Department of Orthopaedics, Fukui General Hospital, Fukui, Japan.
Arthroscopy. 2019 Oct;35(10):2803-2813. doi: 10.1016/j.arthro.2019.05.026.
To compare the clinical and imaging outcomes between the suture bridge technique (SB) and the medially based single-row technique (medSR) in patients with 1- to 3-cm tear sizes.
All patients were evaluated preoperatively and postoperatively (at 12 and 24 months) using the modified University of California, Los Angeles scoring system; active range of motion (flexion and external rotation); and a visual analog scale for pain. Healing status was examined by postoperative magnetic resonance imaging.
Clinical and imaging evaluations were completed by 92 patients at 1-year follow-up and by 74 patients at 2 years. No significant differences were found between the 2 groups across all measures at final follow-up: The University of California, Los Angeles scores were 33.4 points in SB patients and 33.0 points in medSR patients (P = .58); the visual analog scale scores were 6 mm and 7 mm, respectively (P = .38); the active flexion angles were 161° and 159°, respectively (P = .34); and the external rotation angles were 49° and 52°, respectively (P = .37). Retears were observed in 6.5% of SB patients and 2.1% of medSR patients (P = .31). Medial cuff failure was observed only in SB patients (4.3%, 2 cases), whereas incomplete healing (deep-layer retraction pattern) was observed only in medSR patients (8.7%, 4 cases). Neo-tendon regeneration in the medSR group was observed in 93% of patients.
This study did not show any significant differences in the clinical outcomes and cuff integrity between the 2 treatment groups at final follow-up; however, medial cuff failure was observed only in the SB group, and incomplete healing was more frequent in the medSR group. One should consider the risk of medial cuff failure and incomplete healing of the repaired cuff before choosing the repair technique for medium-sized supraspinatus tears.
Level I, therapeutic, prospective, randomized trial.
比较肩袖缝合桥技术（SB）和内侧单排技术（medSR）在 1-3cm 撕裂患者中的临床和影像学结果。
所有患者均采用改良加利福尼亚大学洛杉矶评分系统（University of California, Los Angeles，UCLA）、主动活动度（屈曲和外旋）和疼痛视觉模拟评分量表（visual analog scale，VAS）进行术前和术后（12 个月和 24 个月）评估。术后磁共振成像（magnetic resonance imaging，MRI）检查愈合情况。
92 例患者在 1 年随访时完成了临床和影像学评估，74 例患者在 2 年随访时完成了评估。在最终随访时，两组在所有指标上均无显著差异：SB 组 UCLA 评分为 33.4 分，medSR 组为 33.0 分（P=0.58）；VAS 评分为 6mm 和 7mm，分别（P=0.38）；主动屈曲角度分别为 161°和 159°（P=0.34）；外旋角度分别为 49°和 52°（P=0.37）。SB 组中有 6.5%的患者出现再撕裂，medSR 组中有 2.1%的患者出现再撕裂（P=0.31）。仅在 SB 组观察到内侧肩袖失败（4.3%，2 例），而仅在 medSR 组观察到不完全愈合（深层回缩模式）（8.7%，4 例）。medSR 组中有 93%的患者观察到新腱的再生。
本研究最终随访时，两组在临床结果和肩袖完整性方面无显著差异；然而，仅在 SB 组观察到内侧肩袖失败，medSR 组中不完全愈合更为常见。在选择修复中等大小冈上肌腱撕裂的修复技术之前，应考虑内侧肩袖失败和修复肩袖不完全愈合的风险。
I 级，治疗性、前瞻性、随机临床试验。
