Busan Bumin Hospital, Busan, Republic of Korea.
Investigation performed at Busan Bumin Hospital, Busan, Republic of Korea.
Am J Sports Med. 2018 Jul;46(8):1909-1918. doi: 10.1177/0363546518768813. Epub 2018 May 14.
Few studies have reported on the radiological characteristics and repair integrity of coexistent rotator cuff tears (RCTs) and shoulder stiffness after simultaneous arthroscopic rotator cuff repair and capsular release.
To evaluate the radiological characteristics and repair integrity of 1-stage arthroscopic surgery of RCTs concomitant with shoulder stiffness.
Cohort study; Level of evidence, 3.
Among patients who underwent arthroscopic repair of full-thickness RCTs, the stiff group underwent simultaneous capsular release for shoulder stiffness, and the nonstiff group had no stiffness. Symptom duration, prevalence of diabetes, tear size, tendon involvement (type 1, supraspinatus; type 2, supraspinatus and subscapularis; and type 3, supraspinatus and infraspinatus; type 4, supraspinatus, subscapularis, and infraspinatus), and fatty infiltration (Goutallier stages 0-4) were evaluated. A retear was appraised using magnetic resonance imaging, and clinical outcomes were assessed using range of motion, the Korean Shoulder Scoring System (KSS), and the University of California, Los Angeles (UCLA) shoulder score.
The stiff group showed a significantly lower retear rate (1/39, 2.6%) than the nonstiff group (47/320, 14.7%) ( P = .043). There were significant differences in symptom duration (7.4 ± 6.6 vs 15.0 ± 23.7 months, respectively; P < .001), mediolateral tear size (18.9 ± 8.9 vs 24.1 ± 12.0 mm, respectively; P = .002), tendon involvement (94.9%, 5.1%, 0.0%, and 0.0% vs 85.3%, 6.9%, 7.8%, and 0.0%, respectively; P = .048), and fatty infiltration of the subscapularis (66.7%, 33.3%, 0.0%, 0.0%, and 0.0% vs 31.9%, 61.3%, 5.6%, 1.3%, and 0.0%, respectively; P < .001) and teres minor (74.4%, 20.5%, 5.1%, 0.0%, and 0.0% vs 47.2%, 48.8%, 3.8%, 0.0%, and 0.3%, respectively; P = .007) between the stiff and nonstiff groups. Preoperatively, the stiff group showed significantly worse forward flexion (95.9° ± 23.6° vs 147.7° ± 4.2°, respectively; P < .001), external rotation (17.4° ± 10.1° vs 51.6° ± 12.1°, respectively; P < .001), and internal rotation (L5 vs L2, respectively; P < .001) and lower KSS (52.1 ± 13.8 vs 66.3 ± 13.5, respectively; P < .001) and UCLA scores (18.7 ± 4.8 vs 22.5 ± 4.5, respectively; P < .001) than the nonstiff group. However, these differences became insignificant from 3 months postoperatively for forward flexion ( P > .05) and KSS ( P > .05) and UCLA scores ( P > .05), from 1 year postoperatively for external rotation ( P > .05), and at the last follow-up for internal rotation ( P > .05). A multiple logistic regression analysis revealed that only mediolateral tear size (odds ratio, 1.043; P = .014) and type 2 tendon involvement (odds ratio, 4.493; P = .003) were independent predictors of a retear.
RCTs concomitant with shoulder stiffness showed a smaller mediolateral tear size, anterosuperior tendon involvement, and less severe fatty infiltration preoperatively and better repair integrity postoperatively than RCTs without stiffness. Furthermore, the clinical outcomes and range of motion at final follow-up were similar between the 2 groups.
鲜有研究报道肩袖撕裂（RCT）和肩关节僵硬并存时关节镜下修复后两者的放射学特征和修复完整性。
评估同时行关节镜下肩袖修复术和囊松解术治疗 RCT 合并肩关节僵硬的放射学特征和修复完整性。
队列研究；证据等级 3 级。
对接受全层 RCT 关节镜修复的患者进行分析，其中僵硬组因肩关节僵硬而行同时行囊松解术，非僵硬组无肩关节僵硬。评估症状持续时间、糖尿病患病率、撕裂大小、肌腱受累（1 型，冈上肌；2 型，冈上肌和肩胛下肌；3 型，冈上肌和冈下肌；4 型，冈上肌、肩胛下肌和冈下肌）和脂肪浸润（Goutallier 分期 0-4）。采用磁共振成像评估再撕裂情况，采用活动范围、韩国肩部评分系统（KSS）和加利福尼亚大学洛杉矶分校（UCLA）肩部评分评估临床结果。
僵硬组的再撕裂率（2.6%，1/39）明显低于非僵硬组（14.7%，47/320）（P =.043）。僵硬组的症状持续时间（7.4±6.6 比 15.0±23.7 个月，P<.001）、肩袖外侧撕裂大小（18.9±8.9 比 24.1±12.0 mm，P =.002）、肌腱受累（94.9%、5.1%、0.0%和 0.0%比 85.3%、6.9%、7.8%和 0.0%，P =.048）以及肩胛下肌（66.7%、33.3%、0.0%、0.0%比 0.0%、31.9%、61.3%、5.6%、1.3%，P<.001）和小圆肌（74.4%、20.5%、5.1%、0.0%和 0.0%比 47.2%、48.8%、3.8%、0.0%和 0.3%，P =.007）的脂肪浸润率均明显低于非僵硬组。术前，僵硬组的前屈活动度（95.9°±23.6°比 147.7°±4.2°，P<.001）、外旋活动度（17.4°±10.1°比 51.6°±12.1°，P<.001）和内旋活动度（L5 比 L2，P<.001）以及 KSS（52.1±13.8 比 66.3±13.5，P<.001）和 UCLA 评分（18.7±4.8 比 22.5±4.5，P<.001）均明显低于非僵硬组。然而，从术后 3 个月开始，前屈活动度（P>.05）和 KSS（P>.05）和 UCLA 评分（P>.05），从术后 1 年开始，外旋活动度（P>.05），直至末次随访时，内旋活动度（P>.05）的差异均无统计学意义。多因素逻辑回归分析显示，仅肩袖外侧撕裂大小（比值比，1.043；P=.014）和 2 型肌腱受累（比值比，4.493；P=.003）是再撕裂的独立预测因素。
RCT 合并肩关节僵硬在术前表现为较小的肩袖外侧撕裂大小、前上肌腱受累和较轻的脂肪浸润，术后具有更好的修复完整性。此外，两组患者的最终随访临床结果和活动范围相似。
