Ramsay Santé, Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France.
Department of Operating Rooms and MITeC Technology Center, Radboud University Medical Center, Nijmegen, The Netherlands.
Knee Surg Sports Traumatol Arthrosc. 2021 Jan;29(1):181-191. doi: 10.1007/s00167-020-05907-8. Epub 2020 Feb 27.
The authors have previously published early outcomes of arthroscopic repairs of 86 massive rotator cuff tears (mRCTs) and aimed to determine whether their clinical scores are maintained or deteriorate after 5 more years.
Of the initial series of 86 shoulders, 2 had deceased, 16 lost to follow-up and 4 reoperated, leaving 64 for assessment. The repairs were complete in 44 and partial in 20, and 17 shoulders had pseudoparalysis. Preoperative assessment included absolute Constant score, shoulder strength, tear pattern, tendon retraction, and fatty infiltration. Patients were evaluated at 8.1 ± 0.6 years (range 7.1-9.3) using absolute and age-/sex-adjusted Constant score, subjective shoulder value (SSV), and simple shoulder test (SST).
Absolute Constant score was 80.0 ± 11.7 at first follow-up (at 2-5 years) but diminished to 76.7 ± 10.2 at second follow-up (at 7-10 years) (p < 0.001). Adjusted Constant score was 99.7 ± 15.9 at first follow-up and remained 98.8 ± 15.9 at second follow-up (ns). Comparing other outcomes revealed a decrease in strength over time (p < 0.001) but no change in pain, SSV or SST. Partially-repaired shoulders had lower strength at both follow-ups (p < 0.05). Pseudoparalytic shoulders had lower absolute and adjusted Constant score at second follow-up (p < 0.05), but their net improvements in absolute Constant score were higher (p = 0.014).
Both partial and complete arthroscopic repairs grant satisfactory long-term outcomes for patients with mRCTs, regardless of their tear pattern, fatty infiltration and presence of pseudoparalysis. Absolute Constant score decreased over time for both repair types, but adjusted Constant score remained stable, suggesting that decline is due to aging rather than tissue degeneration. The clinical relevance of this study is that arthroscopic repair should be considered for mRCTs, even if not completely repairable, rather than more invasive and/or risky treatments, such as reverse shoulder arthroplasty.
IV.
作者先前发表了 86 例巨大肩袖撕裂（mRCT）关节镜修复的早期结果，并旨在确定在 5 年以上的时间后，其临床评分是否保持或恶化。
在最初的 86 例肩关节中，有 2 例死亡，16 例失访，4 例再次手术，64 例接受评估。修复完全的有 44 例，部分修复的有 20 例，17 例有假性瘫痪。术前评估包括绝对 Constant 评分、肩部力量、撕裂模式、肌腱回缩和脂肪浸润。患者在 8.1±0.6 岁（7.1-9.3 岁）时接受评估，使用绝对和年龄/性别校正后的 Constant 评分、主观肩部值（SSV）和简单肩部测试（SST）。
初次随访（2-5 年）时的绝对 Constant 评分为 80.0±11.7，但第二次随访（7-10 年）时降至 76.7±10.2（p<0.001）。校正后的 Constant 评分为初次随访时的 99.7±15.9，第二次随访时仍为 98.8±15.9（ns）。比较其他结果显示，随着时间的推移，力量下降（p<0.001），但疼痛、SSV 或 SST 无变化。部分修复的肩在两次随访时力量均较低（p<0.05）。假性瘫痪的肩在第二次随访时的绝对和校正后的 Constant 评分均较低（p<0.05），但绝对 Constant 评分的净改善更高（p=0.014）。
对于 mRCT 患者，无论撕裂模式、脂肪浸润和假性瘫痪的存在，部分和完全关节镜修复均可获得满意的长期结果。两种修复类型的绝对 Constant 评分随时间下降，但校正后的 Constant 评分保持稳定，提示下降是由于衰老而非组织退变所致。本研究的临床意义在于，即使不能完全修复，也应考虑对 mRCT 进行关节镜修复，而不是采用更具侵袭性和/或风险的治疗方法，如反向肩关节置换术。
IV 级。
