Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Department of Orthopaedic Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea.
J Shoulder Elbow Surg. 2022 Oct;31(10):2096-2105. doi: 10.1016/j.jse.2022.02.040. Epub 2022 Apr 13.
The optimal management for massive rotator cuff tears (MRCTs) without osteoarthritis (OA) remains controversial. The purpose of this study was to evaluate and compare the clinical outcomes of reverse shoulder arthroplasty (RSA) vs. rotator cuff repair (RCR) in patients with MRCTs without OA.
We conducted a retrospective data analysis of 68 patients treated for MRCTs via RSA and 215 patients treated for MRCTs via arthroscopic RCR between January 2014 and April 2019. Through propensity score matching, patients were matched for sex, age, tear size, and global fatty degeneration index. Thirty-nine patients in each group were included, and all patients had completed minimal 2-year follow-up. Postoperative radiologic evaluations of healing failure were performed. The visual analog scale score for pain, range of motion, and functional outcome measures including the American Shoulder and Elbow Surgeons score, QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score, Simple Shoulder Test score, and Constant score were assessed and compared between the 2 groups.
Healing failure was observed in 10 patients in the RCR group (32.3%). No statistically significant differences in preoperative range of motion and functional scores were found between the RCR and RSA groups. Both groups showed significant pain relief and functional improvement at final follow-up. Patients in the RCR group showed significantly greater forward elevation (156.4° ± 23.8° vs. 139.7° ± 22.4°, P < .001) and internal rotation (thoracic vertebra, T8.2 ± 1.2 vs. T9.7 ± 2.6, P = .001). The average American Shoulder and Elbow Surgeons score was 88.3 ± 12.2 in the RCR group and 81.8 ± 16.1 in the RSA group (P = .045). The QuickDASH score was significantly higher in the RCR group (P = .019). A significantly higher Simple Shoulder Test score (9.7 ± 2.8 vs. 8.1 ± 3.0, P = .01) and a significantly higher Constant score (67.2 ± 6.5 vs. 63.2 ± 7.1, P = .011) were seen in the RCR group.
Both RSA and RCR are effective and reliable treatment options for MRCTs without OA. However, the RCR group showed better shoulder function improvement than the RSA group. Considering the possible implications of RSA, RCR should be referred to as a first-line treatment option for patients with MRCTs without OA with proper indications.
对于无骨关节炎（OA）的巨大肩袖撕裂（MRCT），最佳治疗方法仍存在争议。本研究旨在评估和比较反肩关节置换术（RSA）与关节镜下肩袖修复术（RCR）治疗无 OA 的 MRCT 的临床疗效。
我们回顾性分析了 2014 年 1 月至 2019 年 4 月期间采用 RSA 治疗的 68 例 MRCT 患者和采用关节镜 RCR 治疗的 215 例 MRCT 患者。通过倾向评分匹配，对性别、年龄、撕裂大小和全层脂肪变性指数进行匹配。每组纳入 39 例患者，所有患者均完成了至少 2 年的随访。术后对愈合失败进行影像学评估。评估并比较两组患者的疼痛视觉模拟评分（VAS）、活动范围和功能结果测量值，包括美国肩肘外科医师评分（ASES）、简易肩功能测试（QuickDASH）评分、肩肘功能评分（DASH）和 Constant 评分。
RCR 组有 10 例（32.3%）发生愈合失败。RCR 组和 RSA 组在术前活动范围和功能评分方面无统计学差异。两组患者在末次随访时均表现出明显的疼痛缓解和功能改善。RCR 组患者的前向活动度（156.4°±23.8°比 139.7°±22.4°，P<.001）和内旋（T8.2°±1.2 比 T9.7°±2.6，P=.001）明显更大。RCR 组的平均美国肩肘外科医师评分（ASES）为 88.3±12.2，而 RSA 组为 81.8±16.1（P=.045）。RCR 组的简易肩功能测试（QuickDASH）评分明显更高（P=.019）。RCR 组的简单肩功能测试评分（9.7±2.8 比 8.1±3.0，P=.01）和 Constant 评分（67.2±6.5 比 63.2±7.1，P=.011）明显更高。
RSA 和 RCR 均为治疗无 OA 的 MRCT 的有效且可靠的治疗方法。然而，RCR 组的肩关节功能改善优于 RSA 组。鉴于 RSA 的潜在影响，对于有适当适应证的无 OA 的 MRCT 患者，RCR 应作为首选治疗方法。
