Opsomer Gert-Jan, Verstuyft Lotte, Muermans Stijn
Department of Orthopedic Surgery, Shoulder Care Institute, AZ Delta Hospital, Roeselare, Belgium.
JSES Int. 2020 Aug 12;4(4):882-887. doi: 10.1016/j.jseint.2020.07.010. eCollection 2020 Dec.
The effect of the acromion index (AI) and critical shoulder angle (CSA) on the short-term healing rate after arthroscopic repair of the supraspinatus tendons is already known. Long-term effects have not been published yet.
Long-term evaluation of the effect of the AI and CSA on the postoperative healing rate and clinical results after arthroscopic repair of the supraspinatus tendon.
Patients with a symptomatic, single-tendon, full-thickness supraspinatus tear in whom nonoperative management had failed were treated with an arthroscopic repair. Preoperative radiographs were used to measure CSA and AI. Eight years postoperatively, magnetic resonance imaging (MRI) studies were performed and evaluated on repair integrity. Patient-reported outcome measurements were collected pre- and postoperatively.
Thirty-one patients were evaluated 8 years postoperatively. The mean age at the time of surgery was 61 ± 9 years. MRI evaluation showed that 20 patients (65%) had an intact repair and 11 (35%) had a full-thickness retear. No significant differences were found between the intact and retear groups regarding age ( = .605), initial tear size ( = .485), retraction grade ( = .439), and all PROMs. The mean CSA for the intact group (33° ± 1°) was significantly lower than the CSA in the retear group (38° ± 1°; = .004). Eighteen patients (58%) had a CSA ≥35°, and 9 (50%) among them had a retear and 9 (50%) had an intact repair.The mean AI for the intact group (0.72 ± 0.11) was significantly lower than the AI in the retear group (0.81 ± 0.08 ; = .021). Seventeen patients (55%) had an AI ≥0.75, and 9 (53%) among them had a retear and 8 had an intact repair. If the AI was ≥0.75, the odds ratio of having a retear was 6.19 ( = .045). No progressive worsening of PROMs and clinical results could be demonstrated related to a higher CSA or AI during the entire follow-up.
At long-term follow-up, a higher CSA has the tendency to have an increased rate of retear after arthroscopic supraspinatus tendon repair, but this was not significant. A higher AI significantly increased the retear risk. A higher CSA and AI did not impair the clinical results over time. An AI ≥0.75 was associated with a 6-fold increase in risk of retear after arthroscopic supraspinatus tendon repair.
肩峰指数（AI）和临界肩角（CSA）对肩袖肌腱关节镜修复术后短期愈合率的影响已为人所知。但其长期影响尚未见报道。
长期评估AI和CSA对肩袖肌腱关节镜修复术后愈合率及临床结果的影响。
对非手术治疗失败的有症状的单肌腱、全层肩袖撕裂患者进行关节镜修复。术前通过X线片测量CSA和AI。术后8年，进行磁共振成像（MRI）检查并评估修复完整性。收集患者术前和术后的自我报告结局指标。
对31例患者进行了术后8年的评估。手术时的平均年龄为61±9岁。MRI评估显示，20例患者（65%）修复完整，11例（35%）发生全层再撕裂。在年龄（P = 0.605）、初始撕裂大小（P = 0.485）、回缩程度（P = 0.439）以及所有患者报告结局指标方面，修复完整组和再撕裂组之间未发现显著差异。修复完整组的平均CSA（33°±1°）显著低于再撕裂组（38°±1°；P = 0.004）。18例患者（58%）的CSA≥35°，其中9例（50%）发生再撕裂，9例（50%）修复完整。修复完整组的平均AI（0.72±0.11）显著低于再撕裂组（0.81±0.08；P = 0.021）。17例患者（55%）的AI≥0.75，其中9例（53%）发生再撕裂，8例修复完整。如果AI≥0.75，发生再撕裂的比值比为6.19（P = 0.045）。在整个随访期间，未发现与较高的CSA或AI相关的患者报告结局指标和临床结果的进行性恶化。
在长期随访中，较高的CSA有使肩袖肌腱关节镜修复术后再撕裂率增加的趋势，但不显著。较高的AI显著增加再撕裂风险。随着时间推移，较高的CSA和AI并未损害临床结果。AI≥0.75与肩袖肌腱关节镜修复术后再撕裂风险增加6倍相关。
