Millett Peter J, Espinoza Chris, Horan Marilee P, Ho Charles P, Warth Ryan J, Dornan Grant J, Katthagen J Christoph
Steadman Philippon Research Institute, Center for Outcomes-Based Orthopaedic Research (COOR), 181 West Meadow Drive, Suite 1000, Vail, CO, 81657, USA.
The Steadman Clinic, 181 West Meadow Drive, Suite 400, Vail, CO, 81657, USA.
Arch Orthop Trauma Surg. 2017 Oct;137(10):1399-1408. doi: 10.1007/s00402-017-2750-7. Epub 2017 Jul 26.
To evaluate the outcomes of two commonly used transosseous-equivalent (TOE) arthroscopic rotator cuff repair (RCR) techniques for full-thickness supraspinatus tendon tears (FTST) using a robust multi-predictor model.
155 shoulders in 151 patients (109 men, 42 women; mean age 59 ± 10 years) who underwent arthroscopic RCR of FTST, using either a knotted suture bridging (KSB) or a knotless tape bridging (KTB) TOE technique were included. ASES and SF-12 PCS scores assessed at a minimum of 2 years postoperatively were modeled using propensity score weighting in a multiple linear regression model. Patients able to return to the study center underwent a follow-up MRI for evaluation of rotator cuff integrity.
The outcome data were available for 137 shoulders (88%; n = 35/41 KSB; n = 102/114 KTB). Seven patients (5.1%) that underwent revision rotator cuff surgery were considered failures. The median postoperative ASES score of the remaining 130 shoulders was 98 at a mean follow-up of 2.9 years (range 2.0-5.4 years). A higher preoperative baseline outcome score and a longer follow-up had a positive effect, whereas a previous RCR and workers' compensation claims (WCC) had a negative effect on final ASES or SF 12 PCS scores. The repair technique, age, gender and the number of anchors used for the RCR had no significant influence. Fifty-two patients returned for a follow-up MRI at a mean of 4.4 years postoperatively. Patients with a KSB RCR were significantly more likely to have an MRI-diagnosed full-thickness rotator cuff re-tear (p < 0.05).
Excellent outcomes can be achieved at a minimum of 2 years following arthroscopic KSB or KTB TOE RCR of FTST. The preoperative baseline outcome score, a prior RCR, WCC and the length of follow-up significantly influenced the outcome scores. The repair technique did not affect the final functional outcomes, but patients with KTB TOE RCR were less likely to have a full-thickness rotator cuff re-tear.
Level III, Retrospective Comparative Study.
使用强大的多预测模型评估两种常用的经骨等效（TOE）关节镜下肩袖修复（RCR）技术治疗全层冈上肌腱撕裂（FTST）的效果。
纳入151例患者的155个肩部（男109例，女42例；平均年龄59±10岁），这些患者接受了FTST的关节镜下RCR，采用打结缝线桥接（KSB）或无结带桥接（KTB）TOE技术。在术后至少2年评估的ASES和SF-12 PCS评分，在多元线性回归模型中使用倾向评分加权进行建模。能够返回研究中心的患者接受了随访MRI，以评估肩袖完整性。
137个肩部（88%；KSB组35/41例，KTB组102/114例）有结局数据。7例（5.1%）接受翻修肩袖手术的患者被视为治疗失败。其余130个肩部术后ASES评分中位数为98分，平均随访2.9年（范围2.0 - 5.4年）。术前基线结局评分较高和随访时间较长有积极影响，而既往RCR和工伤赔偿申请（WCC）对最终ASES或SF 12 PCS评分有负面影响。修复技术、年龄、性别和RCR使用的锚钉数量无显著影响。52例患者在术后平均4.4年返回接受随访MRI。KSB RCR患者MRI诊断为全层肩袖再次撕裂的可能性显著更高（p < 0.05）。
FTST的关节镜下KSB或KTB TOE RCR术后至少2年可取得优异效果。术前基线结局评分、既往RCR、WCC和随访时间显著影响结局评分。修复技术不影响最终功能结局，但KTB TOE RCR患者全层肩袖再次撕裂的可能性较小。
III级，回顾性比较研究。
