Lee Seung-Jun, Kang Suk-Woong, Chung Ilkwon, Jang Hyungseo
Shoulder, Elbow and Sports Medicine Center, Busan Central Hospital, Busan, Republic of Korea.
Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
Orthop J Sports Med. 2020 Dec 16;8(12):2325967120966410. doi: 10.1177/2325967120966410. eCollection 2020 Dec.
Arthroscopic superior capsular reconstruction (ASCR) has recently been introduced as an alternative treatment for patients with massive irreparable rotator cuff tears. However, the results of ASCR are still limited, and little information about retear after ASCR or subsequent treatment has been reported.
To investigate the retear rate of patients who underwent ASCR and to analyze the clinical outcomes of treatments performed for a retear.
Case-control study; Level of evidence, 3.
This was a retrospective analysis of prospectively collected data from 42 patients (46 shoulders) who underwent ASCR between March 2015 and April 2018. All patients were divided into 2 groups: those with no retear (30 shoulders) and those with retear (16 shoulders). Pre- and postoperative clinical and radiological results were compared between the 2 groups. The retear pattern and treatment outcomes of the retear group were analyzed.
The overall incidence of retear was 35% (16/46). No difference was found in preoperative demographic or clinical data between the 2 groups. Preoperative magnetic resonance imaging data showed a significant between-group difference in the preoperative Goutallier grade of the subscapularis (1.5 ± 1.1 in the no-retear group vs 2.5 ± 1.3 in the retear group; = .016). In the retear group, there were 10 cases of lateral side tears, 3 cases of midsubstance tears, 2 cases of medial side tears, and 1 case of medial and lateral tears. Reoperation was performed in 8 patients who had lateral insertion tear.
Overall, clinical scores improved after ASCR in patients with massive irreparable rotator cuff tears. However, 35% (16/46) of the patients showed retear, and lateral side retear occurred in 68% (11/16). The clinical outcome of the patients with preoperative subscapularis atrophy or postoperative lateral side retears was worse, and reoperation was often required. Therefore, it is important that the lateral side be firmly fixed during the ASCR procedure.
关节镜下上盂唇重建术（ASCR）最近已被引入，作为治疗巨大不可修复性肩袖撕裂患者的一种替代治疗方法。然而，ASCR的结果仍然有限，关于ASCR术后再撕裂或后续治疗的信息报道较少。
调查接受ASCR患者的再撕裂率，并分析针对再撕裂所进行治疗的临床结果。
病例对照研究；证据等级，3级。
这是一项对2015年3月至2018年4月期间接受ASCR的42例患者（46个肩部）前瞻性收集数据的回顾性分析。所有患者分为2组：无再撕裂组（30个肩部）和再撕裂组（16个肩部）。比较两组术前和术后的临床及影像学结果。分析再撕裂组的再撕裂模式和治疗结果。
再撕裂的总体发生率为35%（16/46）。两组术前人口统计学或临床数据无差异。术前磁共振成像数据显示，两组间肩胛下肌术前Goutallier分级存在显著差异（无再撕裂组为1.5±1.1，再撕裂组为2.5±1.3；P = 0.016）。在再撕裂组中，外侧撕裂10例，中部撕裂3例，内侧撕裂2例，内外侧撕裂1例。8例外侧插入部撕裂的患者进行了再次手术。
总体而言，巨大不可修复性肩袖撕裂患者接受ASCR后临床评分有所改善。然而，35%（16/46）的患者出现再撕裂，其中68%（11/16）为外侧再撕裂。术前肩胛下肌萎缩或术后外侧再撕裂患者的临床结果较差，且常需再次手术。因此，在ASCR手术过程中牢固固定外侧很重要。
