ONS Foundation for Clinical Research and Education, Greenwich, Connecticut, USA.
Musculoskeletal Institute, Department of Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA.
Am J Sports Med. 2018 Mar;46(4):779-785. doi: 10.1177/0363546517746986. Epub 2018 Jan 12.
Numerous studies have identified factors that may affect the chances of rotator cuff healing after surgery. Intraoperative tendon quality may be used to predict healing and to determine type of repair and/or consideration of augmentation. There are no data that correlate how gross tendon morphology and degree of tendinopathy affect patient outcome or postoperative tendon healing. Purpose/Hypothesis: The purposes of this study were to (1) compare the gross appearance of the tendon edge during arthroscopic rotator cuff repair with its histological degree of tendinopathy and (2) determine if gross appearance correlated with postoperative repair integrity. The hypothesis was that gross (macroscopic) tendon with normal thickness, no delamination, and elastic tissue before repair would have a correlation with low Bonar scores, higher postoperative American Shoulder and Elbow Surgeons (ASES) scores, and increased rates of postoperative tendon healing on ultrasound.
Cross-sectional study; Level of evidence, 3.
A total of 105 patients undergoing repair of medium-size (1-3 cm) full-thickness rotator cuff tears were enrolled in the study. Intraoperatively, the supraspinatus tendon was rated on thickness, fraying, and stiffness. Tendon tissue was recovered for histological analysis based on the Bonar scoring system. Postoperative ASES and ultrasound assessment of healing were obtained 1 year after repair. Correlation between gross appearance of the tendon and rotator cuff histology was determined.
Of the 105 patients, 85 were followed the study to completion. The mean age of the patients was 61.6 years; Bonar score, 7.5; preoperative ASES score, 49; and postoperative ASES score, 86. Ninety-one percent of repairs were intact on ultrasound. Gross appearance of torn rotator cuff tendon tissue did not correlate with histological appearance. Neither histological (Bonar) score nor gross appearance correlated with multivariate analysis of ASES score, postoperative repair status, or demographic data.
The degree of tendinopathy did not correlate with morphological appearance of the tendon. Neither of these parameters correlated with healing or patient outcome. This study suggests that the degree of tendinopathy, unlike muscle atrophy, may not be predictive of outcomes and that, on appearance, poor quality tendon has adequate healing capacity. Therefore, abnormal gross tendon appearance should not affect the repair effort or technique.
许多研究已经确定了可能影响手术后肩袖愈合机会的因素。术中肌腱质量可用于预测愈合，并确定修复类型和/或增强的考虑因素。目前尚无数据表明肌腱的大体形态和程度的腱病如何影响患者的预后或术后肌腱愈合。目的/假设：本研究的目的是：(1)比较关节镜下肩袖修复术中肌腱边缘的大体外观与其组织学程度的腱病；(2)确定大体外观是否与术后修复完整性相关。假设是，在修复前具有正常厚度、无分层和弹性组织的大体（宏观）肌腱与较低的 Bonar 评分、较高的术后美国肩肘外科医生 (ASES) 评分以及增加的术后肌腱超声愈合率相关。
横断面研究；证据水平，3 级。
共有 105 名接受中等大小（1-3 厘米）全层肩袖撕裂修复的患者参与了本研究。术中对冈上肌腱进行厚度、磨损和僵硬评分。根据 Bonar 评分系统回收肌腱组织进行组织学分析。术后 1 年获得 ASES 和超声评估愈合情况。确定肌腱大体外观与肩袖组织学之间的相关性。
在 105 名患者中，有 85 名完成了研究。患者的平均年龄为 61.6 岁；Bonar 评分为 7.5；术前 ASES 评分为 49；术后 ASES 评分为 86。91%的修复在超声上是完整的。撕裂的肩袖肌腱组织的大体外观与组织学外观不相关。组织学（Bonar）评分和大体外观均与 ASES 评分、术后修复状态或人口统计学数据的多变量分析不相关。
腱病的程度与肌腱的形态外观无关。这些参数均与愈合或患者预后无关。本研究表明，与肌肉萎缩不同，腱病的程度可能无法预测结果，而且外观较差的质量肌腱具有足够的愈合能力。因此，异常的大体肌腱外观不应影响修复的努力或技术。
