Ramsay Sante, Hopital Prive de l'Estuaire, Le Havre, France.
Department of Orthopaedic Surgery, Rouen University Hospital, Rouen, France.
Am J Sports Med. 2021 Feb;49(2):298-304. doi: 10.1177/0363546520985224.
Rotator cuff tears are common shoulder injuries that often cause pain and loss of function. Nonanatomic side-to-side techniques facilitate repair by minimizing tensions within tendons to improve healing and optimize the thickness of sutured tissues.
PURPOSE/HYPOTHESIS: The purpose was to evaluate long-term clinical and radiographic outcomes of arthroscopic side-to-side repair of massive rotator cuff tears (mRCTs). The hypothesis was that, at a minimum follow-up of 12 years, arthroscopic side-to-side repair maintains clinically important improvements.
Case series; Level of evidence, 4.
The authors reviewed records of all patients who underwent arthroscopic repair of mRCTs over 2 consecutive years. A total of 30 adult patients met the eligibility criteria and underwent side-to-side repair. Patients were evaluated clinically using the Constant score (CS) and ultrasound to assess retears at 3 timepoints after surgery: 2 to 4 years, 5 to 7 years, and 12 to 14 years.
At first follow-up (3.2 ± 0.5 years), all 30 patients had clinical and ultrasound assessment, which revealed 13 retears (43%). At second follow-up (6.2 ± 0.5 years), all 30 patients had clinical and ultrasound assessment, which revealed 2 new retears (total 50%). At final follow-up (13.0 ± 0.7 years), only 21 patients had clinical assessment (1 died and 8 could not be reached), and only 19 patients had ultrasound assessment, which revealed 6 new retears (total 79%). Both absolute CS and age-/sex-adjusted CS improved significantly from baseline values at first follow-up (73.5 and 96.6, respectively), and remained stable at second follow-up (69.0 and 91.9, respectively), and final follow-up (64.4 and 87.0, respectively). Compared to shoulders with intact repairs, those with retears tended to have lower absolute CS at all follow-up visits, although differences were not statistically significant.
Patients with mRCTs maintain satisfactory clinical scores at 12 to 14 years after arthroscopic side-to-side repair despite a high incidence of retears. Repair is a safe and effective treatment for mRCTs, providing a less invasive and less complex alternative to reverse shoulder arthroplasty and tendon transfer procedures.
肩袖撕裂是常见的肩部损伤，常导致疼痛和功能丧失。非解剖侧对侧技术通过最大限度地减少肌腱内的张力来促进修复，从而改善愈合并优化缝合组织的厚度。
目的/假设：本研究旨在评估关节镜下治疗巨大肩袖撕裂（mRCT）的侧对侧修复的长期临床和影像学结果。假设在至少 12 年的随访中，关节镜下侧对侧修复能够保持重要的临床改善。
病例系列；证据水平，4 级。
作者回顾了连续两年内接受 mRCT 关节镜修复的所有患者的记录。共有 30 名成年患者符合纳入标准并接受了侧对侧修复。患者在术后 3 个时间点（2 至 4 年、5 至 7 年和 12 至 14 年）接受临床评估（Constant 评分[CS]和超声检查）以评估再撕裂。
在初次随访（3.2±0.5 年）时，所有 30 例患者均接受了临床和超声评估，发现 13 例再撕裂（43%）。在第二次随访（6.2±0.5 年）时，所有 30 例患者均接受了临床和超声评估，发现 2 例新的再撕裂（总计 50%）。在最终随访（13.0±0.7 年）时，仅 21 例患者接受了临床评估（1 例死亡，8 例无法联系），19 例患者接受了超声评估，发现 6 例新的再撕裂（总计 79%）。与初次随访时相比，绝对 CS 和年龄/性别校正 CS 均显著提高（分别为 73.5 和 96.6），且在第二次随访（分别为 69.0 和 91.9）和最终随访（分别为 64.4 和 87.0）时保持稳定。与修复完好的肩部相比，有再撕裂的肩部在所有随访时的绝对 CS 均较低，尽管差异无统计学意义。
尽管肩袖再撕裂的发生率较高，但关节镜下侧对侧修复巨大肩袖撕裂后 12 至 14 年，患者仍能保持满意的临床评分。修复术是巨大肩袖撕裂的一种安全有效的治疗方法，为反肩关节置换术和肌腱转移术提供了一种微创且不复杂的替代方法。
