Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea.
KS Hospital, Seoul, 06143, Republic of Korea.
Knee Surg Sports Traumatol Arthrosc. 2019 Dec;27(12):3881-3889. doi: 10.1007/s00167-019-05433-2. Epub 2019 Mar 8.
This study was to evaluate the efficacy and safety of coracohumeral ligament (CHL) release from the coracoid process concomitant with arthroscopic rotator cuff repair for preventing postoperative stiffness.
Data on patients who underwent arthroscopic rotator cuff repair with a minimum follow-up of 1 year were collected retrospectively. Propensity score matching (1-to-1) was performed between a no-releasing group (Group I) and CHL-releasing group (Group II). In total, 76 patients in each group were matched. Clinical outcomes were assessed and compared between the two groups, including range of motion (ROM) and visual analogue scale for pain (pVAS) at postoperative 3 months, 6 months, and 1 year. The integrity of the repaired tendon was assessed at 1-year follow-up using either magnetic resonance imaging or ultrasonography.
External rotation (ER) at side at postoperative 3 months in Group II was better than that in Group I (48.6° ± 11.6° vs. 38.4° ± 13.0°, P < 0.001). When evaluating only patients with a small-to-medium sized tear at postoperative 3 months, ER at side was 49.8° ± 10.9° in Group II versus 37.8° ± 13.1° in Group I (P < 0.001). In patients with a large-to-massive sized tear, however, there was no significant difference in ER at side at postoperative 3 months (n.s.). There was no significant difference in ROM and functional scores at postoperative 6 months and 1 year, and there was no significant difference in healing failure rate (6 cases in Group I (7.9%), 2 cases in Group II (2.6%); n.s.). No complications of the CHL release procedure occurred.
In arthroscopic rotator cuff repair, CHL release from the coracoid process without creating a rotator interval defect could be an effective and safe method to prevent early postoperative stiffness, especially ER at side in patients with a small-to-medium sized tear. Therefore, CHL release can be used as a selective procedure to prevent postoperative stiffness in patients that may benefit from this procedure with decreased preoperative ER compared to the normal side.
Level III.
本研究旨在评估在关节镜下修复肩袖的同时从喙突上松解喙肱韧带（CHL）以预防术后僵硬的疗效和安全性。
回顾性收集了至少随访 1 年的关节镜下肩袖修复患者的数据。对无松解组（I 组）和 CHL 松解组（II 组）进行倾向评分匹配（1:1）。每组匹配 76 例患者。比较两组患者的临床结果，包括术后 3 个月、6 个月和 1 年的关节活动度（ROM）和疼痛视觉模拟量表（pVAS）。术后 1 年时，通过磁共振成像或超声评估修复肌腱的完整性。
术后 3 个月时，II 组的外旋（ER）在体侧明显优于 I 组（48.6°±11.6°比 38.4°±13.0°，P<0.001）。仅在术后 3 个月时评估小到中等大小撕裂的患者，II 组的 ER 在体侧为 49.8°±10.9°，而 I 组为 37.8°±13.1°（P<0.001）。然而，对于大到巨大撕裂的患者，术后 3 个月时 ER 在体侧无显著差异（n.s.）。术后 6 个月和 1 年时，ROM 和功能评分无显著差异，愈合失败率也无显著差异（I 组 6 例（7.9%），II 组 2 例（2.6%）；n.s.）。CHL 松解术无并发症发生。
在关节镜下肩袖修复中，从喙突上松解 CHL 而不造成旋转间隔缺损可能是一种有效且安全的方法，可以预防早期术后僵硬，特别是在小到中等大小撕裂的患者中改善 ER 在体侧的情况。因此，CHL 松解术可以作为一种选择性手术，用于预防可能从该手术中受益的患者术后僵硬，与健侧相比，术前 ER 减少。
III 级。
