Institut Locomoteur de l'Ouest CHP Saint-Grégoire (Vivalto Santé), Saint-Grégoire, France.
Hôpital Privé des Côtes d'Armor, Plérin, France.
J Bone Joint Surg Am. 2018 Nov 7;100(21):1854-1863. doi: 10.2106/JBJS.17.01190.
Massive rotator cuff tears are challenging to treat, with few or no studies on long-term outcomes of repair. The purpose of this study was to report 10-year outcomes following repair of massive posterosuperior rotator cuff tears, with and without extension into the subscapularis, and to determine prognostic factors that could influence clinical scores and retear rates.
The records of 234 patients who underwent repair of a massive posterosuperior rotator cuff tear at a total of 15 centers were retrieved. Patients were asked to return for evaluation at 10 years; 78 patients could not be contacted, 7 had died, and 19 had undergone a reoperation. A total of 130 patients (68% men) with a mean age (and standard deviation) of 56.1 ± 7.7 years (range, 26 to 79 years) were evaluated clinically, and 102 of them were also evaluated using magnetic resonance imaging (MRI). The tear was confined to the supraspinatus and infraspinatus tendons in 94 shoulders and also involved the superior portion of the subscapularis in 36 shoulders. Univariable and multivariable regressions were performed to determine whether 10-year total Constant-Murley scores and repair integrity were associated with patient characteristics, tear patterns, or repair techniques.
In the study cohort, complications were noted in 14 shoulders (11%) (stiffness in 10 and infection in 4). For the 130 shoulders evaluated clinically, the mean total Constant-Murley score improved from 53.1 ± 15.9 (range, 14 to 83) preoperatively to 78.5 ± 11.3 (range, 36 to 98) at 10 years. Of the 102 shoulders evaluated using MRI, 32 had a retear (Sugaya type IV or V). Of the 19 shoulders that underwent a reoperation (excluded from the study cohort), 9 had a retear. The overall prevalence of retears was 34%. Multivariable regression analysis revealed a significant association between the 10-year Constant-Murley score and preoperative retraction of the infraspinatus tendon, but no association between retears and any of the variables. Involvement of the subscapularis had no significant effect on preoperative or postoperative Constant-Murley scores or retear rates.
Patients who had repair of a massive posterosuperior rotator cuff tear maintained considerable improvements in clinical and radiographic outcomes at 10 years. Partial concomitant tears of the subscapularis did not affect the total postoperative Constant-Murley scores or retear rates.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
巨大肩袖撕裂的治疗具有挑战性，关于修复的长期结果的研究很少或没有。本研究旨在报告修复巨大肩袖后上撕裂的 10 年结果，包括是否延伸至肩胛下肌，并确定可能影响临床评分和再撕裂率的预后因素。
从 15 个中心检索了 234 例接受巨大肩袖后上撕裂修复的患者的记录。要求患者在 10 年时返回进行评估；78 名患者无法联系，7 名患者死亡，19 名患者接受了再次手术。对 130 名（68%为男性）患者进行了临床评估，平均年龄（标准差）为 56.1±7.7 岁（范围，26 至 79 岁），其中 102 名患者还进行了磁共振成像（MRI）评估。94 例肩的撕裂局限于冈上肌和冈下肌腱，36 例肩的撕裂还累及肩胛下肌的上部。进行单变量和多变量回归分析，以确定 10 年总常数-穆雷评分和修复完整性与患者特征、撕裂模式或修复技术是否相关。
在研究队列中，14 例（11%）出现并发症（10 例僵硬，4 例感染）。在接受临床评估的 130 例肩中，术前平均总常数-穆雷评分从 53.1±15.9（范围，14 至 83）改善至 10 年后的 78.5±11.3（范围，36 至 98）。在接受 MRI 评估的 102 例肩中，32 例有再撕裂（Sugaya 型 IV 或 V）。在接受再次手术的 19 例肩中（不包括在研究队列中），9 例有再撕裂。总的再撕裂发生率为 34%。多变量回归分析显示，10 年常数-穆雷评分与术前冈下肌腱回缩显著相关，但与任何变量均无相关性。肩胛下肌的参与对术前和术后常数-穆雷评分或再撕裂率无显著影响。
接受巨大肩袖后上撕裂修复的患者在 10 年内保持了显著的临床和影像学改善。肩胛下肌的部分伴随撕裂并未影响术后总常数-穆雷评分或再撕裂率。
治疗水平 IV。请参阅作者说明，以获取完整的证据水平描述。
