Gatot Cheryl, Lee Merrill, Chen Jerry Yongqiang, Fu Hong Benjamin Ang, Tijauw Tjoen Denny Lie
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
JSES Int. 2020 Dec 7;5(1):72-76. doi: 10.1016/j.jseint.2020.10.008. eCollection 2021 Jan.
The greater tuberosity angle (GTA) is a newly described radiological parameter identified in a 2018 study by Cunningham et al that sought to investigate the effect of GT morphology on cuff tears. Increased GTA has been conceptualized to affect rotator cuff pathology through both extrinsic and intrinsic mechanisms. GTA > 70° was highly predictive of a degenerative rotator cuff tear. This study seeks to examine if increased GTA predicts for worse functional outcomes 2 years postoperatively after arthroscopic rotator cuff repair.
Between May 2010 and December 2016, 169 patients who underwent arthroscopic rotator cuff repair with subacromial decompression were included in this study. GTA was measured on preoperative radiographs. These patients were evaluated preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. Outcomes were assessed with the Visual Analog Scale Pain score, Constant Shoulder Score, and the Oxford Shoulder Score. Power analysis was performed based on the minimal clinically important difference of the Constant Shoulder Score. Statistical analysis was performed by dividing patients into two groups based on GTA: 1) ≤ 70 (control GTA); and 2) >70 (increased GTA) and comparisons were made between the 2 groups.
The patients' demographics were comparable between both groups. All 169 patients had statistically significant improvements in all functional scores at 2 years postoperatively. There were no statistically significant differences between the two groups of patients in Visual Analog Scale and functional scores at 3 months, 6 months, 1 year, and 2 year postoperatively. The changes in functional scores from their preoperative baseline were also tabulated, and there were no statistically significant differences between the 2 groups. Finally, there was no significant correlation between GTA with CSS or Oxford Shoulder Score at 2 years follow-up.
This study represents the largest single series available investigating the influence of GTA on midterm functional outcomes after arthroscopic rotator cuff repair. Although GTA remains a reliable radiographic predictor of rotator cuff tears, the authors conclude that increased GTA does not negatively influence midterm functional outcomes. As there is also no statistical significance between increased GTA vs. control in relative functional gain 2 years postoperatively, corrective tuberoplasty may not be mandatory during arthroscopic repair of cuff tears. Standard arthroscopic double-row rotator cuff repair with subacromial decompression can still be offered as a suitable treatment option.
大结节角（GTA）是2018年坎宁安等人的一项研究中确定的一个新描述的放射学参数，该研究旨在调查大结节形态对肩袖撕裂的影响。GTA增大被认为通过外在和内在机制影响肩袖病变。GTA>70°对退行性肩袖撕裂具有高度预测性。本研究旨在探讨GTA增大是否能预测关节镜下肩袖修复术后2年功能预后更差。
2010年5月至2016年12月期间，169例行关节镜下肩袖修复并肩峰下减压的患者纳入本研究。术前X线片测量GTA。这些患者在术前、术后3个月、6个月、1年和2年进行评估。采用视觉模拟量表疼痛评分、Constant肩关节评分和牛津肩关节评分评估预后。基于Constant肩关节评分的最小临床重要差异进行功效分析。根据GTA将患者分为两组进行统计分析：1）≤70（对照GTA）；2）>70（增大GTA），并对两组进行比较。
两组患者的人口统计学特征具有可比性。所有169例患者术后2年所有功能评分均有统计学意义的改善。两组患者术后3个月、6个月、1年和2年的视觉模拟量表和功能评分无统计学显著差异。还列出了功能评分相对于术前基线的变化，两组之间无统计学显著差异。最后，在2年随访中，GTA与CSS或牛津肩关节评分之间无显著相关性。
本研究是现有调查GTA对关节镜下肩袖修复术后中期功能预后影响的最大单一系列研究。虽然GTA仍然是肩袖撕裂的可靠影像学预测指标，但作者得出结论，GTA增大不会对中期功能预后产生负面影响。由于术后2年增大GTA与对照在相对功能增益方面也无统计学意义，因此在关节镜下修复肩袖撕裂时可能无需进行矫正性结节成形术。标准的关节镜下双排肩袖修复并肩峰下减压仍可作为合适的治疗选择。
