Department of Orthopedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea.
Department of Pathology, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea.
J Orthop Res. 2021 Oct;39(10):2226-2233. doi: 10.1002/jor.24941. Epub 2020 Dec 16.
Synovitis of the glenohumeral joint (GHJ) and subacromial space (SAS) is one of the most common findings during arthroscopic rotator cuff repair (RCR). The purpose of this study is to determine clinical factors associated with the degree of synovitis in patients with a rotator cuff tear and whether macroscopic synovitis affects early clinical outcomes following arthroscopic RCR. Arthroscopic videos of 230 patients treated with arthroscopic RCR were randomly reviewed by two experienced shoulder surgeons. The synovitis scores of the GHJ using Davis's grading system and the SAS using Jo's grading system were rated with a consensus. Univariate and multivariate analyses were used to identify the associations between the synovitis scores and various parameters, including demographics, preoperative, and postoperative clinical outcomes. Univariate analyses revealed that age, side, body mass index, duration of symptoms, preoperative stiffness, diabetes, muscle atrophy, fatty infiltration, tear size, preoperative clinical scores, and preoperative range of motion were significantly associated with the GHJ synovitis score (all p < 0.05). Multivariate analyses revealed that the duration of symptoms, tear size, and diabetes was significantly associated with the GHJ synovitis score (p = 0.048, p = 0.025, p = 0.011, respectively). Longer duration of symptoms, larger tear size, and the presence of diabetes was independently associated with increased GHJ synovitis in patients with a rotator cuff tear. These results suggest that GHJ synovitis might be more involved in the pathogenesis for pain and tear progression of rotator cuff disease compared with SAS synovitis.
肩盂肱关节（GHJ）和肩峰下间隙（SAS）的滑膜炎是关节镜肩袖修复（RCR）中最常见的发现之一。本研究旨在确定与肩袖撕裂患者滑膜炎程度相关的临床因素，以及宏观滑膜炎是否会影响关节镜 RCR 后的早期临床结果。随机回顾了 230 例接受关节镜 RCR 治疗的患者的关节镜录像，由两名经验丰富的肩部外科医生进行戴维斯分级系统的 GHJ 滑膜炎评分和乔氏分级系统的 SAS 滑膜炎评分的一致性评估。采用单因素和多因素分析来确定滑膜炎评分与各种参数（包括人口统计学、术前和术后临床结果）之间的关联。单因素分析显示，年龄、性别、体重指数、症状持续时间、术前僵硬、糖尿病、肌肉萎缩、脂肪浸润、撕裂大小、术前临床评分和术前活动范围与 GHJ 滑膜炎评分显著相关（均 p<0.05）。多因素分析显示，症状持续时间、撕裂大小和糖尿病与 GHJ 滑膜炎评分显著相关（p=0.048、p=0.025、p=0.011）。症状持续时间较长、撕裂较大以及存在糖尿病与肩袖撕裂患者 GHJ 滑膜炎的增加独立相关。这些结果表明，与 SAS 滑膜炎相比，GHJ 滑膜炎可能更多地参与肩袖疾病疼痛和撕裂进展的发病机制。
