Funabashi Orthopaedic Sports Medicine and Joint Center, Funabashi, Chiba, Japan.
Am J Sports Med. 2020 Aug;48(10):2510-2517. doi: 10.1177/0363546520934786. Epub 2020 Jul 14.
Type 2 failure is a big issue after suture-bridge rotator cuff repair, which may be because of stress concentration at the medial row stitches. We have been performing medial knot-tying after suture-bridge lateral row repair to avoid the stress concentration. This study aimed to evaluate clinical and radiological outcomes after arthroscopic rotator cuff repair using this technique.
This technique would yield better radiological outcomes with a reduced type 2 failure rate compared with reported outcomes after conventional suture-bridge repair.
Case series; Level of evidence, 4.
The inclusion criteria of this study were (1) full-thickness tears, (2) primary surgery, and (3) minimum 2-year follow-up with pre- and postoperative magnetic resonance imaging (MRI). We investigated active ranges of motion (forward elevation and external rotation), as well as the Japanese Orthopaedic Association (JOA) and University of California, Los Angeles (UCLA), scores preoperatively and at the final follow-up.
This study included 384 shoulders in 373 patients (205 men and 168 women) with a mean age of 65 years (range, 24-89 years) at the time of surgery. The mean follow-up was 29 months (range, 24-60 months). There were 91 small, 137 medium, 121 large, and 35 massive tears. Postoperative MRI scans demonstrated successful repair in 324 shoulders (84.4%, group S) and retear in 60 shoulders (15.6%). Among 60 retears, 40 shoulders (67%) had type 1 failure (group F1) and 20 shoulders (33%) had type 2 failure (group F2). Forward elevation and external rotation significantly improved after surgery ( < .001 for both). Postoperative JOA and UCLA scores in group F2 were significantly lower than those in the other groups.
The medial knot-tying after suture-bridge lateral row repair demonstrated excellent functional and radiological outcomes after surgery, with a retear rate of 15.6%. The type 2 failure showed significantly inferior functional outcomes; however, the rate of type 2 failure was less relative to previous studies using conventional suture-bridge techniques. Our technique could be a good alternative to conventional suture-bridging rotator cuff repair because it may reduce the rate of postoperative type 2 failure.
缝线桥修复后出现 2 型失败是一个大问题，这可能是由于内侧排缝线处的应力集中所致。我们一直在进行缝线桥外侧排修复后的内侧打结，以避免应力集中。本研究旨在评估使用该技术行关节镜下肩袖修复的临床和影像学结果。
与传统缝线桥修复后的报告结果相比，该技术可获得更好的影像学结果，并降低 2 型失败率。
病例系列；证据等级，4 级。
本研究的纳入标准为（1）全层撕裂，（2）初次手术，以及（3）至少 2 年的随访，随访时均有术前和术后磁共振成像（MRI）。我们调查了主动活动范围（前向抬高和外旋），以及术前和最终随访时的日本骨科协会（JOA）和加利福尼亚大学洛杉矶分校（UCLA）评分。
本研究共纳入 373 名患者（205 名男性和 168 名女性）的 384 个肩，手术时的平均年龄为 65 岁（范围，24-89 岁）。平均随访时间为 29 个月（范围，24-60 个月）。有 91 例小撕裂、137 例中撕裂、121 例大撕裂和 35 例巨大撕裂。术后 MRI 扫描显示 324 个肩（84.4%，组 S）成功修复，60 个肩（15.6%）出现再撕裂。在 60 例再撕裂中，40 个肩（67%）出现 1 型失败（组 F1），20 个肩（33%）出现 2 型失败（组 F2）。术后，前向抬高和外旋明显改善（均<.001）。组 F2 的术后 JOA 和 UCLA 评分明显低于其他组。
缝线桥外侧排修复后的内侧打结在术后具有极好的功能和影像学结果，再撕裂率为 15.6%。2 型失败的功能结果明显较差；然而，与使用传统缝线桥技术的先前研究相比，其失败率相对较低。我们的技术可能是传统缝线桥肩袖修复的一种较好的替代方法，因为它可以降低术后 2 型失败的发生率。
