Department of Orthopaedic Surgery, Tokushima Red Cross Hospital, Tokushima.
Department of Orthopaedic Surgery, Tokushima Red Cross Hospital, Tokushima.
Arthroscopy. 2021 Sep;37(9):2735-2742. doi: 10.1016/j.arthro.2021.03.069. Epub 2021 Apr 19.
This study aimed to examine the correlation of repair tension during arthroscopic rotator cuff repair (ARCR) with preoperative factors and to evaluate whether measuring tension during ARCR is effective for predicting rotator cuff integrity after ARCR.
Patients who underwent ARCR from May 2014 to June 2017 were enrolled in this study. Inclusion criteria were patients with medium or larger-sized tears and with a minimum of 6 months' follow-up. Patients with a partial repair were excluded. Intraoperative repair tension was measured according to Davidson's method. Correlation of repair tension with preoperative factors was evaluated with Pearson and Spearman correlation coefficient tests. Logistic regression analysis was performed on intraoperative factors, including repair tension, to identify independent predictors of retear after ARCR. Receiver operating characteristic (ROC) curve was used to determine the cutoff value of repair tension for retear.
One-hundred twenty patients met the inclusion criteria. Mean repair tension was 26.6 ± 12.6 N, and retear was found in 29 shoulders (24.2%). Among the preoperative factors, tear size in the mediolateral (P < .001) and anteroposterior (P < .001) directions, DeOrio and Cofield's classification (P <0.001), geometric classification (P <.001), and fatty infiltration of supraspinatus (P = .006) and infraspinatus (P = .003) were significantly correlated with repair tension. However, multivariable logistic regression analysis identified only tear size in the mediolateral direction as an independent predictor of repair tension (P = .036). Logistic regression analysis showed that repair tension (P = .02) and geometric classification (P < .001) are significant factors affecting rotator cuff integrity after ARCR. ROC curve analysis showed the cutoff value of repair tension of large to massive tears for retear to be 35.6 N.
This study demonstrated that intraoperative repair tension is strongly correlated with tear size in the mediolateral direction based on preoperative magnetic resonance imaging and that measuring tension during ARCR is effective for predicting rotator cuff integrity after ARCR.
Level IV, prognostic study.
本研究旨在探讨关节镜下肩袖修复术（ARCR）中修复张力与术前因素的相关性，并评估在 ARCR 中测量张力是否有助于预测 ARCR 后肩袖的完整性。
本研究纳入了 2014 年 5 月至 2017 年 6 月期间接受 ARCR 的患者。纳入标准为中大型撕裂且随访时间至少 6 个月的患者。部分修复的患者被排除在外。根据 Davidson 法测量术中修复张力。采用 Pearson 和 Spearman 相关系数检验评估修复张力与术前因素的相关性。对包括修复张力在内的术中因素进行 logistic 回归分析，以确定 ARCR 后再撕裂的独立预测因素。使用受试者工作特征（ROC）曲线确定再撕裂的修复张力截断值。
符合纳入标准的患者共有 120 例。平均修复张力为 26.6 ± 12.6 N，29 例（24.2%）出现再撕裂。在术前因素中，肩袖撕裂在中侧（P <.001）和前侧（P <.001）方向、DeOrio 和 Cofield 分级（P <0.001）、几何分级（P <.001）以及冈上肌（P =.006）和冈下肌（P =.003）的脂肪浸润与修复张力显著相关。然而，多变量 logistic 回归分析仅发现肩袖撕裂在中侧方向是修复张力的独立预测因素（P =.036）。logistic 回归分析表明，修复张力（P =.02）和几何分级（P <.001）是 ARCR 后肩袖完整性的重要影响因素。ROC 曲线分析显示，修复张力对于大到巨大撕裂的再撕裂的截断值为 35.6 N。
本研究表明，基于术前磁共振成像，术中修复张力与肩袖撕裂在中侧方向的大小密切相关，并且在 ARCR 中测量张力有助于预测 ARCR 后肩袖的完整性。
IV 级，预后研究。
