Department of Orthopedics and Traumatology, Gülhane Training and Research Hospital, 06000, Ankara, Turkey.
Department of Orthopedics and Traumatology, Ankara City Hospital, Ankara, Turkey.
Knee Surg Sports Traumatol Arthrosc. 2022 Oct;30(10):3499-3507. doi: 10.1007/s00167-022-06958-9. Epub 2022 Apr 2.
To evaluate whether an arthroscopic transosseous technique (ATO) with cortical implants is effective for rotator cuff tear (RCT) repair in patients with cysts of the greater tuberosity (GTC).
Patients treated with the ATO technique between January 2013 and October 2017 were evaluated. Inclusion criteria were patients treated for both cyst-related and non-cyst-related RCTs and patients with a moderate-sized tear (1-3 cm) according to the DeOrio and Cofield classification. A total of 39 patients were separated into two groups: Group 1 (n = 16) patients with cyst-associated RCT, and Group 2 (n = 23) patients with no cyst. Implant pull-out and migration were evaluated radiologically on standard antero-posterior shoulder radiographs and rotator cuff re-tear was assessed on magnetic resonance images at the final follow-up examination. Group 1 patients were separated into two subgroups according to cyst size (cyst < 5 mm and cyst ≥ 5 mm) and subgroup analysis was performed. Clinical assessment was performed using a visual analog scale, the Constant score and Oxford shoulder score.
The mean follow-up time was 33.7 ± 11.7 months. The mean cyst size was 5.4 ± 1.5 mm. There was no significant difference in re-tear rates between the cystic and non-cystic groups. The mean implant migration distance was 3.0 ± 2.2 mm in patients with a RCT -related cyst and 0.7 ± 0.8 mm in those without a cyst. A statistically significant difference was found between the groups (p = 0.002). There was no statistically significant difference between the groups in respect of clinical scores. No implant failure was observed.
The ATO method performed with a cortical implant in RCTs resulted in satisfactory recovery and clinical outcomes in the short to medium term with low failure rates. While no implant failures were observed, implant migration was associated with cyst presence. Therefore, judicious use is advocated in the choice of transosseous fixation for cyst-related RCTs and patients should be informed of the possibility of implant migration.
III.
评估关节镜下经骨技术（ATO）联合皮质骨钉治疗伴有大结节骨囊肿（GTC）的肩袖撕裂（RCT）的疗效。
评估 2013 年 1 月至 2017 年 10 月期间接受 ATO 技术治疗的患者。纳入标准为同时接受与囊肿相关和非囊肿相关的 RCT 治疗的患者，以及 DeOrio 和 Cofield 分类中 1-3cm 中等大小撕裂的患者。共 39 例患者分为两组：组 1（n=16）为伴囊肿相关 RCT 的患者，组 2（n=23）为无囊肿的患者。通过标准的前后位肩部 X 线片评估植入物的拔出和迁移，在最终随访时通过磁共振成像评估肩袖再撕裂。根据囊肿大小（囊肿<5mm 和囊肿≥5mm）将组 1 患者分为两个亚组，并进行亚组分析。临床评估采用视觉模拟评分、Constant 评分和牛津肩评分。
平均随访时间为 33.7±11.7 个月。平均囊肿大小为 5.4±1.5mm。有囊肿和无囊肿组的再撕裂率无显著差异。与 RCT 相关的囊肿患者的平均植入物迁移距离为 3.0±2.2mm，无囊肿患者为 0.7±0.8mm。两组间差异有统计学意义（p=0.002）。两组间临床评分无统计学差异。未观察到植入物失败。
在 RCT 中使用皮质骨钉的 ATO 方法在短期至中期内可获得满意的恢复和临床结果，失败率较低。虽然未观察到植入物失败，但植入物迁移与囊肿的存在有关。因此，建议在选择与囊肿相关的 RCT 的经骨固定时谨慎使用，并告知患者存在植入物迁移的可能性。
III。
