Carbone S, Razzano C, Passaretti D, Mezzoprete R
Orthopaedic and Traumatology Department, Ospedale San Camillo de Lellis, Via Giulio Pittarelli 114, 00166, Rieti, Rome, Italy.
Casa di Cura San Feliciano, Rome, Italy.
Musculoskelet Surg. 2018 Oct;102(Suppl 1):13-19. doi: 10.1007/s12306-018-0555-7. Epub 2018 Oct 20.
We retrospectively evaluated the results of complete repair of massive potentially irreparable postero-superior tears in a consecutive cohort of patients. With the increasing and widespread use of superior capsular reconstruction, a complete repair of the superior cuff, also if not functional, may be a valuable option for irreparable cuff lesions.
A consecutive case series of massive potentially irreparable postero-superior cuff tears that underwent complete repair was included in the study. Irreparability of cuff tear was defined when on preoperative MRI images, a positive tangent sign, a Goutallier 3-4 stage of fatty infiltration, and an absent acromion-humeral distance were present. A single-row complete repair was performed using triple-loaded titanium suture anchors. Operative time was recorded, as well as intra- and postoperative complications. Patients were followed for 12 months post-op; they were clinically evaluated with the use of constant score (CS) and subjective shoulder value (SSV) at 3, 6, and 12 months; a 12-month postoperative ultrasound evaluation was obtained.
Thirty-two patients satisfying the inclusion criteria were enrolled. The mean age was 52 years (range 41-58). The repair was completed with a mean use of 2.4 triple-loaded suture anchors (range 2-4); the mean operative time was 70 min (range 45-90). The mean preoperative CS was 55 (range 45-75, SD 17), while the SSV was 40 (range 30-70, SD 22). At the final follow-up, the mean CS and SSV were 72 (range 62-85, SD 8) and 80 (range 60-90, SD 10) (p < 0.001 with respect to the preoperative scores), respectively. At the final follow-up, sonography showed a complete healing of the cuff in 20 cases (62.5%). No intra-operative complications occurred; at the final follow-up, five patients (15, 6%) were not satisfied of the results and asked for revision surgery.
The complete repair of massive potentially irreparable rotator cuff tear in patients younger than 60 years old yielded good results at a short-term follow-up, with a sonographic re-tear rate of about 20%. Even if it is logical to consider a tendon with severe fatty degeneration as non-functional, the superior soft tissue reconstruction we achieved may have at least the same results of a superior capsular reconstruction, with obvious lower costs.
Level 4, case series with no comparison group.
我们回顾性评估了一组连续患者中巨大的潜在不可修复的后上盂唇撕裂的完全修复结果。随着上盂唇重建技术的日益广泛应用，即使上盂唇修复后功能不佳，对不可修复的盂唇损伤进行完全修复也可能是一种有价值的选择。
本研究纳入了一组连续的巨大潜在不可修复的后上盂唇撕裂并接受完全修复的病例。当术前MRI图像显示有阳性切线征、脂肪浸润的Goutallier 3-4期以及肩峰-肱骨头距离消失时，定义为盂唇撕裂不可修复。使用三股钛缝线锚钉进行单排完全修复。记录手术时间以及术中及术后并发症。患者术后随访12个月；在3、6和12个月时使用Constant评分（CS）和主观肩关节评分（SSV）进行临床评估；术后12个月进行超声评估。
32例符合纳入标准的患者入组。平均年龄为52岁（范围41-58岁）。平均使用2.4个三股缝线锚钉完成修复（范围2-4个）；平均手术时间为70分钟（范围45-90分钟）。术前平均CS为55分（范围45-75分，标准差17），而SSV为40分（范围30-70分，标准差22）。在最后随访时，平均CS和SSV分别为72分（范围62-85分，标准差8）和80分（范围60-90分，标准差10）（相对于术前评分，p<0.001）。在最后随访时，超声检查显示20例（62.5%）盂唇完全愈合。术中无并发症发生；在最后随访时，5例患者（15.6%）对结果不满意并要求进行翻修手术。
对60岁以下患者的巨大潜在不可修复的肩袖撕裂进行完全修复，在短期随访中取得了良好的结果，超声检查再撕裂率约为20%。即使将严重脂肪变性的肌腱视为无功能是合理的，但我们实现的上软组织重建可能至少与上盂唇重建有相同的结果，且成本明显更低。
4级，无比较组的病例系列。
