Department of Orthopedic Surgery, Dong-Tan Sacred Heart Hospital, Hallym University School of Medicine, Hwasung, Republic of Korea.
Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
J Bone Joint Surg Am. 2020 Jul 15;102(14):1248-1254. doi: 10.2106/JBJS.19.01014.
The purpose of this retrospective study was to assess the clinical and radiographic outcomes of large and massive rotator tears treated with arthroscopic complete repair with a posterior interval slide compared with partial repair without a posterior interval slide at a minimum follow-up of 5 years.
This study included 58 patients with large and massive rotator cuff tears that were unable to be treated with arthroscopic complete repair with an anterior interval slide and margin convergence alone. Each patient underwent either arthroscopic complete repair with an additional posterior interval slide and a subsequent side-to-side repair of the interval slide edge (complete-repair group) or arthroscopic partial repair with margin convergence and without the additional posterior interval slide (partial-repair group). Patient assignment to treatment group was not randomized. Clinical assessments included the visual analog scale pain score, the Subjective Shoulder Value, the American Shoulder and Elbow Surgeons score, the University of California Los Angeles shoulder score, and active range of motion. Preoperative and 6-month follow-up magnetic resonance arthrography (MRA) images were compared within and between groups.
At the time of the latest follow-up evaluation, both groups had significant improvements in clinical outcomes (p < 0.001). There were no significant differences in the clinical outcomes between groups. A retear was identified in 22 (88%) of the 25 patients in the complete-repair group and 28 (85%) of the 33 patients in the partial-repair group. Patients in the complete-repair group had larger retear sizes (p = 0.001) and reduced acromiohumeral intervals (p = 0.007) compared with those in the partial-repair group.
Although larger retear size on early postoperative MRA led to significantly reduced acromiohumeral intervals in the complete-repair group, there were no significant differences in clinical outcomes between groups during the minimum 5-year follow-up period. Therefore, it may be preferable to perform partial rotator cuff repair rather than aggressive release in large and massive rotator cuff tears to achieve complete repair.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
本回顾性研究的目的是评估在至少 5 年的随访中，与未行后侧间隙滑动修补的部分修复相比，关节镜下完全修复伴后侧间隙滑动修补治疗巨大肩袖撕裂的临床和影像学结果。
本研究纳入了 58 例无法通过单纯前侧间隙滑动和边缘收敛进行关节镜下完全修复的巨大肩袖撕裂患者。每位患者均接受了关节镜下完全修复伴额外后侧间隙滑动和随后的间隙滑动边缘侧侧修补（完全修复组）或关节镜下部分修复伴边缘收敛且无额外后侧间隙滑动（部分修复组）。患者分组治疗并非随机。临床评估包括视觉模拟评分疼痛、主观肩部评分、美国肩肘外科评分、加州大学洛杉矶分校肩部评分和主动活动范围。在组内和组间比较术前和 6 个月随访的磁共振关节造影（MRA）图像。
在末次随访评估时，两组的临床结果均有显著改善（p<0.001）。两组之间的临床结果无显著差异。完全修复组 25 例患者中有 22 例（88%）和部分修复组 33 例患者中有 28 例（85%）发现再撕裂。完全修复组患者的再撕裂尺寸更大（p=0.001），肩峰肱骨头间距更小（p=0.007）。
尽管完全修复组术后早期 MRA 显示更大的再撕裂尺寸导致肩峰肱骨头间距明显减小，但在至少 5 年的随访期间，两组之间的临床结果无显著差异。因此，在巨大肩袖撕裂中，行部分肩袖修复而不是激进的松解可能更有利于实现完全修复。
治疗性 III 级。请参阅作者指南以获取完整的证据等级描述。
