Baumgarten Keith M, Chang Peter S, Schweinle Will E
Orthopedic Institute, Sioux Falls, South Dakota, USA.
University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA.
Orthop J Sports Med. 2020 Oct 21;8(10):2325967120957993. doi: 10.1177/2325967120957993. eCollection 2020 Oct.
There are limited data available to guide patients to their prognosis when glenohumeral chondral lesions are found during arthroscopic rotator cuff repair.
The primary hypothesis was that patients with glenohumeral chondral lesions will have inferior outcomes after arthroscopic rotator cuff repair compared with patients without chondral lesions. The secondary hypothesis was that patients with concomitant chondral lesions will have more severe preoperative symptoms compared with those without chondral lesions.
Cohort study; Level of evidence, 3.
A retrospective analysis was performed of patients who underwent arthroscopic rotator cuff repair between 2008 and 2012. We examined the effects of chondral lesions on patient-determined outcomes, which included the Western Ontario Rotator Cuff Index (WORC), American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), Single Assessment Numeric Evaluation (SANE), and the Shoulder Activity Level (SAL). Shoulders without chondral lesions were compared with shoulders with chondral lesions to determine whether differences in severity of preoperative symptoms as well as postoperative improvements were statistically significant.
A total of 281 shoulders were included from 273 patients, with a mean follow-up of 3.7 years. In total, 90 shoulders (32%) had concomitant chondral lesions in the glenohumeral joint. The presence and degree of chondral damage were not associated with the severity of preoperative symptoms or the amount of improvement after arthroscopic rotator cuff repair, as determined by patient outcome scores. Shoulders with bipolar chondral lesions had less postoperative improvement in their outcome scores compared with shoulders with unipolar lesions, with significant differences found in the SST ( = .0005), the SANE ( = .005), and the SAL ( = .04). Regardless of this, the majority of shoulders with bipolar chondral lesions (80%-92%) had postoperative improvements that superseded the minimal clinically important difference of the ASES, WORC, and SANE.
At a mean 3.7-year follow-up, the presence of chondral damage did not appear to negatively affect the improvement in patient-determined outcomes after arthroscopic rotator cuff repair. However, improvement in outcomes was negatively affected by the presence of bipolar chondral lesions.
在关节镜下肩袖修复术中发现盂肱关节软骨损伤时，可用于指导患者预后的数据有限。
主要假设是，与没有软骨损伤的患者相比，患有盂肱关节软骨损伤的患者在关节镜下肩袖修复术后的预后较差。次要假设是，与没有软骨损伤的患者相比，伴有软骨损伤的患者术前症状更严重。
队列研究；证据等级，3级。
对2008年至2012年间接受关节镜下肩袖修复术的患者进行回顾性分析。我们研究了软骨损伤对患者自我评估结果的影响，这些结果包括西 Ontario 肩袖指数（WORC）、美国肩肘外科医师学会（ASES）评分、简易肩部测试（SST）、单评估数字评价（SANE）以及肩部活动水平（SAL）。将没有软骨损伤的肩部与有软骨损伤的肩部进行比较，以确定术前症状严重程度以及术后改善情况的差异是否具有统计学意义。
共纳入273例患者的281个肩部，平均随访3.7年。总共有90个肩部（32%）在盂肱关节伴有软骨损伤。根据患者的结果评分，软骨损伤的存在和程度与术前症状的严重程度或关节镜下肩袖修复术后的改善程度无关。与单极软骨损伤的肩部相比，双极软骨损伤的肩部术后结果评分改善较少，在SST（P = 0.0005）、SANE（P = 0.005）和SAL（P = 0.04）方面发现有显著差异。尽管如此，大多数双极软骨损伤肩部（80%-92%）术后的改善超过了ASES、WORC和SANE的最小临床重要差异。
在平均3.7年的随访中，软骨损伤的存在似乎并未对关节镜下肩袖修复术后患者自我评估结果的改善产生负面影响。然而，双极软骨损伤的存在对结果的改善有负面影响。
