Department of Orthopaedic Surgery, The Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL, USA.
J Shoulder Elbow Surg. 2021 Jul;30(7S):S66-S70. doi: 10.1016/j.jse.2021.04.008. Epub 2021 Apr 21.
The benefit of rotator cuff repair (RCR) in patients with concurrent osteoarthritic changes remains unclear. RCR has the theoretical potential to increase the compressive force across the glenohumeral joint, further exacerbating osteoarthritis pain. The purpose of this study is to investigate pain relief and patient-reported outcomes of patients undergoing simultaneous RCR and microfracture of focal glenohumeral osteoarthritis.
Thirty-four patients undergoing simultaneous RCR and microfracture were retrospectively reviewed at a minimum 1-year follow-up. Patient demographics, preoperative range of motion, functional outcomes (visual analog scale [VAS], Single Assessment Numeric Evaluation [SANE], American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES], and Simple Shoulder Test [SST]), and operative metrics were recorded. The patients were then contacted to obtain postoperative functional outcome scores (VAS, SANE, ASES, and SST).
Twenty-seven patients (11 male/16 female [79%]) were evaluated at a mean follow-up of 25.8 months (range, 12-46). The average age at surgery was 64.9 years (range, 56-78). Chronic tears were more common than acute tears (57.7% vs. 42.3%). The majority of patients had a full rotator cuff tear (89%) involving a mean 1.7 ± 0.8 tendons (range, 1-3). Eighty-eight percent of the humeral lesions were Outerbridge 4 compared with 84% on the glenoid. The mean estimated involvement between the 2 groups with 38.4% ± 18.4% of the humeral head involved and 34.6% ± 18.4% of the glenoid involved. PRO scores improved postoperatively with a reduction in mean VAS (6.6-2.0, P < .01), SANE (33.8-79.8, P < .01), ASES (38.0-80.9, P < .01), and SST (3.07-9.70, P < .01) scores. Cumulatively, only 52% (14/27) of the patients improved, however, by the MCID for all collected PROs.
Our results demonstrate modest improvements in postoperative pain and functional scores at a minimum of 1-year follow-up in a cohort of patients who have undergone RCR and glenohumeral microfracture. In cases of small focal lesions of full-thickness cartilage loss, RCR with microfracture is a reasonable treatment option; however, patients should be counseled on expectations accordingly.
在伴有骨关节炎变化的患者中，肩袖修复（RCR）的益处尚不清楚。RCR 具有增加盂肱关节压缩力的理论潜力，从而进一步加剧骨关节炎疼痛。本研究旨在探讨同时行 RCR 和微骨折治疗肱骨头骨关节炎的患者的疼痛缓解和患者报告的结果。
对 34 例在至少 1 年随访时接受同时行 RCR 和微骨折的患者进行回顾性研究。记录患者的人口统计学资料、术前活动范围、功能结果（视觉模拟评分[VAS]、单项评估数值评估[SANE]、美国肩肘外科医生协会标准肩部评估表[ASES]和简单肩部测试[SST]）和手术指标。然后联系患者以获得术后功能结果评分（VAS、SANE、ASES 和 SST）。
27 例患者（男性 11 例，女性 16 例[79%]）平均随访 25.8 个月（12-46 个月）后进行了评估。手术时的平均年龄为 64.9 岁（56-78 岁）。慢性撕裂比急性撕裂更常见（57.7%比 42.3%）。大多数患者有全层肩袖撕裂（89%），涉及平均 1.7±0.8 根肌腱（范围 1-3 根）。88%的肱骨病变为 Outerbridge 4 级，而盂骨病变为 84%。两组之间的平均受累程度为肱骨头部受累 38.4%±18.4%，盂骨受累 34.6%±18.4%。PRO 评分术后改善，平均 VAS（6.6-2.0，P<.01）、SANE（33.8-79.8，P<.01）、ASES（38.0-80.9，P<.01）和 SST（3.07-9.70，P<.01）评分降低。累计而言，只有 52%（14/27）的患者得到改善，但所有收集的 PRO 均达到了 MCID。
在一组接受 RCR 和盂肱关节微骨折的患者中，我们的结果显示在至少 1 年的随访时，术后疼痛和功能评分有适度改善。在全层软骨缺失的小病灶性病变的情况下，RCR 联合微骨折是一种合理的治疗选择；然而，应相应告知患者预期。
