Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Myongji Hospital, Goyang-si, Gyeonggi-do, Republic of Korea.
Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea.
J Shoulder Elbow Surg. 2021 Nov;30(11):2560-2569. doi: 10.1016/j.jse.2021.04.026. Epub 2021 May 5.
Follow-up magnetic resonance imaging (MRI) after rotator cuff repair can sometimes demonstrate healing with nontendinous tissue that extends from the footprint to the retracted tendon end, which is inferred as fibrous tissue formation. The aim was to investigate this particular finding and its significance.
There were 494 eligible cases of healed supero-posterior medium-sized to massive rotator cuff repairs, after the exclusion of retears. A retrospective review was performed for the 3 groups that were divided according to their MRI appearances of healing: type I described the direct healing of the tendon to the footprint, whereas type II demonstrated the distinctive continuity of nontendinous tissue from the footprint to the retracted tendinous portion, and type III also showed a similar appearance but with obvious thinning of the tissue, without any evidence of defect confirmed on the routine outpatient ultrasonograph.
Only 108 of 494 patients (21.9%) demonstrated type I healing, whereas the signs of nontendinous healing were evident for the rest, with the 116 patients (23.5%) being classified as type III with attenuation. Comparing the preoperative tendon retraction, 34.8% and 37.2% of the Patte stages 2 and 3, respectively, resulted in type III healing, which were significantly higher compared with that of stage 1 (15.3%, P < .001). Type III healing had the highest average preoperative Goutallier grades. The average postoperative visual analog scale and the American Shoulder and Elbow Surgeons (ASES) scores have improved significantly for all 3 groups (P < .05), with the ASES score being 86.1±15.9 for type I, 93.7±36.1 for type II, and 87.8±15.1 for type III without significant differences between the groups (P = .3).
Only a fifth of the rotator cuff repairs led to a direct healing to the footprint, and the rest healed with MRI appearance of nontendinous tissue formation bridging the retracted tendinous portion and the footprint. These MRI appearances did not represent the true tendinous tissue formation between the torn end of the tendon and the bone after healing. Such appearances did not seem to affect the clinical outcomes.
肩袖修复后的随访磁共振成像（MRI）有时可显示愈合的非肌腱组织从足迹延伸至回缩的肌腱末端，这被推断为纤维组织形成。目的是研究这一特殊发现及其意义。
在排除再撕裂后，共有 494 例愈合的超后部中到大体积肩袖修复的病例符合入选标准。对根据愈合 MRI 表现分为 3 组的病例进行回顾性分析：I 型描述了肌腱直接愈合至足迹，而 II 型显示了从足迹到回缩肌腱部分的非肌腱组织的明显连续性，III 型也显示了类似的外观，但组织明显变薄，常规门诊超声检查未发现任何缺陷证据。
494 例患者中仅有 108 例（21.9%）表现为 I 型愈合，其余患者均有非肌腱愈合的迹象，其中 116 例（23.5%）为 III 型伴衰减。比较术前肌腱回缩，Patte 分期 2 期和 3 期分别有 34.8%和 37.2%的患者出现 III 型愈合，明显高于分期 1 期（15.3%，P<0.001）。III 型愈合的术前 Goutallier 分级平均最高。三组患者的术后平均视觉模拟评分和美国肩肘外科医生（ASES）评分均显著改善（P<0.05），I 型为 86.1±15.9，II 型为 93.7±36.1，III 型为 87.8±15.1，组间差异无统计学意义（P=0.3）。
只有五分之一的肩袖修复导致直接愈合至足迹，其余的修复则通过 MRI 显示非肌腱组织形成桥接回缩的肌腱部分和足迹。这些 MRI 表现并不代表愈合后肌腱撕裂端与骨之间真正的肌腱组织形成。这些表现似乎并不影响临床结果。
