Nair Ayyappan V, Jangale Ajit, Kumar M Praveen, Reddy Premsai, Kuntwad Vikas, Goud Naresh, Murthy Raghu
Bangalore Shoulder Institute, Bangalore, Karnataka, India.
JSES Int. 2021 Sep 14;5(6):1072-1076. doi: 10.1016/j.jseint.2021.07.012. eCollection 2021 Nov.
Various arthroscopic portals have been described for repair of superior labrum anterior-posterior (SLAP) lesions. The difficulty in doing repair through the rotator interval and the problems in direction and placement of anchors still persist. Functional outcomes of the patients after treating them using trans-cuff portal are well established in literature, but the actual healing of the portal is not clear. We made a sincere effort to identify healing of the trans-cuff portal with ultrasound guidance and functional outcome using American Shoulder and Elbow Surgeons Shoulder Score (ASES score), Constant Shoulder Score, and Oxford Shoulder Score.
Twenty-two patients with SLAP or labral tears and normal contralateral shoulders were included. Surgery was performed using the trans-cuff portal as a viewing or working portal for biceps repair and labral repair. Rehabilitation was initiated from day 1 and followed up on 6 weeks, 3 months and, 6 months with a maximum follow-up duration of 2 years. Ultrasound was used to measure the depth of healing and graded at 6 weeks of follow-up postoperatively. Functional outcomes were measured using ASES score, Constant Shoulder Score, and Oxford Shoulder Score measured at 6 months.
Seventeen patients were of grade 1 (complete healing); 1 patient was of grade 2 (more than 50% healing); 1 of grade 3 (less than 50% healing), and 3 were lost to follow-up. Fourteen patients out of 19 had excellent ASES scores, 4 patients had good scores, and 1 patient was considered as poor with an average ASES score of 84.51 (range 93-48) and standard deviation of 10.37. The ASES score indicated that healing of the rotator cuff portal is directly related to the functional outcome of the shoulder. The Constant Shoulder Score and Oxford Shoulder Score on the contrary were statistically not significant indicating no relation of the Oxford and Constant scores with healing of the rotator cuff portals.
Trans-cuff portal is safe, gives proper angle for insertion of anchors, and can be used for repair of SLAP lesions with ease. Ultrasonography helps in confirming the healing of portal.
已描述了多种用于修复肩盂唇前后上（SLAP）损伤的关节镜入路。通过旋转间隙进行修复存在困难，且锚钉的方向和放置问题仍然存在。文献中已明确使用经袖套入路治疗患者后的功能结果，但该入路的实际愈合情况尚不清楚。我们真诚地努力通过超声引导来确定经袖套入路的愈合情况，并使用美国肩肘外科医师学会肩评分（ASES评分）、Constant肩评分和牛津肩评分来评估功能结果。
纳入22例患有SLAP或盂唇撕裂且对侧肩部正常的患者。手术使用经袖套入路作为观察或操作入路进行肱二头肌修复和盂唇修复。术后第1天开始康复治疗，并在6周、3个月和6个月进行随访，最长随访时间为2年。术后6周随访时，使用超声测量愈合深度并进行分级。6个月时使用ASES评分、Constant肩评分和牛津肩评分测量功能结果。
17例患者为1级（完全愈合）；1例为2级（愈合超过50%）；1例为3级（愈合少于50%），3例失访。19例患者中，14例ASES评分优秀，4例评分良好，1例被认为较差，平均ASES评分为84.51（范围93 - 48），标准差为10.37。ASES评分表明，肩袖入路的愈合与肩部功能结果直接相关。相反，Constant肩评分和牛津肩评分在统计学上无显著意义，表明牛津评分和Constant评分与肩袖入路的愈合无关。
经袖套入路安全，为锚钉插入提供合适角度，可轻松用于SLAP损伤的修复。超声有助于确认入路的愈合情况。
