Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.
Department of Orthopaedics, Taichung Veterans' General Hospital, Taichung, Taiwan.
Arthroscopy. 2021 Aug;37(8):2420-2431. doi: 10.1016/j.arthro.2021.04.003. Epub 2021 Apr 15.
To retrospectively assess the clinical outcomes of the patients with large to massive reparable RCTs treated by arthroscopic rotator cuff repair (ARCR) combined with modified superior capsule reconstruction (mSCR) using the long head of biceps tendon (LHBT) as reinforcement with a minimum of 2 years of follow-up.
We retrospectively evaluated 40 patients with large to massive reparable RCTs who underwent ARCR and mSCR (group I) between February 2017 and June 2018 (18 patients) or underwent ARCR and tenotomy of LHBT performed at the insertion site (group II) between January 2015 and January 2017 (22 patients). The pain visual analog score (VAS) was assessed preoperatively and 1, 3, 6, 12, 24 months postoperatively. American Shoulder and Elbow Surgeons (ASES) scores, the University of California, Los Angeles (UCLA) shoulder rating scale, and active range of motion (AROM) were assessed before surgery and 6, 12, and 24 months after surgery. The integrity of the rotator cuff and mSCR was evaluated using magnetic resonance images at 12 months postoperatively.
After surgery, both groups had significantly improved in VAS, ASES, UCLA and AROM scores in the final follow-up. There were no significant between-group differences in the characteristics of the patients before surgery. Group I had improved pain relief at 1 month (P < .001) and at 3 months (P < .01) after surgery. For the AROM, group I (flexion, external rotation, internal rotation) demonstrated better improvement than group II 6 months after surgery (all P < .05) and better internal rotation 12 and 24 months after surgery (all P < .05). The mSCR survival rate was 94.4% (17/18). The retear rate of repaired rotator cuffs for groups I and II was 16.7% (3/18) and 40.9% (9/22), respectively, and the differences were significant (P < .046).
ARCR combined with mSCR using LHBT as reinforcement may lead to a lower retear rate and earlier functional recovery than conventional ARCR with tenotomy of LHBT for large to massive reparable RCTs.
Level III, retrospective therapeutic comparative trial.
回顾性评估采用关节镜下肩袖修复术（ARCR）联合改良上囊重建术（mSCR）并用肱二头肌长头肌腱（LHBT）作为加强物治疗大型至巨大可修复 RCT 的患者的临床结果，随访时间至少 2 年。
我们回顾性评估了 2017 年 2 月至 2018 年 6 月期间（18 例）或 2015 年 1 月至 2017 年 1 月期间（22 例）接受 ARCR 和 LHBT 止点处肌腱切断术的 40 例大型至巨大可修复 RCT 患者，接受 ARCR 和 mSCR（组 I）的患者。术前和术后 1、3、6、12、24 个月评估疼痛视觉模拟评分（VAS）。术前和术后 6、12 和 24 个月评估美国肩肘外科医生（ASES）评分、加利福尼亚大学洛杉矶分校（UCLA）肩部评分量表和主动活动范围（AROM）。术后 12 个月行磁共振成像评估肩袖和 mSCR 的完整性。
两组患者在末次随访时 VAS、ASES、UCLA 和 AROM 评分均显著改善。两组患者术前一般特征无统计学差异。术后 1 个月（P <.001）和 3 个月（P <.01）时，组 I 的疼痛缓解情况改善更明显。术后 6 个月时，组 I 的 AROM（屈伸、外展、内旋）改善情况优于组 II（均 P <.05），术后 12 和 24 个月时组 I 的内旋改善情况优于组 II（均 P <.05）。mSCR 的存活率为 94.4%（17/18）。组 I 和 II 的修复肩袖再撕裂率分别为 16.7%（3/18）和 40.9%（9/22），差异有统计学意义（P <.046）。
与常规的 LHBT 切断术联合 ARCR 相比，ARCR 联合 mSCR 并用 LHBT 作为加强物可能导致大型至巨大可修复 RCT 的再撕裂率更低，功能恢复更早。
III 级，回顾性治疗比较试验。
