Division of Orthopaedics and Trauma Service, University Hospitals of Geneva, Geneva, Switzerland.
Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland.
J Bone Joint Surg Am. 2019 Mar 20;101(6):494-503. doi: 10.2106/JBJS.18.00773.
Patients are commonly advised to wear a sling for 4 to 6 weeks after rotator cuff repair despite negative effects of early immobilization and benefits of motion rehabilitation. The aim of this study was to compare clinical and radiographic outcomes up to 6 months following rotator cuff repair with and without postoperative sling immobilization.
We randomized 80 patients scheduled for arthroscopic repair of a small or medium superior rotator cuff tear into sling and no-sling groups (40 patients each). Passive mobilization was performed in both groups during the first 4 postoperative weeks, and this was followed by progressive active mobilization. Patients were evaluated clinically at 10 days and 1.5, 3, and 6 months and using ultrasound at 6 months. Univariable and multivariable analyses were performed to determine if postoperative scores were associated with sex, age at surgery, immobilization, arm dominance, a biceps procedure, resection of the distal part of the clavicle, or preoperative scores.
The sling and no-sling groups had similar preoperative patient characteristics, function, and adjuvant procedures. At 10 days, there was no difference in pain between the 2 groups (mean pain score [and standard deviation], 5.2 ± 2.3 versus 5.2 ± 1.9, p = 0.996). In comparison with the sling group, the no-sling group showed greater mean external rotation (23.5° ± 15.6° versus 15.3° ± 14.6°, p = 0.017) and active elevation (110.9° ± 31.9° versus 97.0° ± 25.0°, p = 0.038) at 1.5 months as well as better mean active elevation (139.0° ± 24.7° versus 125.8° ± 24.4°, p = 0.015) and internal rotation (T12 or above in 50% versus 28%, p = 0.011) at 3 months. Ultrasound evaluation revealed no significant differences at 6 months in tendon thickness anteriorly (p = 0.472) or posteriorly (p = 0.639), bursitis (p = 1.000), echogenicity (p = 0.422), or repair integrity (p = 0.902). Multivariable analyses confirmed that the mean American Shoulder and Elbow Surgeons (ASES) score increased with patient age (beta, 0.60; p = 0.009), the Single Assessment Numeric Evaluation (SANE) decreased with sling immobilization (beta, -6.33; p = 0.014), and pain increased with sling immobilization (beta, 0.77; p = 0.022).
No immobilization after rotator cuff repair is associated with better early mobility and functional scores in comparison with sling immobilization. Postoperative immobilization with a sling may therefore not be required for patients treated for a small or medium tendon tear.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
尽管早期固定和运动康复的益处，但患者仍常被建议在肩袖修复后佩戴吊带 4 至 6 周。本研究旨在比较肩袖修复后使用和不使用术后吊带固定的临床和影像学结果，随访时间长达 6 个月。
我们将 80 名计划接受关节镜下小或中上部肩袖撕裂修复的患者随机分为吊带组和无吊带组（每组 40 例）。两组患者术后第 1 至 4 周均行被动活动，随后行渐进性主动活动。术后 10 天、1.5 个月、3 个月和 6 个月进行临床评估，并在 6 个月时进行超声检查。采用单变量和多变量分析确定术后评分是否与性别、手术时年龄、固定、手臂优势、二头肌手术、锁骨远端切除或术前评分相关。
吊带组和无吊带组患者术前的一般特征、功能和辅助手术相似。术后 10 天，两组疼痛评分无差异（平均疼痛评分[标准差]，5.2 ± 2.3 对 5.2 ± 1.9，p = 0.996）。与吊带组相比，无吊带组在 1.5 个月时的外展旋转（23.5° ± 15.6°对 15.3° ± 14.6°，p = 0.017）和主动抬高（110.9° ± 31.9°对 97.0° ± 25.0°，p = 0.038）方面有更大的改善，在 3 个月时的主动抬高（139.0° ± 24.7°对 125.8° ± 24.4°，p = 0.015）和内旋（T12 或以上 50%对 28%，p = 0.011）方面有更好的改善。超声检查在 6 个月时，肩袖前侧（p = 0.472）和后侧（p = 0.639）的肌腱厚度、滑囊炎（p = 1.000）、回声（p = 0.422）或修复完整性（p = 0.902）方面均无显著差异。多变量分析证实，美国肩肘外科医生（ASES）评分的平均水平随患者年龄的增加而增加（β值为 0.60，p = 0.009），单一评估数字评估（SANE）随吊带固定而降低（β值为-6.33，p = 0.014），疼痛随吊带固定而增加（β值为 0.77，p = 0.022）。
与吊带固定相比，肩袖修复后不固定可获得更好的早期活动度和功能评分。对于治疗小或中等大小的肌腱撕裂患者，术后可能不需要吊带固定。
治疗性 I 级。有关完整的证据水平说明，请参见作者说明。
