Monroe Emily J, Flores Sergio E, Zhang Alan L, Feeley Brian T, Lansdown Drew A, Ma C Benjamin
Heartland Orthopedic Specialists, Alexandria, Minnesota, USA.
Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA.
Orthop J Sports Med. 2020 Apr 3;8(4):2325967120913036. doi: 10.1177/2325967120913036. eCollection 2020 Apr.
Rotator cuff fatty infiltration has been correlated with poorer radiographic and clinical outcomes in supraspinatus and infraspinatus tendon repairs, but this has not been well-studied in subscapularis tendon repairs.
To evaluate the influence of preoperative rotator cuff fatty infiltration on postoperative outcomes for patients undergoing arthroscopic subscapularis tendon repair.
Cohort study; Level of evidence, 3.
Patients who underwent arthroscopic subscapularis repair between 2010 and 2016 were retrospectively identified, and demographic data and surgical findings were recorded. The extent of fatty infiltration was determined on preoperative magnetic resonance imaging by the Fuchs modification of the Goutallier classification. At the most recent follow-up, patients completed the Patient-Reported Outcomes Measurement Information System for Upper Extremity (PROMIS-UE) computer adaptive test and a postoperative visual analog scale for pain. The distribution of fatty infiltration was compared between patients undergoing subscapularis tendon repair versus subscapularis tendon repair combined with a posterior cuff repair. Outcomes were compared for patients using Goutallier grade 0-1 versus grade ≥2 changes in each rotator cuff muscle. Multivariate linear regression analysis was performed to evaluate the influence of muscle quality, as well as demographic factors, on PROMIS-UE scores. Significance was defined as < .05.
There were 140 shoulders included (mean age, 61.8 years; 42.1% female; mean follow-up, 51.7 months). The prevalence of Goutallier grade 2 changes or higher was significantly greater in patients with multitendon repair relative to isolated subscapularis tendon repair. For the overall group of all patients undergoing subscapularis tendon repair, whether in isolation or as part of a multitendon repair, PROMIS-UE scores were significantly lower for patients with infraspinatus muscle grade 2 or higher Goutallier changes relative to grade 0 or 1. After adjustment for age, body mass index, patient sex, and fatty infiltration in other rotator cuff muscles, poor infraspinatus muscle quality remained the only significant predictor for lower PROMIS-UE scores.
Patients undergoing arthroscopic subscapularis tendon repair with poor infraspinatus muscle quality had worse patient-reported outcomes. This was true whether subscapularis tendon repair was isolated or was performed in conjunction with supraspinatus and infraspinatus tendon repairs.
在冈上肌和冈下肌肌腱修复中，肩袖脂肪浸润与较差的影像学和临床结果相关，但在肩胛下肌肌腱修复中尚未得到充分研究。
评估术前肩袖脂肪浸润对接受关节镜下肩胛下肌肌腱修复患者术后结果的影响。
队列研究；证据等级，3级。
回顾性确定2010年至2016年间接受关节镜下肩胛下肌修复的患者，并记录人口统计学数据和手术结果。术前通过Goutallier分类法的Fuchs改良版在磁共振成像上确定脂肪浸润程度。在最近的随访中，患者完成了上肢患者报告结局测量信息系统（PROMIS-UE）计算机自适应测试和术后疼痛视觉模拟量表。比较了接受肩胛下肌肌腱修复与肩胛下肌肌腱修复联合后袖修复患者的脂肪浸润分布情况。比较了Goutallier分级为0-1级与≥2级的各肩袖肌肉患者的结局。进行多变量线性回归分析以评估肌肉质量以及人口统计学因素对PROMIS-UE评分的影响。显著性定义为P<0.05。
共纳入140例肩部病例（平均年龄61.8岁；42.1%为女性；平均随访51.7个月）。与单纯肩胛下肌肌腱修复相比，多肌腱修复患者中Goutallier分级为2级或更高的患病率显著更高。对于所有接受肩胛下肌肌腱修复的患者总体而言，无论单独修复还是作为多肌腱修复的一部分，冈下肌Goutallier分级为2级或更高的患者的PROMIS-UE评分相对于0级或1级患者显著更低。在调整年龄、体重指数、患者性别和其他肩袖肌肉的脂肪浸润后, 冈下肌质量差仍然是PROMIS-UE评分较低的唯一显著预测因素。
冈下肌质量差的接受关节镜下肩胛下肌肌腱修复的患者，其患者报告的结局较差。无论肩胛下肌肌腱修复是单独进行还是与冈上肌和冈下肌肌腱修复联合进行，都是如此。
