Meshram Prashant, Liu Bei, Kim Sang Woo, Heo Kang, Oh Joo Han
Shoulder Division, Department of Orthopedics, Johns Hopkins University, Baltimore, Maryland, USA.
Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea.
Orthop J Sports Med. 2021 Apr 20;9(4):2325967121998791. doi: 10.1177/2325967121998791. eCollection 2021 Apr.
The retear rate after revision rotator cuff repair (rRCR) ranges from 50% to 90%. Patients who undergo primary RCR (pRCR) for large to massive rotator cuff tear (mRCT) also have unpredictable outcomes.
To compare the clinical outcomes after rRCR for a posterosuperior rotator cuff tear of any size with those after pRCR for mRCT and to identify the risk factors for poor outcomes and retear after rRCR.
Cohort study; Level of evidence, 3.
Among patients with posterosuperior cuff tear treated between 2010 and 2017, the clinical outcomes of 46 patients who underwent rRCR were compared with 106 patients who underwent pRCR for mRCT. Between-group differences in patient-reported outcomes (visual analog scale [VAS] for pain, VAS for satisfaction and American Shoulder and Elbow Surgeons [ASES] and Constant scores) at final follow-up were evaluated and compared with previously published minimal clinically important difference (MCID) values. Radiological outcomes were evaluated using magnetic resonance imaging or ultrasonography at a minimum 1-year follow-up. Multivariate linear regression analysis was performed to identify the risk factors for poor ASES score, and multivariate logistic regression analysis was used to assess the risk factors for retear after rRCR.
The mean follow-up was 26.4 months (range, 24-81 months). Although final VAS for pain, VAS for satisfaction, and ASES scores in the rRCR group were significantly worse than those in the pRCR group, the Constant score was similar between the groups. These differences in outcomes did not exceed the MCID threshold. The retear rate in the rRCR group was 50% compared with 39% for the pRCR group ( = .194). In the rRCR group, risk factors for worse ASES score were retear ( = .043; -11.3), lower body mass index ( = .032; 1.9), and lower preoperative VAS for pain ( = .038; 2.3), and risk factors for retear were preoperative high-grade fatty degeneration (Goutallier grades 3 and 4) of the supraspinatus muscle ( = .026; odds ratio, 5.2) and serum hyperlipidemia ( = .035; odds ratio, 11.8).
Both study groups had similar clinical and radiological outcomes. Patients with symptomatic failed rotator cuff repairs having high-grade fatty degeneration of the supraspinatus muscle and/or serum hyperlipidemia had a greater likelihood of retear after rRCR.
翻修性肩袖修复术（rRCR）后的再撕裂率在50%至90%之间。因巨大至 massive 肩袖撕裂（mRCT）接受初次肩袖修复术（pRCR）的患者，其预后也难以预测。
比较任意大小的后上肩袖撕裂行rRCR后的临床结局与mRCT行pRCR后的临床结局，并确定rRCR后预后不良和再撕裂的危险因素。
队列研究；证据等级，3级。
在2010年至2017年接受治疗的后上肩袖撕裂患者中，将46例行rRCR的患者的临床结局与106例行pRCR治疗mRCT的患者的临床结局进行比较。评估最终随访时患者报告结局（疼痛视觉模拟量表[VAS]、满意度VAS、美国肩肘外科医师学会[ASES]评分和Constant评分）的组间差异，并与先前发表的最小临床重要差异（MCID）值进行比较。在至少1年的随访时，使用磁共振成像或超声评估影像学结局。进行多变量线性回归分析以确定ASES评分不佳的危险因素，并使用多变量逻辑回归分析评估rRCR后再撕裂的危险因素。
平均随访时间为26.4个月（范围24 - 81个月）。虽然rRCR组的最终疼痛VAS、满意度VAS和ASES评分显著低于pRCR组，但两组间的Constant评分相似。这些结局差异未超过MCID阈值。rRCR组的再撕裂率为50%，而pRCR组为39%（P = 0.194）。在rRCR组中，ASES评分较差的危险因素为再撕裂（P = 0.043；β = -11.3）、较低的体重指数（P = 0.032；β = 1.9）和较低的术前疼痛VAS（P = 0.038；β = 2.3），而再撕裂的危险因素为术前冈上肌高级别脂肪变性（Goutallier分级3级和4级）（P = 0.026；比值比，5.2）和血清高脂血症（P = 0.035；比值比，11.8）。
两个研究组的临床和影像学结局相似。肩袖修复失败且有症状、冈上肌存在高级别脂肪变性和/或血清高脂血症的患者，rRCR后再撕裂的可能性更大。
