Kim Sung-Jae, Choi Yun-Rak, Jung Min, Lee Wonyong, Chun Yong-Min
Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Am J Sports Med. 2017 Jul;45(8):1762-1768. doi: 10.1177/0363546517694028. Epub 2017 Feb 1.
The purpose of this study was to investigate clinical outcomes and structural integrity after arthroscopic repair of anterosuperior massive rotator cuff tears (RCTs) and to compare clinical outcomes between healed and retear groups.
The authors hypothesized that although both groups would exhibit improved clinical outcomes compared with their preoperative status, the healed group would have better clinical outcomes than the retear group, and in the retear group, the subscapularis retear subgroup would have inferior outcomes compared with the intact subscapularis repair subgroup.
Case-control study; Level of evidence, 3.
This study included 73 of 90 eligible patients who underwent arthroscopic repair of an anterosuperior massive RCT. Functional outcomes after 2-year follow-up were assessed using the visual analog scale (VAS) pain score, subjective shoulder value (SSV), American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) shoulder score, and active range of motion. Patients were assigned to the healed group (group H, n = 34) or retear group (group R, n = 39) based on magnetic resonance arthrography results at 6 months postoperatively. Group R was composed of subgroup R1 (subscapularis retear) and subgroup R2 (intact subscapularis repair).
Retearing occurred in 53% of patients. At 2-year follow-up, group H exhibited better outcomes for all functional scores versus group R, respectively ( P < .001): VAS pain score (1.0 vs 2.1), SSV (90.2 vs 77.4), ASES score (90.8 vs 76.6), and UCLA shoulder score (31.0 vs 24.9). Within both groups, all scores improved significantly compared with preoperative values ( P < .001). At follow-up, group H had significantly better forward flexion ( P = .018) and internal rotation ( P = .002) than group R; within both groups, active range of motion improved in all planes compared with the preoperative condition ( P < .001). Subgroup R1 exhibited inferior outcomes versus subgroup R2, respectively: VAS pain score (2.6 vs 1.5; P = .012), ASES score (70.9 vs 83.6; P = .013), SSV (70.9 vs 85.4; P = .005), and UCLA shoulder score (22.0 vs 28.5; P = .001).
After arthroscopic repair of anterosuperior massive RCTs, 53% of patients exhibited retearing. The healed group had better functional outcomes than the retear group. The subscapularis retear subgroup exhibited significantly inferior outcomes compared with the intact subscapularis repair subgroup.
本研究旨在探讨关节镜下修复巨大肩袖前上撕裂（RCTs）后的临床疗效和结构完整性，并比较愈合组和再撕裂组的临床疗效。
作者假设，尽管两组与术前状态相比临床疗效均有所改善，但愈合组的临床疗效优于再撕裂组，且在再撕裂组中，肩胛下肌再撕裂亚组的疗效低于肩胛下肌完整修复亚组。
病例对照研究；证据等级，3级。
本研究纳入了90例符合条件的患者中的73例，这些患者接受了关节镜下巨大肩袖前上撕裂修复术。采用视觉模拟量表（VAS）疼痛评分、主观肩关节评分（SSV）、美国肩肘外科医师学会（ASES）评分、加州大学洛杉矶分校（UCLA）肩关节评分和主动活动范围，对2年随访后的功能结局进行评估。根据术后6个月的磁共振关节造影结果，将患者分为愈合组（H组，n = 34）或再撕裂组（R组，n = 39）。R组由亚组R1（肩胛下肌再撕裂）和亚组R2（肩胛下肌完整修复）组成。
53%的患者发生再撕裂。在2年随访时，H组在所有功能评分方面均分别显示出比R组更好的结局（P <.001）：VAS疼痛评分（1.0对2.1）、SSV（90.2对77.4）、ASES评分（90.8对76.6）和UCLA肩关节评分（31.0对24.9）。两组内，与术前值相比，所有评分均显著改善（P <.00！）。随访时，H组的前屈（P = 0.018）和内旋（P = 0.002）明显优于R组；两组内，与术前情况相比，所有平面的主动活动范围均有所改善（P <.001）。亚组R1的结局分别低于亚组R2：VAS疼痛评分（2.6对1.5；P = 0.012）、ASES评分（70.9对83.6；P = 0.013）、SSV（70.9对85.4；P = 0.005）和UCLA肩关节评分（22.0对28.5；P = 0.001）。
关节镜下修复巨大肩袖前上撕裂后，53%的患者出现再撕裂。愈合组的功能结局优于再撕裂组。肩胛下肌再撕裂亚组的结局明显低于肩胛下肌完整修复亚组。
