with failure of arthroscopic rotator cuff repair but independent of age or gender in symptomatic patients. There is also a quantitative cutoff on magnetic resonance imaging for the size of infraspinatus involvement that can be used clinically as a predicting factor. Although reported in the literature, smoking and diabetes were not associated with failure.
Level III, retrospective case control.
评估肩袖撕裂的形态学特征在确定关节镜下肩袖修复的症状性结构失败方面是否具有预后价值，且不受年龄或性别的影响。
回顾性分析了2006年至2013年在本机构由五位接受过 fellowship 培训的外科医生进行的关节镜下肩袖修复病例。数据提取包括人口统计学、合并症、修复技术、临床检查和影像学检查结果。有症状患者的失败定义为术后磁共振成像显示的结构缺陷或检查时的假性麻痹。失败病例与成功修复病例按1:2的比例进行年龄和性别匹配。
共确定了30例失败病例和60例对照。冈上肌萎缩（P = 0.03）和撕裂大小（失败组为18.3 mm，对照组为13.9 mm；P = 0.02）是失败的重要危险因素，大于10 mm的冈下肌撕裂的存在也是如此（62%对17%，P < 0.01）。单排修复（P = 0.06）和简单缝合构型（P = 0.17）更常见，但两组之间相似。糖尿病和当前吸烟与失败风险增加无显著关联，但失败组使用精神科药物更为频繁。
本研究证实了先前的怀疑，即撕裂大小和脂肪浸润与关节镜下肩袖修复失败相关，但在有症状患者中不受年龄或性别的影响。磁共振成像上也有一个关于冈下肌受累大小的定量临界值，可在临床上用作预测因素。虽然文献中有报道，但吸烟和糖尿病与失败无关。
III级，回顾性病例对照研究。
