Shim Jae Woo, Hong Sung Woo, Park Yong Bok, Lee Sang Min, Yoo Jae Chul
1 Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, South Korea.
2 Division of Sports Medicine, Department of Physical Medicine and Rehabilitation, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, South Korea.
J Orthop Surg (Hong Kong). 2019 Jan-Apr;27(1):2309499018821771. doi: 10.1177/2309499018821771.
The objective of the study is to determine clinical and radiological outcomes of arthroscopic repair for delaminated tears versus non-delaminated tears.
Consecutive 138 patients with full-thickness rotator cuff tear were retrospectively enrolled. They were divided into two groups based on the presence of delamination. All delaminated tears were repaired by en bloc technique (suturing both layers by single stitch). Delaminated tears were categorized into two types: (1) posterior type, delamination involving mainly infraspinatus and (2) complete type, delamination involving both supraspinatus and infraspinatus. Clinical assessments were done using pain visual analog scale (PVAS), functional VAS, American Shoulder Elbow Surgeons score, the Constant score, and range of motion. Postoperative MRI was performed at 6 months after surgery to determine repair integrity.
Of the 138 patients, 78 (56.5%) had delaminated tears, including 30 cases of posterior type and 48 cases of complete type. The retear rate was 6.7% (4/60) in the non-delamination group and 5.1% (4/78) in the delamination group, showing no significant difference between the two groups. There was no significant difference in Sugaya classification between the two groups. Clinical scores were improved significantly in both delamination and non-delamination groups postoperatively, showing no significant difference between the two groups. Delamination subgroup (posterior or complete type) showed no significant correlation with retear rate, Sugaya classification, or clinical outcome.
Arthroscopic en bloc repair for delaminated rotator cuff tear showed no significant difference in clinical or radiological outcome from that for non-delaminated rotator cuff tear. The extent of delamination did not affect outcome either. Levels of Evidence: Level III, Retrospective comparative study.
本研究的目的是确定关节镜下修复分层撕裂与非分层撕裂的临床和影像学结果。
回顾性纳入138例全层肩袖撕裂患者。根据是否存在分层将他们分为两组。所有分层撕裂均采用整块技术修复（单针缝合两层）。分层撕裂分为两种类型：（1）后型，分层主要累及冈下肌；（2）完全型，分层累及冈上肌和冈下肌。使用疼痛视觉模拟量表（PVAS）、功能视觉模拟量表、美国肩肘外科医生评分、Constant评分和活动范围进行临床评估。术后6个月进行MRI检查以确定修复完整性。
138例患者中，78例（56.5%）有分层撕裂，包括30例后型和48例完全型。非分层组的再撕裂率为6.7%（4/60），分层组为5.1%（4/78），两组之间无显著差异。两组间Sugaya分级无显著差异。分层组和非分层组术后临床评分均显著改善，两组之间无显著差异。分层亚组（后型或完全型）与再撕裂率、Sugaya分级或临床结果无显著相关性。
关节镜下整块修复分层肩袖撕裂与非分层肩袖撕裂在临床或影像学结果上无显著差异。分层程度也不影响结果。证据水平：III级，回顾性比较研究。
