Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany.
Institute of Sports Science, University of Hildesheim, Hildesheim, Germany.
PLoS One. 2020 Nov 12;15(11):e0241277. doi: 10.1371/journal.pone.0241277. eCollection 2020.
To evaluate the clinical and radiographic outcome of low-demand patients with massive rotator cuff tears undergoing arthroscopic debridement in mid- and long-term follow-up, as well as the rate of conversion to reverse shoulder arthroplasty.
We performed a retrospective analysis of 19 patients with a mean age at surgery of 68 years (range, 55-80 years) from a previously described consecutive cohort and after a mean follow up of 47 month (FU1) and 145 month (FU2). The functional outcome was evaluated with the VAS score, the American Shoulder and Elbow Surgeons (ASES) score, and the age- and gender-adjusted Constant (aCS) score. The radiographic outcome was classified according to the Hamada classification. Non-parametric analyses were carried out with the Mann-Whitney U for independent samples and the Wilcoxon signed-rank test for related samples.
Five patients (26%) developed symptomatic cuff tear arthropathy and underwent reverse shoulder arthroplasty after a mean time of 63 months (range, 45-97 months). These patients were excluded from further analyses. The mean VAS score of the remaining 14 patients at FU1 was significantly lower compared to preoperatively (P = .041), while there were no significant differences between the VAS score at FU1 and FU2 (P = 1.0). The ASES score of the affected shoulder at FU1 was significantly higher compared to prior to surgery (P = .028), while there were no significant differences between the scores of the affected shoulder between FU1 and FU2 (P = .878). While the ASES score of the contralateral shoulder at FU1 was significantly higher than the score of the affected shoulder (P = .038), there were no significant differences in the ASES scores of the affected and the healthy shoulder at FU2 (P = .575). The evaluation of the aCS produced similar results. A progression of the Hamada grade was documented in 6 patients.
Arthroscopic debridement is a safe and valid option for low-demand middle-age or elderly patients with symptomatic massive rotator cuff tears, leading to a significant pain relief and significantly improved functional outcome at mid- and long-term follow up. However, about a quarter of the patients in our cohort had to undergo reverse shoulder arthroplasty due to symptomatic cuff tear arthropathy. Furthermore, some of the remaining patients continued to undergo radiographic progression. This might be due to the natural history of their disease and/or the surgical procedure, and the clinical relevance of this finding should be evaluated in further studies.
评估中老年人大量肩袖撕裂患者行关节镜下清创术的临床和影像学结果，以及行反向肩关节置换术的转化率。
我们对先前描述的连续队列中的 19 名患者进行了回顾性分析，这些患者的平均手术年龄为 68 岁（55-80 岁），平均随访时间为 47 个月（FU1）和 145 个月（FU2）。使用视觉模拟评分（VAS）、美国肩肘外科医师协会（ASES）评分和年龄与性别调整的Constant（aCS）评分评估功能结果。根据 Hamada 分类对影像学结果进行分类。使用独立样本的曼-惠特尼 U 检验和相关样本的 Wilcoxon 符号秩检验进行非参数分析。
5 名患者（26%）出现症状性肩袖撕裂性关节炎，在平均 63 个月（45-97 个月）后行反向肩关节置换术。这些患者被排除在进一步分析之外。剩余 14 名患者在 FU1 时的平均 VAS 评分与术前相比显著降低（P=0.041），而 FU1 与 FU2 时的 VAS 评分无显著差异（P=1.0）。在 FU1 时患肩的 ASES 评分明显高于术前（P=0.028），而 FU1 与 FU2 时患肩的评分无显著差异（P=0.878）。在 FU1 时对侧肩的 ASES 评分明显高于患肩（P=0.038），但在 FU2 时患肩和健侧肩的 ASES 评分无显著差异（P=0.575）。对 aCS 的评估结果相似。6 名患者的 Hamada 分级进展。
对于有症状的大量肩袖撕裂、低需求的中老年人，关节镜下清创术是一种安全有效的选择，可在中期和长期随访中显著缓解疼痛，显著改善功能结果。然而，我们队列中有四分之一的患者因症状性肩袖撕裂性关节炎而不得不行反向肩关节置换术。此外，我们队列中的一些其余患者仍继续出现影像学进展。这可能是由于其自然病史和/或手术过程，需要在进一步的研究中评估该发现的临床意义。
