Hasler Anita, Beeler Silvan, Götschi Tobias, Catanzaro Sabrina, Jost Bernhard, Gerber Christian
Department of Orthopaedics, Balgrist University Hospital, Zürich, Switzerland.
Unit for Clinical and Applied Research, Balgrist University Hospital, Zürich, Switzerland.
JSES Int. 2020 Sep 18;4(4):818-825. doi: 10.1016/j.jseint.2020.08.005. eCollection 2020 Dec.
Arthroscopic rotator cuff repair techniques have almost replaced open repairs. Short- and mid-term studies have shown comparable outcomes, with no clear superiority of either procedure. The aim of this study was to compare the long-term clinical and imaging outcomes following arthroscopic or open rotator cuff repair.
Forty patients with magnetic resonance imaging (MRI)-documented, symptomatic supraspinatus or supraspinatus and infraspinatus tears were randomized to undergo arthroscopic or open rotator cuff repair. Clinical and radiographic follow-up was obtained at 6 weeks, 3 months, 1 year, 2 years, and >10 years postoperatively. Clinical assessment included measurement of active range of motion, visual analog scale score for pain, functional scoring according to the Constant-Murley score (CS), and assessment of the Subjective Shoulder Value. Imaging included conventional radiography and MRI for the assessment of cuff integrity and alteration of the deltoid muscle.
We enrolled 20 patients with a mean age of 60 years (range, 50-71 years; standard deviation [SD], 6 years) in the arthroscopic surgery group and 20 patients with a mean age of 55 years (range, 39-67 years; SD, 8 years) in the open surgery group. More than 10 years' follow-up was available for 13 patients in the arthroscopic surgery group and 11 patients in the open surgery group, with mean follow-up periods of 13.8 years (range, 11.9-15.2 years; SD, 1.1 years) and 13.1 years (range, 11.7-15 years; SD, 1.1 years), respectively. No statistically significant differences in clinical outcomes were identified between the 2 groups: The median absolute CS was 79 points (range, 14-84 points) in the arthroscopic surgery group and 84 points (range, 56-90 points) in the open surgery group ( = .177). The median relative CS was 94% (range, 20%-99%) and 96% (range, 65%-111%), respectively ( = .429). The median Subjective Shoulder Value was 93% (range, 20%-100%) and 93% (range, 10%-100%), respectively ( = .976). MRI evaluation showed a retear rate of 30% equally distributed between the 2 groups. Neither fatty infiltration of the deltoid muscle, deltoid muscle volume, nor the deltoid origin were different between the 2 groups.
In a small cohort of patients, we could not document any difference in clinical and radiographic outcomes at long-term follow-up between arthroscopic and open rotator cuff repair. The postulated harm to the deltoid muscle with the open technique could not be confirmed.
关节镜下肩袖修复技术几乎已取代开放修复术。短期和中期研究显示，两种手术效果相当，无明显优势。本研究旨在比较关节镜下或开放肩袖修复术后的长期临床和影像学结果。
40例经磁共振成像（MRI）证实有症状的冈上肌或冈上肌与冈下肌撕裂患者被随机分为关节镜下或开放肩袖修复组。术后6周、3个月、1年、2年及超过10年进行临床和影像学随访。临床评估包括测量主动活动范围、疼痛视觉模拟量表评分、根据Constant-Murley评分（CS）进行功能评分以及主观肩关节价值评估。影像学检查包括传统X线摄影和MRI，用于评估肩袖完整性和三角肌改变。
关节镜手术组纳入20例患者，平均年龄60岁（范围50 - 71岁；标准差[SD]6岁）；开放手术组纳入20例患者，平均年龄55岁（范围39 - 67岁；SD 8岁）。关节镜手术组13例患者和开放手术组11例患者有超过10年的随访资料，平均随访时间分别为13.8年（范围11.9 - 15.2年；SD 1.1年）和13.1年（范围11.7 - 15年；SD 1.1年）。两组临床结果无统计学显著差异：关节镜手术组CS中位数绝对值为79分（范围14 - 84分），开放手术组为84分（范围56 - 90分）（P = 0.177）。相对CS中位数分别为94%（范围20% - 99%）和96%（范围65% - 111%）（P = 0.429）。主观肩关节价值中位数分别为93%（范围20% - 100%）和93%（范围10% - 100%）（P = 0.976）。MRI评估显示两组再撕裂率均为30%。两组三角肌脂肪浸润、三角肌体积及三角肌起点均无差异。
在一小群患者中，我们未能证明关节镜下和开放肩袖修复术在长期随访中的临床和影像学结果存在差异。开放技术对三角肌的假定损害未得到证实。
