Ayanoglu Tacettin, Ozer Mustafa, Cetinkaya Mehmet, Kaptan Ahmet Yigit, Ulucakoy Coskun, Ataoglu Baybars, Kanatlı Ulunay
Department of Orthopedics and Traumatology, Abant Izzet Baysal University, 14300 Bolu, Turkey.
Department of Orthopaedics and Traumatology, Meram Medical Faculty of Necmettin, Erbakan University, Konya, Turkey.
Indian J Orthop. 2021 Aug 11;56(2):289-294. doi: 10.1007/s43465-021-00479-2. eCollection 2022 Feb.
The aim of this study is to examine the effect of preoperative conservative treatment on the success of high-grade bursal/articular-sided partial rotator cuff repair.
Patients who had undergone shoulder arthroscopy in institution for Ellman Stage 3 bursal-side or articular-side partial tears between January 2008 and April 2018 were investigated retrospectively. This study assessed 201 patients diagnosed with isolated partial rotator cuff tears with a history of failed conservative management and persistent shoulder pain who underwent arthroscopic surgery. The demographic data of patients and pre- and postoperative The American Shoulder and Elbow Surgeons Shoulder Scores (ASES) that were recorded in the archive were evaluated.
While 55 of the patients with Ellman grade 3 bursal-sided partial tears received preoperative conservative management for at least 6 months (Group 1), 62 of them could not tolerate conservative management and early arthroscopic repair was performed (Group 2). On the other hand, 42 of the patients with Ellman grade 3 articular-sided tears received preoperative conservative management (Group 3), 42 of them could not tolerate preoperative conservative management (Group 4). The mean ASES score improvement was 52.33 ± 8.55 for Group 1, 54.68 ± 11.29 for Group 2, 48.4 ± 7.77 for Group 3 and 49.33 ± 10.05 for Group 4. A statistically significant difference was found between the groups with one-way ANOVA test ( = 0.05). With the Tukey test, this difference was seen to be caused by Group 2.
Although there are many factors affecting its success, conservative management should be the first option in the treatment of partial rotator cuff tears. However, we think that it should not be insisted especially in patients with bursal-sided tears (> 50% of the tendon thickness) that cannot tolerate conservative management due to severe pain since the results of early arthroscopic repair of bursal-sided tears were found to be better.
Retrospective comparative study, Level III.
本研究旨在探讨术前保守治疗对高级别滑囊侧/关节侧部分肩袖修复成功率的影响。
回顾性研究2008年1月至2018年4月期间在本机构接受肩关节镜检查的Ellman 3期滑囊侧或关节侧部分撕裂患者。本研究评估了201例诊断为孤立性部分肩袖撕裂、保守治疗失败且持续存在肩部疼痛并接受关节镜手术的患者。评估了存档中记录的患者人口统计学数据以及术前和术后美国肩肘外科医师学会肩评分（ASES）。
55例Ellman 3级滑囊侧部分撕裂患者接受了至少6个月的术前保守治疗（第1组），其中62例无法耐受保守治疗而进行了早期关节镜修复（第2组）。另一方面，42例Ellman 3级关节侧撕裂患者接受了术前保守治疗（第3组），42例无法耐受术前保守治疗（第4组）。第1组的平均ASES评分改善为52.33±8.55，第2组为54.68±11.29，第3组为48.4±7.77，第4组为49.33±10.05。单向方差分析检验发现组间存在统计学显著差异（=0.05）。通过Tukey检验，发现这种差异是由第2组引起的。
虽然影响其成功的因素很多，但保守治疗应是部分肩袖撕裂治疗的首选。然而，我们认为，对于因严重疼痛而无法耐受保守治疗的滑囊侧撕裂（>肌腱厚度的50%）患者，尤其不应坚持保守治疗，因为发现滑囊侧撕裂的早期关节镜修复效果更好。
回顾性比较研究，III级。
