Centre Épaule Main Besançon, 16, rue Madeleine Brès, 25000 Besançon, France.
Centre ostéoarticulaire des Cèdres, Parc Sud Galaxie, 5, rue des Tropiques, 38130 Echirolles, France.
Orthop Traumatol Surg Res. 2020 Dec;106(8S):S207-S211. doi: 10.1016/j.otsr.2020.08.006. Epub 2020 Sep 14.
Rotator cuff tears often occur in combination with acromioclavicular (AC) arthropathy. But it can be difficult to separate pain caused by the rotator cuff tear from pain caused by the AC joint, despite clinical and other examinations. Distal clavicle resection (DCR) is increasingly being done at the same time as arthroscopic rotator cuff repair. The aim of this study was to compare the functional outcomes 1 year after arthroscopic rotator cuff repair between patients who simultaneously undergo DCR and patients who do not. The primary hypothesis was that DCR improves the clinical outcomes.
This was a prospective, multicenter, randomized, single-blind study of 200 patients who underwent isolated supraspinatus repair using the same technique. The patients were randomized into two groups: 97 patients who also underwent DCR and 103 patients who did not. The patients were followed until 1 year postoperative according to a standardized radiological and clinical review protocol.
At 1 year postoperative, all the clinical outcomes were worse in the DCR group, although only external rotation with elbow at side (53° vs. 59°, p=0.04) and the SSV (86.5 vs. 90.1, p=0.04) were statistically different. Overall shoulder pain was higher in the DCR group during the first 3 months postoperative (p=0.04). At 1 year, the DCR group had more residual pain; this pain was mainly located on the superior side of the shoulder (p=0.03), especially when more than 11 mm was resected (p=0.01). More of the shoulders in the DCR group had failures in rotator cuff healing based on ultrasonography (p=0.5).
Our hypothesis was not confirmed. We do not recommend doing routine DCR with arthroscopic rotator cuff repair.
I, prospective randomized simple blind study.
肩袖撕裂常与肩锁关节（AC）关节炎同时发生。尽管进行了临床和其他检查，但仍难以将肩袖撕裂引起的疼痛与 AC 关节引起的疼痛分开。锁骨远端切除术（DCR）在关节镜肩袖修复的同时进行的情况越来越多。本研究旨在比较同时行 DCR 与不行 DCR 的关节镜肩袖修复患者 1 年后的功能结果。主要假设是 DCR 可改善临床结果。
这是一项前瞻性、多中心、随机、单盲研究，纳入了 200 名接受同种技术单独修复冈上肌的患者。患者被随机分为两组：97 例同时行 DCR，103 例不行 DCR。根据标准化的影像学和临床复查方案，患者随访至术后 1 年。
术后 1 年，DCR 组的所有临床结果均较差，尽管仅外展伴肘位于体侧时的外旋（53°比 59°，p=0.04）和 SSV（86.5 比 90.1，p=0.04）有统计学差异。术后 3 个月内，DCR 组的总肩痛更高（p=0.04）。术后 1 年，DCR 组仍有更多残余疼痛；这种疼痛主要位于肩部上方（p=0.03），尤其是切除超过 11 毫米时（p=0.01）。DCR 组中有更多的肩袖超声检查愈合失败（p=0.5）。
我们的假设未得到证实。我们不建议在关节镜肩袖修复时常规行 DCR。
I 级，前瞻性随机简单盲法研究。
