Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea; Department of Orthopedic Surgery, the Second Hospital of Jilin University, ChangChun, China.
Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea; Department of Orthopedic Surgery, the Armed Forces Daejeon Hospital, Daejeon, South Korea.
Arthroscopy. 2018 Jan;34(1):50-57. doi: 10.1016/j.arthro.2017.07.035. Epub 2017 Nov 1.
To evaluate the functional and anatomical outcomes after arthroscopic transosseous suture (TOS) repair of 2 to 4 cm sized rotator cuff tears and to identify preoperative factors influencing repair failure.
From May 2013 to August 2014, patients with symptomatic 2 to 4 cm full-thickness tears underwent arthroscopic TOS repair, and those who could be followed up for a minimum of 2 years were included in this retrospective study. Functional and anatomical outcomes were analyzed up to 2 years postoperatively. Factors affecting cuff repair failure were evaluated, using both univariate and multivariate analyses.
Twenty-seven patients were included. On preoperative magnetic resonance imaging data, the mean anteroposterior dimension tear size was 27.0 ± 3.3 mm and mean retraction was 30.7 ± 3.1 mm. Anatomic failure (Sugaya III, IV, and V) rate was 33% with arthroscopic TOS repair; however, significant improvements were found regardless of cuff healing. Mean American Shoulder and Elbow Surgeons score (range, 0-100) improved from 48.8 ± 16.6 preoperatively to 80.1 ± 11.1 postoperatively (P < .001), mean Constant score (range, 0-100) improved from 54.5 ± 11.8 to 73.7 ± 8.5 (P < .001), and mean pain visual analog scale score (range, 0-10) improved from 3.9 ± 1.7 to 2.0 ± 1.1 (P < .001). These changes reached each minimal clinically important difference previously reported. Greater tear size in anteroposterior dimension (P = .034), decreased acromiohumeral distance (P = .022), and higher fatty infiltration of supraspinatus (P = .011) were independent preoperative factors associated with repair failure. Twelve patients (44%) experienced intraoperative bone laceration.
Arthroscopic TOS repair was a reliable technique for patients with 2 to 4 cm size rotator cuff tear. Preoperative factors associated with cuff repair failure were greater tear size in anteroposterior dimension, decreased acromiohumeral distance, and higher fatty infiltration of supraspinatus.
Level III, retrospective comparative study.
评估关节镜下经骨缝合（TOS）修复 2 至 4cm 大小肩袖撕裂的功能和解剖学结果，并确定影响修复失败的术前因素。
2013 年 5 月至 2014 年 8 月，对有症状的 2 至 4cm 全层撕裂的患者行关节镜 TOS 修复，对至少随访 2 年的患者进行回顾性研究。术后 2 年分析功能和解剖学结果。使用单变量和多变量分析评估影响肩袖修复失败的因素。
共纳入 27 例患者。术前磁共振成像数据显示，前-后向撕裂尺寸的平均直径为 27.0±3.3mm，回缩的平均直径为 30.7±3.1mm。关节镜 TOS 修复后的解剖学失败（Sugaya III、IV 和 V 级）率为 33%；然而，无论肩袖愈合情况如何，均发现显著改善。美国肩肘外科医生评分（范围：0-100）从术前的 48.8±16.6 分提高到术后的 80.1±11.1 分（P<0.001），Constant 评分（范围：0-100）从 54.5±11.8 分提高到 73.7±8.5 分（P<0.001），疼痛视觉模拟评分（范围：0-10）从 3.9±1.7 分降低到 2.0±1.1 分（P<0.001）。这些变化均达到了先前报道的最小临床重要差异。前-后向撕裂尺寸较大（P=0.034）、肩峰-肱骨头间距减小（P=0.022）和冈上肌脂肪浸润程度较高（P=0.011）是与修复失败相关的独立术前因素。12 例患者（44%）术中发生骨裂。
关节镜 TOS 修复术是治疗 2 至 4cm 大小肩袖撕裂的可靠技术。与肩袖修复失败相关的术前因素包括前-后向撕裂尺寸较大、肩峰-肱骨头间距减小和冈上肌脂肪浸润程度较高。
III 级，回顾性比较研究。
