Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, Pittsburgh, PA, USA.
UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA.
Knee Surg Sports Traumatol Arthrosc. 2021 Jul;29(7):2370-2375. doi: 10.1007/s00167-021-06524-9. Epub 2021 Mar 8.
High-grade partial thickness rotator cuff tears (i.e., those involving at least 50% of the tendon thickness) are especially challenging to treat and various treatment strategies have been described. Prior studies have demonstrated equivalent outcomes between in situ tear fixation and tear completion repair techniques. However, it is unknown how repair of completed high-grade partial thickness tears to full tears compares to repair of full-thickness tears. The purpose of this study was to compare clinical outcome measures at least 1 year postoperatively between patients who had completion of a high-grade partial thickness supraspinatus tear to a full-thickness tear (PT) and those who had an isolated full-thickness supraspinatus tear (FT). The hypothesis of this study was equivalent retear rates as well as equivalent clinical and patient-reported outcomes between the two groups.
A retrospective review of 100 patients who underwent isolated arthroscopic supraspinatus repair between 2013 and 2018 with a minimum of 1 year follow-up was performed. Patients were separated into two groups based on their treatment: 56 had completion of a partial thickness supraspinatus tear to full-thickness tear with repair (PT) and 44 had isolated full-thickness supraspinatus repairs (FT). The primary outcome was rotator cuff retear, which was defined as a supraspinatus retear requiring revision repair. Secondary outcomes were patient-reported outcome measures (PROs) including visual analog pain scale (VAS) and subjective shoulder value (SSV), range of motion (ROM) and strength in forward flexion (FF), external rotation (ER), and internal rotation (IR).
There was a significantly lower rate of retear between the PT versus FT groups (3.6% vs. 16.3%, p = 0.040). There were no significant differences between groups for all PROs, all ROM parameters, and all strength parameters (all n.s.).
The data from this study demonstrated that the PT group had a significantly lower retear rate at 1 year follow-up than the FT group, while PROs, ROM, and strength were similar between the two groups. Patients with PT supraspinatus tears can have excellent outcomes, equivalent to FT tears, after completion of the tear, and subsequent repair with low retear rates. These findings may aid the treating surgeon when choosing between in situ fixation of the PT supraspinatus tear or completion of the tear and subsequent repair, as it allows the treating surgeon to choose the procedure based on comfort and experience level.
Level III.
对于高级部分厚度肩袖撕裂（即至少涉及肌腱厚度的 50%），治疗尤其具有挑战性，已经描述了各种治疗策略。先前的研究表明，原位撕裂固定和撕裂完成修复技术之间的结果相当。然而，尚不清楚完成高级部分厚度撕裂至全厚度撕裂的修复与修复全厚度撕裂相比如何。本研究的目的是比较至少 1 年后接受高级部分厚度冈上肌腱撕裂完成至全厚度撕裂（PT）和接受单纯全厚度冈上肌腱撕裂（FT）的患者的临床结果测量值。本研究的假设是两组的再撕裂率以及等效的临床和患者报告的结果。
对 2013 年至 2018 年间接受单纯关节镜下冈上肌腱修复的 100 例患者进行回顾性分析，随访至少 1 年。根据治疗方法将患者分为两组：56 例患者进行部分厚度冈上肌腱撕裂完成至全厚度撕裂修复（PT），44 例患者进行单纯全厚度冈上肌腱修复（FT）。主要结果是肩袖再撕裂，定义为需要修复的冈上肌腱再撕裂。次要结果是患者报告的结果测量（PRO），包括视觉模拟疼痛量表（VAS）和主观肩部值（SSV）、活动范围（ROM）以及前屈（FF）、外旋（ER）和内旋（IR）的力量。
PT 组的再撕裂率明显低于 FT 组（3.6%比 16.3%，p=0.040）。两组之间所有 PRO、所有 ROM 参数和所有力量参数均无显著差异（均为 n.s.）。
本研究的数据表明，在 1 年随访时，PT 组的再撕裂率明显低于 FT 组，而两组之间的 PRO、ROM 和力量相似。完成撕裂后完成修复的 PT 冈上肌腱撕裂患者可以获得极好的结果，与 FT 撕裂相当，且再撕裂率较低。这些发现可能有助于治疗医生在选择原位固定 PT 冈上肌腱撕裂或完成撕裂并随后修复时提供帮助，因为这允许治疗医生根据舒适度和经验水平选择手术。
III 级。
