Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Am J Sports Med. 2021 Oct;49(12):3202-3211. doi: 10.1177/03635465211034503. Epub 2021 Sep 14.
Among symptomatic partial-thickness rotator cuff tears (PTRCT) indicated for surgery, both-sided (concurrent articular and bursal side) PTRCT are rarely reported and discussed in the literature. Without clinical data on and definite guidelines for treating these rare partial tears, appropriate management cannot be expected.
To calculate the prevalence of both-sided PTRCT and to evaluate clinical outcomes after arthroscopic transtendon suture bridge repair of both-sided PTRCT at a minimum 3-year follow-up.
Case series; Level of evidence, 4.
Among symptomatic PTRCT that required arthroscopic surgery (765 patients) between March 2008 and December 2014, 178 both-sided partial tears were confirmed arthroscopically, and arthroscopic transtendon suture bridge repair was performed in 100 patients enrolled in our study after exclusion criteria were applied. The presence of concurrent articular and bursal side partial tears was confirmed via arthroscopy, with Ellman grade >2 on either the bursal or the articular side of these both-sided partial tears. Without tear completion, transtendon suture bridge repair was performed in all cases. Clinical outcomes including clinical scores and range of motion were evaluated at a mean of 5.3 ± 1.4 years (range, 3-8 years). Follow-up magnetic resonance imaging (MRI) was performed at 6 to 12 months (mean ± SD, 11 ± 5.20 months) after surgery to evaluate the tendon integrity (Sugaya classification) of the repaired rotator cuff.
The mean age was 57.5 ± 7.8 years, and 65% of patients were women. Mean preoperative American Shoulder and Elbow Surgeons, University of California Los Angeles, Simple Shoulder Test, and Constant-Murley outcome scores of 52 ± 14, 19 ± 4, 6 ± 2, and 69 ± 10 significantly improved postoperatively to 94 ± 5, 33 ± 2, 11 ± 1, and 93 ± 5, respectively ( < .001). Mean forward flexion, abduction, external rotation, and internal rotation improved significantly from 148°± 31°, 134°± 39°, 22°± 13°, and L2 preoperatively to 154°± 17°, 151°± 60°, 29°± 14°, and T10 postoperatively, respectively ( < .001). The retear rate on follow-up MRI scans was 2%. As per Sugaya classification on postoperative MRI scans, type 1 healing was found in 29%; type 2, in 60%; type 3, in 9%; and type 4, in 2%.
Among all symptomatic PTRCT that required surgery, both-sided PTRCT were more common than expected. Arthroscopic transtendon suture bridge repair of these both-sided PTRCT showed satisfactory clinical outcomes at a minimum 3-year follow-up.
在有症状的部分厚度肩袖撕裂（PTRCT）中，需要手术治疗的患者中，双侧（同时累及关节面和肩袖面）的 PTRCT 很少在文献中报道和讨论。由于缺乏这些罕见部分撕裂的临床数据和明确的治疗指南，因此无法进行适当的治疗。
计算双侧 PTRCT 的发生率，并评估在至少 3 年的随访中，对双侧 PTRCT 进行关节镜下腱骨缝合桥修复的临床结果。
病例系列；证据等级，4 级。
在 2008 年 3 月至 2014 年 12 月期间，对需要关节镜手术的有症状 PTRCT（765 例患者）中，有 178 例双侧部分撕裂通过关节镜得到确认，并在排除标准后，对 100 例符合条件的患者进行了关节镜下腱骨缝合桥修复。通过关节镜检查确定了同时存在关节面和肩袖面部分撕裂的情况，这些双侧部分撕裂中至少有一侧的 Ellman 分级 >2。所有病例均在没有撕裂完成的情况下进行腱骨缝合桥修复。平均 5.3 ± 1.4 年（范围，3-8 年）后进行临床评分和运动范围等临床结果评估。术后 6 至 12 个月（平均 ± SD，11 ± 5.20 个月）进行随访 MRI 检查，以评估修复的肩袖的肌腱完整性（Sugaya 分类）。
平均年龄为 57.5 ± 7.8 岁，65%为女性。术前美国肩肘外科医师协会、加利福尼亚大学洛杉矶分校、简易肩测试和 Constant-Murley 评分分别为 52 ± 14、19 ± 4、6 ± 2 和 69 ± 10，术后分别显著改善至 94 ± 5、33 ± 2、11 ± 1 和 93 ± 5（<.001）。术前前屈、外展、外旋和内旋分别为 148°± 31°、134°± 39°、22°± 13°和 L2，术后分别显著改善至 154°± 17°、151°± 60°、29°± 14°和 T10（<.001）。在随访的 MRI 扫描中，再撕裂率为 2%。根据术后 MRI 扫描的 Sugaya 分类，1 型愈合占 29%；2 型，60%；3 型，9%；4 型，2%。
在所有需要手术治疗的有症状 PTRCT 中，双侧 PTRCT 比预期更为常见。对这些双侧 PTRCT 进行关节镜下腱骨缝合桥修复，在至少 3 年的随访中可获得满意的临床效果。
