Department of Orthopedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul.
Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym university Medical College, Gangwon-do, Republic of Korea.
Arthroscopy. 2021 Jul;37(7):2077-2086. doi: 10.1016/j.arthro.2021.01.059. Epub 2021 Feb 10.
To evaluate the correlation between cutting-through at the greater tuberosity (GT) in arthroscopic suture-bridge rotator cuff repair and the bone mineral density (BMD) of the lumbar spine, hip, and ipsilateral GT of the proximal humerus and to evaluate factors and clinical outcomes related to cutting-through.
This study prospectively enrolled patients who underwent arthroscopic knotted suture-bridge rotator cuff repair for full-thickness rotator cuff tears between June 2014 and October 2015 and who had undergone dual-energy X-ray absorptiometry cans within 1 month before surgery with a minimum 2-year follow-up. Cutting-through was defined as the occurrence of cortical breakage of the GT just medial to the lateral knotless anchor hole due to the tension of the sutures from the medial anchor, and it was assessed. Clinical and radiologic data were analyzed. Univariate and regression analyses were performed to evaluate factors related to cutting-through.
A total of 78 patients were analyzed. Patients were divided into 2 groups: patients who had cutting-through (46, group I) and patients who did not (32, group II). In an analysis of lumbar spine, hip, and GT BMD, GT BMD was the most effective for predicting cutting-through (area under the receiver operating characteristic curve = 0.94, 95% confidence interval 0.89-0.99). GT BMD (P < .001) and tear size (P = .004) were independent factors for cutting-through. Although a significant difference was found between the 2 groups in terms of age, sex, lumbar spine and hip BMD, fatty infiltration of the supraspinatus and infraspinatus, and atrophy of the supraspinatus, these variables were not independent factors. Clinical and structural outcomes showed no significant difference between the 2 groups, and anchor failure was not identified intraoperatively.
GT BMD and rotator cuff tear size are independent factors associated with cutting-through at the GT. A dual-energy X-ray absorptiometry scan of the proximal humerus is useful for predicting bone quality before arthroscopic suture-bridge rotator cuff repair.
Level II, Prospective cohort study.
评估关节镜下缝合桥肩袖修复术中大结节（GT）穿透与腰椎、髋关节和肱骨近端 GT 骨矿物质密度（BMD）之间的相关性，并评估与穿透相关的因素和临床结果。
本研究前瞻性纳入 2014 年 6 月至 2015 年 10 月期间因全层肩袖撕裂而行关节镜下带结缝合桥肩袖修复术的患者，并在术前 1 个月内行双能 X 线吸收法（DXA）检查，随访时间至少 2 年。穿透定义为由于内侧锚钉的缝线张力导致 GT 内侧刚好位于无结锚钉孔处的皮质破裂，并进行评估。分析临床和影像学数据。进行单变量和回归分析以评估与穿透相关的因素。
共分析了 78 例患者。患者分为 2 组：发生穿透的患者（46 例，组 I）和未发生穿透的患者（32 例，组 II）。在腰椎、髋关节和 GT BMD 的分析中，GT BMD 是预测穿透最有效的指标（受试者工作特征曲线下面积=0.94，95%置信区间 0.89-0.99）。GT BMD（P<0.001）和撕裂大小（P=0.004）是穿透的独立因素。虽然两组在年龄、性别、腰椎和髋关节 BMD、冈上肌和冈下肌脂肪浸润以及冈上肌萎缩方面存在显著差异，但这些变量不是独立因素。两组的临床和结构结果无显著差异，术中未发现锚钉失败。
GT BMD 和肩袖撕裂大小是与 GT 穿透相关的独立因素。在关节镜下缝合桥肩袖修复术前，肱骨近端的 DXA 扫描有助于预测骨质量。
II 级，前瞻性队列研究。
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