Kim Sung-Jae, Choi Yun-Rak, Jung Min, Lee Won-Yong, Chun Yong-Min
Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Am J Sports Med. 2017 May;45(6):1269-1275. doi: 10.1177/0363546516688666. Epub 2017 Mar 20.
No previous study has examined whether isolated subscapularis tendon repair in irreparable posterosuperior massive rotator tears involving the subscapularis tendon in relatively young patients without arthritis can yield satisfactory outcomes.
We hypothesized that this procedure would produce favorable outcomes in patients who might otherwise be candidates for reverse arthroplasty.
Case series; Level of evidence, 4.
This retrospective study included 24 patients in their 50s and 60s, without shoulder arthritis, who underwent arthroscopic isolated subscapularis repair for an irreparable massive rotator cuff tear involving the subscapularis tendon. Preoperative and postoperative visual analog scale (VAS) pain scores, subjective shoulder values (SSVs), University of California at Los Angeles (UCLA) shoulder scores, American Shoulder and Elbow Surgeons (ASES) scores, subscapularis strength (modified bell-press test; maximum of 5), and shoulder active range of motion (ROM) were assessed. Postoperative magnetic resonance arthrography (MRA) was performed 6 months postoperatively to assess structural integrity of the repaired subscapularis.
At a mean 34.8 months (range, 24-49 months) of follow-up, VAS pain scores (improved from 7.1 to 2.5), SSVs (33.3 to 75.2), ASES scores (35.9 to 76.0), UCLA shoulder scores (11.6 to 24.8), subscapularis strength, and ROM were significantly improved compared with preoperative measurements ( P < .001). Subscapularis muscle strength improved from 3.7 to 4.2 ( P < .001). For active ROM, forward flexion and internal rotation improved significantly ( P < .001); however, external rotation exhibited no significant improvement. Follow-up MRA was performed in 22 patients (92%) and showed retear of the repaired subscapularis in 6 (27% of the 22).
Isolated repair of the subscapularis tendon in irreparable massive rotator cuff tears involving the subscapularis tendon yielded satisfactory short-term outcomes and structural integrity in patients in their 50s and 60s without arthritis. If patients with irreparable massive rotator cuff tears involving the subscapularis tendon are relatively young or have minimal concomitant arthritis, this repair can be worthwhile.
既往尚无研究探讨在相对年轻且无关节炎的患者中，对于累及肩胛下肌腱的不可修复的巨大肩袖后上部分撕裂，单纯进行肩胛下肌腱修复能否取得满意疗效。
我们假设该手术对于那些原本可能适合行反式肩关节置换术的患者能产生良好疗效。
病例系列研究；证据等级为4级。
本回顾性研究纳入了24例年龄在50多岁和60多岁、无肩关节关节炎的患者，这些患者因累及肩胛下肌腱的不可修复的巨大肩袖撕裂而接受了关节镜下单纯肩胛下肌修复术。评估术前和术后的视觉模拟评分（VAS）疼痛评分、主观肩关节评分（SSV）、加利福尼亚大学洛杉矶分校（UCLA）肩关节评分、美国肩肘外科医师学会（ASES）评分、肩胛下肌力量（改良钟摆试验；最高5分）以及肩关节活动范围（ROM）。术后6个月进行磁共振关节造影（MRA）以评估修复后的肩胛下肌的结构完整性。
在平均34.8个月（范围24 - 49个月）的随访中，与术前测量值相比，VAS疼痛评分（从7.1改善至2.5）、SSV（从33.3至75.2）、ASES评分（从35.9至76.0）、UCLA肩关节评分（从11.
