Department of Orthopedics and Traumatology, Koc University Hospital, Istanbul, Turkey.
Department of Orthopedics and Traumatology, Vehbi Koc Vakfı American Hospital, Istanbul, Turkey.
J Shoulder Elbow Surg. 2021 Dec;30(12):2767-2777. doi: 10.1016/j.jse.2021.04.034. Epub 2021 May 13.
The objective of this study was to evaluate the long-term functional outcomes and structural integrity of medium to massive rotator cuff tears at 10-12 years of follow-up after arthroscopic transosseous-equivalent (TOE) repair.
This was a retrospective study of a consecutive series of patients who underwent primary arthroscopic TOE repair of medium- to massive-sized degenerative rotator cuff tears performed by a single surgeon between January 2007 and August 2009. Patients were examined at a minimum follow-up of 10 years, and magnetic resonance imaging (MRI) was performed to assess tendon integrity. The Constant score (CS), American Shoulder and Elbow Surgeons score, and pain level documented using a visual analog scale were compared between intact repairs and recurrent defects. Univariate analysis was performed to identify factors related to recurrent defects.
A total of 102 patients met the inclusion criteria, and 79 shoulders in 76 patients (74.5% of eligible patients) with a mean age at surgery of 55 ± 8 years (range, 40-72 years) were available for clinical evaluation at a mean follow-up time of 10.9 years (range, 10-12 years). The mean anteroposterior tear size was 3.1 ± 1.1 cm, and there were 41 medium (52%), 26 large (33%), and 12 massive (15%) tears. MRI was performed in 72 shoulders in 69 patients (91% of available shoulders) and revealed that 13 shoulders had recurrent defects (Sugaya stages 4 and 5). During the follow-up period, 3 patients underwent revision surgery, and the overall recurrent defect rate was 21.3%. A clinically meaningful improvement was observed in all outcome measures at the final follow-up regardless of tendon integrity. Patients with intact repairs showed superior outcomes compared with those with recurrent defects; however, only the overall CS met the threshold for clinical relevance. A significant linear correlation was observed between the Sugaya classification and all outcome scores except the CS pain subscale; however, the strength of correlation was weak. The presence of diabetes (odds ratio [OR], 8.6; 95% confidence interval [CI], 2.25-33.2; P = .002), tear size (OR, 2.08; 95% CI, 1.16-3.46; P = .012), and tear retraction (OR, 4.07; 95% CI, 1.11-14.83; P = .033) were associated with recurrent defects in the univariate analysis.
Arthroscopic TOE repair of rotator cuff tears provided improved clinical outcomes with a recurrent defect rate of 21.3% at 10-12 years after surgery. Future research focusing on tendon healing is needed as repair integrity on MRI correlates with clinical outcomes.
本研究旨在评估关节镜下经骨隧道等长修复术（TOE）治疗中至大量肩袖撕裂的长期功能结果和结构完整性，随访时间为 10-12 年。
这是一项回顾性连续病例系列研究，纳入了 2007 年 1 月至 2009 年 8 月期间由同一位外科医生行关节镜下 TOE 修复的中至大量退行性肩袖撕裂患者。所有患者均接受了至少 10 年的随访，并进行了磁共振成像（MRI）检查以评估肌腱完整性。比较了完整修复组和复发性缺损组的 Constant 评分（CS）、美国肩肘外科医生评分和疼痛程度（视觉模拟评分）。采用单因素分析确定与复发性缺损相关的因素。
共纳入 102 例患者，76 例患者中的 79 个肩（符合条件患者的 74.5%）接受了手术，平均年龄为 55±8 岁（范围 40-72 岁），平均随访时间为 10.9 年（范围 10-12 年）。平均前后向撕裂大小为 3.1±1.1cm，其中 41 例为中等撕裂（52%）、26 例为大撕裂（33%）、12 例为巨大撕裂（15%）。72 例患者中的 69 例（可评估肩的 91%）进行了 MRI 检查，发现 13 例存在复发性缺损（Sugaya 分期 4 或 5 期）。随访期间，3 例患者接受了翻修手术，总的复发性缺损率为 21.3%。无论肌腱完整性如何，所有患者在末次随访时的所有结局测量指标均有明显的临床改善。完整修复组的结果优于复发性缺损组，但只有 CS 总体评分具有临床相关性。Sugaya 分类与除 CS 疼痛亚量表以外的所有结局评分均呈显著线性相关；然而，相关性较弱。糖尿病（比值比 [OR]，8.6；95%置信区间 [CI]，2.25-33.2；P=.002）、撕裂大小（OR，2.08；95% CI，1.16-3.46；P=.012）和撕裂回缩（OR，4.07；95% CI，1.11-14.83；P=.033）与单因素分析中的复发性缺损相关。
关节镜下 TOE 修复肩袖撕裂在术后 10-12 年时的临床结果得到改善，但仍有 21.3%的复发性缺损率。需要进一步开展有关肌腱愈合的研究，因为 MRI 上的修复完整性与临床结局相关。
