Franceschetti Edoardo, Giovannetti de Sanctis Edoardo, Palumbo Alessio, Ranieri Riccardo, Casti Paola, Mencattini Arianna, Maffulli Nicola, Franceschi Francesco
Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy.
Department of Orthopaedics and Traumatology, Catholic University, Agostino Gemelli Hospital, 00168 Rome, Italy.
J Clin Med. 2020 Dec 5;9(12):3950. doi: 10.3390/jcm9123950.
A Critical Shoulder Angle (CSA), evaluated on plain radiographs, greater than 35° is considered predictive of rotator cuff tears. The present prospective comparative study aimed, firstly, to develop a formula to calculate the amount of acromion that should be resected performing a lateral acromioplasty and, secondly, verify whether lateral acromioplasty to reduce the CSA associated with arthroscopic cuff repair decreased the rate of recurrence of the tears, and impacted favorably on clinical postoperative outcomes.
Patients undergoing arthroscopic rotator cuff repair (RCR) for rotator cuff tears with a CSA greater than 35° were included in this study and divided into two groups, based on whether the CSA had been reduced by arthroscopic resection of the lateral portion of the acromion. A new mathematical formula was developed in order to quantify the amount of bone to be resected while performing the lateral acromioplasty. Patients with traumatic tears, previous surgery, osteoarthritis or plain radiographs, not classified as A1 according to Suter-Henninger, were excluded. Clinical and radiographic outcomes were assessed at a minimum of 2 years of follow-up considering the tear size.
289 patients were included in this study. Thirty-seven were lost to follow-up. Group A (Lateral acromioplasty) patients included: 38 small tears, 30 medium tears, 28 large tears and 22 massive tears; Group B (control group) was composed of 40 small tears, 30 medium tears, 30 large tears and 23 massive tears. The Constants Score value and retear Rate were, respectively, significant higher ( = 0.007 and = 0.004) and lower ( = 0.029 and = 0.028) in Group A, both in the Small-and Medium-size subgroups. No complications were outlined. The mediolateral width of the acromion was reduced, according to the preoperatively calculated measure.
Arthroscopic lateral acromioplasty decreased the CSA within the favorable range (30°-35°) in all patients treated, resecting the amount of bone predicted by the mathematical formula. Lateral acromioplasty is a safe and reproducible technique which may prevent recurrence of rotator cuff tears in patients with small and medium lesions.
II.
在X线平片上评估的临界肩峰角（CSA）大于35°被认为可预测肩袖撕裂。本前瞻性对照研究的目的，一是制定一个公式来计算在进行外侧肩峰成形术时应切除的肩峰量，二是验证通过外侧肩峰成形术降低与关节镜下肩袖修复相关的CSA是否能降低撕裂复发率，并对术后临床结果产生有利影响。
本研究纳入因肩袖撕裂接受关节镜下肩袖修复（RCR）且CSA大于35°的患者，并根据外侧肩峰的关节镜切除是否降低了CSA将其分为两组。为了量化进行外侧肩峰成形术时要切除的骨量，制定了一个新的数学公式。排除有创伤性撕裂、既往手术史、骨关节炎或根据Suter-Henninger分类不属于A1型的X线平片患者。考虑撕裂大小，在至少2年的随访中评估临床和影像学结果。
本研究纳入289例患者。37例失访。A组（外侧肩峰成形术）患者包括：38例小撕裂、30例中等撕裂、28例大撕裂和22例巨大撕裂；B组（对照组）由40例小撕裂、30例中等撕裂、30例大撕裂和23例巨大撕裂组成。在小尺寸和中等尺寸亚组中，A组的常数评分值和再撕裂率分别显著更高（分别为P = 0.007和P = 0.004）和更低（分别为P = 0.029和P = 0.028）。未概述并发症。根据术前计算的测量值，肩峰的内外侧宽度减小。
关节镜下外侧肩峰成形术在所有接受治疗的患者中将CSA降低到了有利范围（30°-35°），切除了数学公式预测的骨量。外侧肩峰成形术是一种安全且可重复的技术，可能会预防中小病变患者的肩袖撕裂复发。
II级。
