Tonotsuka Hisahiro, Sugaya Hiroyuki, Takahashi Norimasa, Kawai Nobuaki, Sugiyama Hajime, Marumo Keishi
1 Funabashi Orthopaedic Sports Medicine Center, Funabashi, Chiba, Japan.
3 Department of Orthopaedic Surgery, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
J Orthop Surg (Hong Kong). 2017 Sep-Dec;25(3):2309499017730423. doi: 10.1177/2309499017730423.
The postoperative protocol after arthroscopic rotator cuff repair (ARCR) is still controversial. Some surgeons recommend slower rehabilitation in order to improve the integrity of the repair, while others prefer early range-of-motion (ROM) exercise to avoid postoperative stiffness. The purpose of this study was to determine target ROM (T-ROM) measurements at 3 months after ARCR that are predictive of eventual full recovery without structural failure.
The cases consisted of 374 shoulders in 360 patients who underwent primary ARCR and were followed up for at least 2 years. Forward flexion (FF) and side-lying external rotation (ER) were measured preoperatively at 3, 6, 9, 12, and 24 months after surgery, and the patients were divided into six subgroups according to the values for each type of ROM at 3 months (ROM-3M). In each subgroup, the final ROM at 24 months after surgery was compared to determine the T-ROM. The average ROMs with time and re-tear rate were then compared between the under-T-ROM and over-T-ROM groups.
The only significant difference in FF was between the 120-129° and 110-119° ROM-3M groups. Therefore, the T-ROM for FF was determined to be 120°. Similarly, the T-ROM for ER was determined to be 20°. Each ROM in the over-T-ROM group was significantly better than that in the under-T-ROM group at all assessments. There was no significant difference in the re-tear rate between the groups.
To acquire sufficient ROM in 2 years without high re-tear rate, a target FF of 120° and ER of 20° should be achieved within 3 months after surgery.
关节镜下肩袖修复术（ARCR）后的术后康复方案仍存在争议。一些外科医生建议进行较慢的康复训练以提高修复的完整性，而另一些医生则倾向于早期进行活动度（ROM）锻炼以避免术后僵硬。本研究的目的是确定ARCR术后3个月时能够预测最终完全恢复且无结构破坏的目标活动度（T-ROM）测量值。
病例包括360例接受初次ARCR的患者的374个肩部，随访至少2年。术前、术后3、6、9、12和24个月测量前屈（FF）和侧卧外旋（ER），并根据术后3个月时每种ROM类型的值（ROM-3M）将患者分为六个亚组。比较每个亚组术后24个月时的最终ROM以确定T-ROM。然后比较T-ROM低于和高于组的平均ROM随时间的变化以及再撕裂率。
FF方面唯一显著的差异存在于ROM-3M为120-129°和110-119°的组之间。因此，FF的T-ROM被确定为120°。同样，ER的T-ROM被确定为20°。在所有评估中，T-ROM高于组的每种ROM均显著优于T-ROM低于组。两组之间的再撕裂率无显著差异。
为了在2年内获得足够的ROM且再撕裂率不高，应在术后3个月内达到120°的目标FF和20°的ER。
