American Sports Medicine Institute, Birmingham, Alabama, USA.
Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA.
Am J Sports Med. 2018 Apr;46(5):1084-1090. doi: 10.1177/0363546517752919. Epub 2018 Feb 13.
Rotator cuff tears are rare injuries in adolescents but cause significant morbidity if unrecognized. Previous literature on rotator cuff repairs in adolescents is limited to small case series, with few data to guide treatment.
Adolescent patients would have excellent functional outcome scores and return to the same level of sports participation after rotator cuff repair but would have some difficulty with returning to overhead sports.
Case series; Level of evidence 4.
A retrospective search of the practice's billing records identified all patients participating in at least 1 sport who underwent rotator cuff repair between 2006 and 2014 with an age <18 years at the time of surgery and a minimum follow-up of 2 years. Clinical records were evaluated for demographic information, and telephone follow-up was obtained regarding return to play, performance, other surgery and complications, a numeric pain rating scale (0-10) for current shoulder pain, American Shoulder and Elbow Surgeons (ASES) Shoulder Assessment Form, and the Western Ontario Rotator Cuff Index.
Thirty-two consecutive adolescent athletes (28 boys and 4 girls) with a mean age of 16.1 years (range, 13.2-17.9 years) met inclusion criteria. Twenty-nine patients (91%) had a traumatic event, and 27 of these patients (93%) had no symptoms before the trauma. The most common single tendon injury was to the supraspinatus (21 patients, 66%), of which 2 were complete tendon tears, 1 was a bony avulsion of the tendon, and 18 were high-grade partial tears. Fourteen patients (56%) underwent single-row repair of their rotator cuff tear, and 11 (44%) underwent double-row repair. All subscapularis injuries were repaired in open fashion, while all other tears were repaired arthroscopically. Twenty-seven patients (84%) completed the outcome questionnaires at a mean 6.2 years after surgery (range, 2-10 years). The mean ASES score was 93 (range, 65-100; SD = 9); mean Western Ontario Rotator Cuff Index, 89% (range, 60%-100%; SD = 13%); and mean numeric pain rating, 0.3 (range, 0-3; SD = 0.8). Overall, 25 patients (93%) returned to the same level of play or higher. Among overhead athletes, 13 (93%) were able to return to the same level of play, but 8 (57%) were forced to change positions. There were no surgical complications, but 2 patients did undergo a subsequent operation.
Surgical repair of high-grade partial-thickness and complete rotator cuff tears yielded successful outcomes among adolescents, with excellent functional outcomes at midterm follow-up. However, overhead athletes may have difficulty playing the same position after surgery.
肩袖撕裂在青少年中较为罕见，但如果未被识别，会导致显著的发病率。既往关于青少年肩袖修复的文献仅限于小样本病例系列，缺乏指导治疗的相关数据。
接受肩袖修复的青少年患者的功能评分结果优异，重返运动的水平与术前相同，但重返过顶运动时可能会遇到一些困难。
病例系列；证据等级 4。
对实践的计费记录进行回顾性搜索，以确定所有至少参加 1 项运动的患者，这些患者在 2006 年至 2014 年间接受了肩袖修复手术，手术时年龄<18 岁，随访时间至少 2 年。临床记录评估了人口统计学信息，并通过电话随访获得了重返运动、表现、其他手术和并发症、当前肩部疼痛的数字疼痛评分（0-10）、美国肩肘外科医生（ASES）肩部评估表和西部安大略肩袖指数。
32 名连续的青少年运动员（28 名男孩和 4 名女孩）符合纳入标准，平均年龄为 16.1 岁（范围，13.2-17.9 岁）。29 名患者（91%）有创伤事件，其中 27 名患者（93%）在创伤前无症状。最常见的单一肌腱损伤是冈上肌腱（21 例，66%），其中 2 例为完全肌腱撕裂，1 例为肌腱骨撕脱，18 例为高级部分撕裂。14 名患者（56%）接受了肩袖撕裂的单排修复，11 名患者（44%）接受了双排修复。所有肩胛下肌损伤均采用开放式修复，而所有其他撕裂均采用关节镜修复。27 名患者（84%）在术后平均 6.2 年（范围，2-10 年）完成了结果问卷。平均 ASES 评分为 93（范围，65-100；标准差=9）；平均西部安大略肩袖指数为 89%（范围，60%-100%；标准差=13%）；平均数字疼痛评分 0.3（范围，0-3；标准差=0.8）。总体而言，25 名患者（93%）恢复到相同或更高水平的运动。在过顶运动员中，13 名（93%）能够恢复到相同的运动水平，但 8 名（57%）被迫改变位置。没有手术并发症，但有 2 名患者随后接受了手术。
青少年高分级部分厚度和全层肩袖撕裂的手术修复可获得良好的中期随访结果，功能结果优异。然而，过顶运动员术后可能难以恢复相同的运动位置。
