Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea.
Clinical Trial Center, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea.
Arthroscopy. 2020 Aug;36(8):2080-2088. doi: 10.1016/j.arthro.2020.04.016. Epub 2020 Apr 25.
To evaluate the clinical characteristics of patients with symptomatic failed rotator cuff repair who required revision surgeries and to identify clinical and radiologic factors related to the need for revision surgery.
Ninety-eight patients who were diagnosed with rotator cuff retear within 2 years after primary arthroscopic surgery were included. Patients were divided into 2 groups: patients who underwent revision surgery within 2 years postoperatively (44 patients, group I) and patients who did not require additional treatment due to minimal discomfort during the same period (54 patients, group II). Demographic and radiographic factors related to cuff healing were analyzed. Univariate and multivariate analyses were performed to evaluate factors related to revision surgery.
Group I showed significantly inferior clinical outcomes at the time of revision compared to group II (American Shoulder and Elbow Surgeons score; 54.0 ± 12.1 vs 86.5 ± 12.2, Constant score; 65.2 ± 10.8 vs 84.0 ± 11.4, P < .001). Total cholesterol level (210.2 ± 40.0 vs 189.7 ± 39.1, P = .012), low-density lipoprotein level (130.7 ± 28.7 vs 115.5 ± 26.9, P = .008), and fatty infiltration of the infraspinatus (20.5% vs 3.7%, P = .011) were significantly greater in group I than in group II. On postoperative magnetic resonance imaging, retear of the infraspinatus tendon occurred significantly more frequently in group I (81.8%) than in group II (37.0%, P < .001). In group I, relative changes in anteroposterior (AP) (19.2 ± 37.8) and mediolateral retear size (29.6 ± 90.7) were significantly greater than in group II (AP; -39.5 ± 19.2, mediolateral; -29.2 ± 26.8, P < .001). Relative change in AP retear size was the most powerful independent predictor of symptomatic failed rotator cuff repair (odds ratio 1.19, confidence interval 1.08-1.31, P < .001).
Preoperative serum total cholesterol level, low-density lipoprotein levels, and fatty infiltration of the infraspinatus were significantly related to symptomatic failed rotator cuff repair. Relative change in AP retear size was the most powerful independent predictor of symptomatic failed rotator cuff repair.
Level III, Case-control study.
评估初次关节镜手术后 2 年内出现症状性肩袖修复失败并需要翻修手术的患者的临床特征，并确定与翻修手术相关的临床和影像学因素。
共纳入 98 例初次关节镜手术后 2 年内诊断为肩袖再撕裂的患者。患者分为 2 组：术后 2 年内接受翻修手术的患者（44 例，组 I）和同期因轻微不适无需额外治疗的患者（54 例，组 II）。分析与肩袖愈合相关的人口统计学和影像学因素。进行单因素和多因素分析，评估与翻修手术相关的因素。
与组 II 相比，组 I 在翻修时的临床结果明显较差（美国肩肘外科医生评分：54.0 ± 12.1 比 86.5 ± 12.2，Constant 评分：65.2 ± 10.8 比 84.0 ± 11.4，P <.001）。组 I 的总胆固醇水平（210.2 ± 40.0 比 189.7 ± 39.1，P =.012）、低密度脂蛋白水平（130.7 ± 28.7 比 115.5 ± 26.9，P =.008）和冈下肌脂肪浸润（20.5%比 3.7%，P =.011）明显高于组 II。术后磁共振成像显示，组 I 的冈下肌腱再撕裂发生率明显高于组 II（81.8%比 37.0%，P <.001）。在组 I 中，前后（AP）撕裂大小的相对变化（19.2 ± 37.8）和内外侧撕裂大小的相对变化（29.6 ± 90.7）明显大于组 II（AP：-39.5 ± 19.2，内外侧：-29.2 ± 26.8，P <.001）。AP 撕裂大小的相对变化是预测症状性肩袖修复失败的最强独立预测因素（优势比 1.19，置信区间 1.08-1.31，P <.001）。
术前血清总胆固醇水平、低密度脂蛋白水平和冈下肌脂肪浸润与症状性肩袖修复失败显著相关。AP 撕裂大小的相对变化是预测症状性肩袖修复失败的最强独立预测因素。
III 级，病例对照研究。
