Lee Sung Hyun, Nam Dae Jin, Kim Se Jin, Kim Jeong Woo
Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Republic of Korea.
Am J Sports Med. 2017 Sep;45(11):2555-2562. doi: 10.1177/0363546517721187. Epub 2017 Aug 8.
The subscapularis tendon is essential in maintaining normal glenohumeral biomechanics. However, few studies have addressed the outcomes of tears extending to the subscapularis tendon in massive rotator cuff tears.
To assess the clinical and structural outcomes of arthroscopic repair of massive rotator cuff tears involving the subscapularis.
Cohort study; Level of evidence, 3.
Between January 2010 and January 2014, 122 consecutive patients with massive rotator cuff tear underwent arthroscopic rotator cuff repair. Overall, 122 patients were enrolled (mean age, 66 years; mean follow-up period, 39.5 months). Patients were categorized into 3 groups based on subscapularis tendon status: intact subscapularis tendon (I group; n = 45), tear involving less than the superior one-third (P group; n = 35), and tear involving more than one-third of the subscapularis tendon (C group; n = 42). All rotator cuff tears were repaired; however, subscapularis tendon tears involving less than the superior one-third in P group were only debrided. Pain visual analog scale, Constant, and American Shoulder and Elbow Surgeons scores and passive range of motion were measured preoperatively and at the final follow-up. Rotator cuff integrity, global fatty degeneration index, and occupation ratio were determined via magnetic resonance imaging preoperatively and 6 months postoperatively.
We identified 37 retears (31.1%) based on postoperative magnetic resonance imaging evaluation. Retear rate in patients in the C group (47.6%) was higher than that in the I group (22.9%) or P group (20.0%) ( P = .011). Retear subclassification based on the involved tendons showed that subsequent subscapularis tendon retears were noted in only the C group. The improvement in clinical scores after repair was statistically significant in all groups but not different among the groups. Between-group comparison showed significant differences in preoperative external rotation ( P = .021). However, no statistically significant difference was found in any shoulder range of motion measurements after surgery.
Arthroscopic repair of massive tears results in substantial improvements in shoulder function, despite the presence of combined subscapularis tears. However, this study showed a high failure rate of massive posterosuperior rotator cuff tear repair extending more than one-third of the subscapularis tendon. When combined subscapularis tendon tear was less than the superior one-third of the subscapularis tendon, arthroscopic debridement was a reasonable treatment method where comparable clinical and anatomic outcomes could be expected.
肩胛下肌腱对于维持正常的盂肱关节生物力学至关重要。然而，很少有研究探讨巨大肩袖撕裂累及肩胛下肌腱时的治疗结果。
评估关节镜下修复累及肩胛下肌的巨大肩袖撕裂的临床和结构结果。
队列研究；证据等级，3级。
2010年1月至2014年1月，122例连续的巨大肩袖撕裂患者接受了关节镜下肩袖修复术。总体而言，共纳入122例患者（平均年龄66岁；平均随访期39.5个月）。根据肩胛下肌腱状态将患者分为3组：肩胛下肌腱完整组（I组；n = 45）、撕裂累及不到上三分之一组（P组；n = 35）和撕裂累及超过肩胛下肌腱三分之一组（C组；n = 42）。所有肩袖撕裂均进行了修复；然而，P组中撕裂累及不到上三分之一的肩胛下肌腱仅进行了清创。术前及末次随访时测量疼痛视觉模拟评分、Constant评分、美国肩肘外科医师协会评分以及被动活动范围。术前及术后6个月通过磁共振成像确定肩袖完整性、整体脂肪变性指数和占有率。
根据术后磁共振成像评估，我们发现37例再撕裂（31.1%）。C组患者的再撕裂率（47.6%）高于I组（22.9%）或P组（20.0%）（P = 0.011）。根据受累肌腱进行的再撕裂亚分类显示，仅在C组中观察到随后的肩胛下肌腱再撕裂。修复后临床评分的改善在所有组中均具有统计学意义，但组间无差异。组间比较显示术前外旋存在显著差异（P = 0.021）。然而，术后任何肩部活动范围测量均未发现统计学显著差异。
尽管存在合并的肩胛下肌撕裂，关节镜下修复巨大撕裂仍能使肩部功能得到显著改善。然而，本研究显示，巨大后上肩袖撕裂修复累及超过肩胛下肌腱三分之一时失败率较高。当合并的肩胛下肌腱撕裂小于肩胛下肌腱上三分之一时，关节镜下清创是一种合理的治疗方法，有望获得可比的临床和解剖学结果。
