Paris shoulder unit, Clinique Bizet, Paris, France; Hand-Upper Limb-Microsurgery Department, KAT Attica General Hospital, Kifissia, Greece.
Paris shoulder unit, Clinique Bizet, Paris, France; Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Orthop Traumatol Surg Res. 2023 Apr;109(2):103296. doi: 10.1016/j.otsr.2022.103296. Epub 2022 May 7.
The footprint medialization allows a tension free repair in severely retracted rotator cuff tears (RCT), thereby de-creasing the rate of retear. The purpose of the study was to evaluate the clinical and radiological results in a cohort of chronic RCT treated with medialized repair. Secondary purpose was to analyze the impact of medialization length on shoulder function and tendon healing.
It was hypothesized that the medialization length would have an impact on clinical and radiological outcome.
A consecutive series of thirty patients that underwent arthroscopic repair of a massive posterosuperior RCT at a single institution were retrospectively studied at mean follow-up 18.4months (SD 15.3; range 9-58). The medialization of the medial footprint was measured intraoperatively. Preoperative and postoperative examination included active range of motion, abduction strength, pain assessment, and functional scores. The postoperative rotator cuff integrity was evaluated according to the Sugaya's classification. Types IV-V were categorized as absence of healing.
At final follow-up the clinical outcomes were significantly improved in all patients (p≤0.001) with the exception of external rotation that displayed no significant improvement (p=0.05). In group 1 (n=8) medialization length was≤10mm (mean 8, SD 1.9) and in group 2 (n=14)>10mm (mean 12.6, SD 1.7). There were no significant differences regarding preoperative and postoperative clinical outcomes (p>0.05) between two groups. Group 2 demonstrated moderate correlation between length of medialization and Sugaya stage of tendon healing (r=0.53, p=0.049). Absence of healing was noted in 4/22 patients, 1/8 in group 1 and 3/14 in group 2.
Medialized repair is an effective technique for treating chronic, massive and retracted posterosuperior RCT. A medialization of the footprint less than or equal to 10mm is recommended, as it was associated with good clinical and radiological results. The rate of tendon healing decreases when medialization exceeds 10mm.
III.
足迹内侧化可在严重回缩的肩袖撕裂（RCT）中实现无张力修复，从而降低再撕裂的发生率。本研究的目的是评估内侧化修复治疗慢性 RCT 患者的临床和影像学结果。次要目的是分析内侧化长度对肩部功能和肌腱愈合的影响。
假设内侧化长度会对临床和影像学结果产生影响。
在一家单机构对连续的 30 例大量后上侧 RCT 患者进行了关节镜修复，在平均随访 18.4 个月（标准差 15.3；范围 9-58）时进行回顾性研究。术中测量内侧足迹的内侧化程度。术前和术后检查包括主动活动范围、外展力量、疼痛评估和功能评分。根据 Sugaya 分类评估术后肩袖完整性。IV-V 型被归类为未愈合。
在最终随访时，所有患者的临床结果均显著改善（p≤0.001），除了外旋外，外旋无明显改善（p=0.05）。在组 1（n=8）中，内侧化长度≤10mm（平均 8，标准差 1.9），在组 2（n=14）中>10mm（平均 12.6，标准差 1.7）。两组之间术前和术后临床结果无显著差异（p>0.05）。组 2 显示内侧化长度与肌腱愈合 Sugaya 分期之间存在中度相关性（r=0.53，p=0.049）。22 例患者中有 4 例（18%）、组 1 中有 1 例（13%）和组 2 中有 3 例（21%）出现未愈合。
内侧化修复是治疗慢性、巨大和回缩性后上侧 RCT 的有效技术。建议足迹内侧化小于或等于 10mm，因为它与良好的临床和影像学结果相关。当内侧化超过 10mm 时，肌腱愈合率会降低。
III。
