Kim Dong Min, Jeon In-Ho, Yang Ha-Sol, Shin Myung Jin, Park Jeong Hee, Kholinne Erica, Kim Hyojune, Park Dongjun, Koh Kyoung Hwan
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Sarang Plus Hospital, Seoul, Republic of Korea.
Orthop J Sports Med. 2021 Apr 2;9(4):2325967121992154. doi: 10.1177/2325967121992154. eCollection 2021 Apr.
The treatment for retears after arthroscopic rotator cuff repair (ARCR) has long been a challenge.
This study aimed to (1) summarize the characteristics of patients with a retear after primary ARCR and (2) determine the risk factors for poor clinical outcomes after a retear.
Case-control study; Level of evidence, 3.
We collected the data of patients with a retear after primary ARCR between January 2011 and December 2016. There were 45 patients with retears included (19 men [42.2%] and 26 women [57.8%]; mean ± SD age, 63.11 ± 8.87 years). Initially, the demographic and outcome data of patients with a retear were analyzed. Patients were classified into good and poor outcome groups according to their overall satisfaction at final follow-up. Univariable and multivariable logistic regression analyses were performed to determine the factors for poor clinical outcomes after a retear.
A total of 31 patients were classified into the good outcome group, and 14 patients were classified into the poor outcome group. Both the good and the poor outcome groups showed that clinical scores significantly improved at the time of the retear diagnosis, but the final scores were maintained or worse compared with scores at the time of the retear diagnosis. Final range of motion (ROM), except external rotation in the good outcome group, was worse or had no significant change compared with ROM at the time of the retear diagnosis. On multivariable logistic regression analysis, current smoking (odds ratio [OR], 45.580 [95% CI, 3.014-689.274]; = .006), female sex (OR, 32.774 [95% CI, 2.433-441.575]; = .009), and retears of the same or larger size than the initial tear (OR, 10.261 [95% CI, 1.544-68.202]; = .016) showed a higher OR for poor clinical outcomes after a retear.
Smoking, female sex, and retears of the same or larger size than the initial tear were independent risk factors for poor clinical outcomes after a rotator cuff retear. Final clinical scores and ROM were similar or worse compared with the scores and ROM at the time of the retear diagnosis. Therefore, revision surgery should be actively considered in female patients or those who smoke with poor clinical outcomes and a larger retear size than the preoperative tear size at the time of the retear diagnosis.
关节镜下肩袖修复术（ARCR）后再撕裂的治疗长期以来一直是一项挑战。
本研究旨在（1）总结初次ARCR后再撕裂患者的特征，以及（2）确定再撕裂后临床预后不良的危险因素。
病例对照研究；证据等级，3级。
我们收集了2011年1月至2016年12月期间初次ARCR后再撕裂患者的数据。纳入45例再撕裂患者（19例男性[42.2%]，26例女性[57.8%]；平均±标准差年龄，63.11±8.87岁）。最初，对再撕裂患者的人口统计学和预后数据进行分析。根据患者末次随访时的总体满意度将其分为预后良好组和预后不良组。进行单变量和多变量逻辑回归分析，以确定再撕裂后临床预后不良的因素。
共有31例患者被分为预后良好组，14例患者被分为预后不良组。预后良好组和预后不良组在再撕裂诊断时临床评分均显著改善，但最终评分与再撕裂诊断时的评分相比维持不变或更差。除预后良好组的外旋外，最终活动范围（ROM）与再撕裂诊断时的ROM相比更差或无显著变化。多变量逻辑回归分析显示，当前吸烟（比值比[OR]，45.580[95%可信区间，3.014 - 689.274]；P = 0.006）、女性（OR，32.774[95%可信区间，2.433 - 441.575]；P = 0.009）以及再撕裂大小与初次撕裂相同或更大（OR，10.261[95%可信区间，1.544 - 68.202]；P = 0.016）在再撕裂后临床预后不良方面显示出较高的OR值。
吸烟、女性以及再撕裂大小与初次撕裂相同或更大是肩袖再撕裂后临床预后不良的独立危险因素。最终临床评分和ROM与再撕裂诊断时的评分和ROM相比相似或更差。因此，对于女性患者或吸烟且临床预后不良以及再撕裂诊断时再撕裂大小比术前撕裂大小更大的患者，应积极考虑进行翻修手术。
