Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
Department of Radiology, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
J Shoulder Elbow Surg. 2018 Mar;27(3):487-492. doi: 10.1016/j.jse.2017.09.005. Epub 2017 Nov 6.
Few studies have investigated the characteristic findings of preoperative magnetic resonance imaging (MRI) and the clinical and radiologic outcomes of interstitial tear of the rotator cuff treated with arthroscopic repair after tear completion.
Forty-one patients (14 men and 27 women; mean age, 56.5 years) with arthroscopically confirmed interstitial tears underwent single-row repair after tear completion. The minimum follow-up period was 2 years.
Twenty-eight patients (68.3%) were properly evaluated with MRI before surgery. Seven cases (17.1%) were misdiagnosed as bursal-sided tears and 5 cases (12.2%) were misdiagnosed as articular-sided tears on the basis of presurgical MRI findings. Arthroscopy revealed fibrillation and dimpling of the tendon surface in all cases and congestion within the defect in 36 cases (87.8%). At the final follow-up, the visual analog scale score for pain during motion decreased to 0.8 from a preoperative mean of 6.1 (P <.001). Moreover, at the final follow-up, the mean University of California-Los Angeles score and Constant score improved from 15.7 and 51.8 to 32.1 and 83.8, respectively (P <.001 for all). At 9 months after surgery, MRI revealed no cases of retear.
Interstitial tears are difficult to diagnose before surgery because MRI findings may lead to the misdiagnosis of interstitial tears as articular- or bursal-sided tears. If MRI-based diagnosis is indicative of articular- or bursal-sided tears but arthroscopy reveals fibrillation and dimpling of the tendon surface, interstitial tears should be suspected. The defective sites in interstitial tears are usually accompanied by congestion.
鲜有研究调查过术前磁共振成像（MRI）的特征表现，以及经撕裂完成后关节镜修复治疗肩袖间质性撕裂的临床和影像学结果。
41 例（14 名男性和 27 名女性；平均年龄 56.5 岁）患者经关节镜证实存在肩袖间质性撕裂，在撕裂完成后接受单排修复。最小随访时间为 2 年。
28 例（68.3%）患者术前有适当的 MRI 评估。7 例（17.1%）术前 MRI 结果误诊为肩峰下侧撕裂，5 例（12.2%）误诊为关节侧撕裂。关节镜检查发现所有病例的肌腱表面均有纤颤和凹陷，36 例（87.8%）病例中有缺损内充血。末次随访时，运动时疼痛的视觉模拟评分从术前的 6.1 均值降至 0.8（P<.001）。此外，末次随访时，加利福尼亚大学洛杉矶分校评分和Constant 评分分别从 15.7 和 51.8 提高到 32.1 和 83.8（均 P<.001）。术后 9 个月时，MRI 未见再撕裂。
术前 MRI 结果可能导致肩袖间质性撕裂误诊为关节或肩峰下侧撕裂，因此间质性撕裂难以诊断。如果基于 MRI 的诊断提示关节或肩峰下侧撕裂，但关节镜检查显示肌腱表面纤颤和凹陷，则应怀疑存在间质性撕裂。间质性撕裂的缺损部位通常伴有充血。
