Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 03722, South Korea.
Knee Surg Sports Traumatol Arthrosc. 2021 Aug;29(8):2624-2630. doi: 10.1007/s00167-021-06527-6. Epub 2021 Mar 12.
This study aimed to investigate the influence of repaired subscapularis integrity on midterm results for anterosuperior massive rotator cuff tears (MRCTs) treated with partial rotator cuff repair.
This study included 57 patients who underwent arthroscopic partial repair for an anterosuperior MRCT. They were assigned to the healed subscapularis group (Group H 37 patients) or subscapularis re-tear group (Group R 20 patients). Preoperative and postoperative functional scores and active ranges of motion (ROMs) were assessed. Preoperative and 6-month follow-up magnetic resonance arthrography (MRA)/computed tomography arthrography (CTA) images were compared between groups.
At the final follow-up, mean functional shoulder scores including ROMs improved significantly in both groups compared to preoperative values (p < 0.001), except for forward flexion and internal rotation in Group R. All final functional values and ROMs (excluding external rotation) were better in Group H than in Group R (p < 0.001). Preoperative stage of fatty infiltration in the subscapularis muscle was significantly worse in Group R (p < 0.001). On follow-up MRA/CTA, the immediate residual defect after partial repair increased in 81% (30/37; mean, 17.8 mm) of patients in Group H and 100% (mean 24.6 mm) in Group R (p < 0.001). At final follow-up, mean acromiohumeral distance significantly decreased from 8.2 to 6.0 mm in Group H (p < 0.001) and from 8.3 to 4.9 mm in Group R (p < 0.001). There was a significant difference in final acromiohumeral distance between groups (p < 0.001).
After a minimum 5-year follow-up after arthroscopic partial repair of anterosuperior MRCT, subscapularis re-tear was identified in 35% of patients (20/57) on early postoperative follow-up MRA/CTA. The subscapularis re-tear group exhibited more preoperative advanced fatty infiltration and greater extents of subscapularis involvement, which led to statistically inferior functional outcomes and decreased acromiohumeral distance at final follow-up. Nonetheless, in terms of a minimal clinically important difference, substantial clinical benefit, and patient-acceptable symptomatic state for clinical significance, there were no significant differences between the groups.
III.
本研究旨在探讨修复后的肩胛下肌完整性对接受部分肩袖修复的前上方巨大肩袖撕裂（MRCT）的中期结果的影响。
本研究纳入了 57 例接受关节镜下部分修复前上方 MRCT 的患者。他们被分为肩胛下肌愈合组（H 组 37 例）或肩胛下肌再撕裂组（R 组 20 例）。评估术前和术后的功能评分和主动活动范围（ROM）。比较两组患者的术前和术后 6 个月的磁共振关节造影术（MRA）/计算机断层扫描关节造影术（CTA）图像。
在末次随访时，与术前相比，两组患者的 ROM 在内的功能评分均显著改善（p<0.001），但 R 组的前屈和内旋除外。H 组的所有最终功能值和 ROM（不包括外旋）均优于 R 组（p<0.001）。R 组肩胛下肌的脂肪浸润术前分期明显更差（p<0.001）。在术后 MRA/CTA 上，H 组 81%（30/37；平均，17.8mm）的患者部分修复后的即刻残余缺损增加，而 R 组的 100%（平均 24.6mm）（p<0.001）。在末次随访时，H 组的肩峰肱骨头间距从 8.2 显著减少至 6.0mm（p<0.001），R 组从 8.3 减少至 4.9mm（p<0.001）。两组间的最终肩峰肱骨头间距有显著差异（p<0.001）。
在接受关节镜下前上方 MRCT 部分修复后的至少 5 年随访中，术后早期 MRA/CTA 发现 35%（57 例中的 20 例）患者存在肩胛下肌再撕裂。肩胛下肌再撕裂组术前表现出更严重的高级脂肪浸润和更大程度的肩胛下肌受累，导致最终随访时功能结果统计学上更差，肩峰肱骨头间距减小。尽管如此，就最小临床重要差异、大量临床获益以及患者可接受的临床意义而言，两组间没有显著差异。
III 级。
