Lee Merrill, Chen Jerry Yongqian, Liow Ming Han Lincoln, Chong Hwei Chi, Chang Paul, Lie Denny
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
Am J Sports Med. 2017 Nov;45(13):2989-2994. doi: 10.1177/0363546517717947. Epub 2017 Aug 14.
Recent studies have shown a correlation between scapular geometry and the development of atraumatic rotator cuff tears. However, a paucity of literature is available on the effects of critical shoulder angle (CSA) and acromial index (AI) on functional outcomes after arthroscopic rotator cuff repair. Hypothesis/Purpose: The purpose was to investigate the influence of CSA and AI on 24-month functional outcomes after arthroscopic rotator cuff repair. The hypothesis was that a larger CSA or AI would result in poorer postoperative outcomes.
Cohort study; Level of evidence, 3.
The study included 147 patients who underwent arthroscopic double-row rotator cuff repair for radiologically documented full-thickness supraspinatus tears. An independent reviewer measured the CSA and AI on preoperative radiographs. These patients were prospectively enrolled and were evaluated preoperatively as well as at 3, 6, 12, and 24 months postoperatively. Functional outcome was assessed with the Constant Shoulder Score (CSS), Oxford Shoulder Score (OSS), and University of California at Los Angeles (UCLA) Shoulder Rating Scale. The patients were first divided based on CSA: (1) ≤35° (control CSA) and (2) >35° (increased CSA); and then based on AI: (1) ≤0.7 and (2) >0.7. The Student unpaired t test, Pearson chi-square test, and Pearson correlation were performed to examine the influence of CSA and AI on postoperative functional outcome scores.
At 6 months of follow-up, the CSS, OSS, and UCLA Shoulder Rating Scale were 10 ± 1, 4 ± 2, and 3 ± 1 points poorer in the increased CSA group compared with the control CSA group ( P = .005, P = .030, and P = .035, respectively). These scores were not significantly different between both AI groups. By 24 months of follow-up, all outcome scores were comparable between both CSA groups as well as between both AI groups. No significant correlation was found between either CSA or AI when compared with CSS, OSS, or UCLA Shoulder Rating Scale at 24 months of follow-up.
CSA and AI do not appear to influence 24-month functional outcomes postoperatively and hence are not contraindications to arthroscopic rotator cuff repair.
近期研究表明肩胛形态与非创伤性肩袖撕裂的发生之间存在关联。然而，关于临界肩角（CSA）和肩峰指数（AI）对关节镜下肩袖修复术后功能结果影响的文献较少。假设/目的：本研究旨在探讨CSA和AI对关节镜下肩袖修复术后24个月功能结果的影响。假设为更大的CSA或AI会导致术后结果更差。
队列研究；证据等级为3级。
本研究纳入147例因影像学证实为全层冈上肌撕裂而接受关节镜下双排肩袖修复的患者。一名独立评估者在术前X线片上测量CSA和AI。这些患者被前瞻性纳入研究，并在术前以及术后3、6、12和24个月进行评估。使用Constant肩关节评分（CSS）、牛津肩关节评分（OSS）和加州大学洛杉矶分校（UCLA）肩关节评分量表评估功能结果。患者首先根据CSA进行分组：（1）≤35°（对照CSA）和（2）>35°（CSA增加）；然后根据AI进行分组：（1）≤0.7和（2）>0.7。采用独立样本t检验、Pearson卡方检验和Pearson相关性分析来检验CSA和AI对术后功能结果评分的影响。
在随访6个月时，CSA增加组的CSS、OSS和UCLA肩关节评分量表得分分别比对照CSA组低10±1、4±2和3±1分（P分别为0.005、0.030和0.035）。两组AI组之间这些得分无显著差异。到随访24个月时，两组CSA组之间以及两组AI组之间的所有结果评分均相当。在随访24个月时，与CSS、OSS或UCLA肩关节评分量表相比，CSA或AI均未发现显著相关性。
CSA和AI似乎不会影响术后24个月的功能结果，因此不是关节镜下肩袖修复的禁忌证。
