Department of Orthopaedic Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
Department of Orthopaedic Surgery, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea.
Arthroscopy. 2019 Feb;35(2):332-340. doi: 10.1016/j.arthro.2018.08.040. Epub 2018 Dec 3.
To evaluate clinical outcomes and repair integrity after en masse transosseous-equivalent suture bridge repair for delaminated rotator cuff tears and to analyze the morphologic factors related to clinical outcomes and repair integrity.
This study included 99 patients who underwent the technique of en masse transosseous-equivalent suture bridge repair for delaminated rotator cuff tears. Morphologic factors were estimated using magnetic resonance imaging, and clinical outcomes were evaluated using the University of California, Los Angeles score; American Shoulder and Elbow Surgeons score; and Constant shoulder score. The morphologic factors included the shape of delamination, retraction length of the bursal and articular layers, gap distance between the layers, and length of the intrasubstance cleavage. According to follow-up magnetic resonance imaging, cases were categorized into the intact or retear group. The morphologic factors were compared between the 2 groups, including the correlation between the morphologic factors and postoperative outcomes.
Retears occurred in 26 of 99 cases (26%). In both the intact and retear groups, the University of California, Los Angeles, American Shoulder and Elbow Surgeons, and Constant scores improved postoperatively (P < .0001). The most common delamination shape was that of a more retracted articular layer in retears. We found no differences in retears in terms of the retraction length of the bursal layer, gap distance, and length of the intrasubstance cleavage. However, the retraction length of the articular layer differed significantly between the groups (P < .0001). No correlation between the morphologic factors and clinical outcomes was found.
Arthroscopic en masse transosseous-equivalent suture bridge repair is a useful technique in delaminated tears to achieve optimal repair outcomes. In addition, although there was no correlation between the morphologic factors and postoperative clinical outcomes, the retraction length of the articular layer was identified as a significant factor influencing repair integrity. We recommend emphasizing the reduction of tension within the articular layer during the repair procedure.
Level III, retrospective comparison study.
评估整体经骨等效缝线桥修复术治疗层裂性肩袖撕裂的临床效果和修复完整性，并分析与临床效果和修复完整性相关的形态学因素。
本研究纳入 99 例行整体经骨等效缝线桥修复术治疗层裂性肩袖撕裂的患者。使用磁共振成像评估形态学因素，采用加利福尼亚大学洛杉矶分校评分、美国肩肘外科协会评分和 Constant 评分评估临床效果。形态学因素包括撕裂的形状、肩袖和关节层的回缩长度、层间间隙距离以及实质内撕裂的长度。根据随访磁共振成像，将病例分为完整或再撕裂组。比较两组间的形态学因素，包括形态学因素与术后结果的相关性。
99 例中共有 26 例（26%）发生再撕裂。在完整组和再撕裂组中，加利福尼亚大学洛杉矶分校评分、美国肩肘外科协会评分和 Constant 评分在术后均得到改善（P＜0.0001）。再撕裂中最常见的撕裂形状是关节层回缩更为明显。我们发现肩袖层的回缩长度、间隙距离和实质内撕裂的长度在再撕裂中无差异。然而，两组间关节层的回缩长度差异显著（P＜0.0001）。形态学因素与临床结果之间无相关性。
关节镜下整体经骨等效缝线桥修复术是治疗层裂性肩袖撕裂的一种有效技术，可获得理想的修复效果。此外，尽管形态学因素与术后临床结果之间无相关性，但关节层的回缩长度被确定为影响修复完整性的重要因素。我们建议在修复过程中强调减少关节层的张力。
III 级，回顾性比较研究。
