Department of Orthopedic Surgery, Eunpyeong St Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Am J Sports Med. 2022 Jul;50(8):2219-2226. doi: 10.1177/03635465221093809. Epub 2022 May 23.
Because the articular layer is more prone to retraction than the bursal layer of the supraspinatus tendon, it is important to restore each layer anatomically while repairing delaminated rotator cuff tears (RCTs).
To compare clinical outcomes and tendon integrity between knotless layer-by-layer and conventional en masse repair techniques for delaminated RCTs.
Cohort study; Level of evidence, 3.
We retrospectively reviewed data from 174 consecutive patients with delaminated RCTs treated by arthroscopic suture bridge repair. Only 115 patients with medium to large supraspinatus tears with delamination were included. The 33 patients treated using the knotless layer-by-layer technique (group 2) were matched 1:1 with patients treated using en masse repair with the suture bridge technique (group 1) based on propensity scores. Tendon thickness was measured on magnetic resonance imaging (MRI). Signal changes in the bursal, articular, and intratendinous layers were assessed using T2-weighted MRI.
Postoperatively, statistically significant improvements were seen in both groups compared with preoperatively functional scores. At the final follow-up, there was a statistically significant difference in the Constant score, which was higher in group 2 than in group 1 (91.4 ± 6.0 and 84.3 ± 16.4, respectively; = .005). There was 1 case of a retear in each group, representing a 3% retear rate. Group 2 had thicker tendons than group 1 (6.9 ± 1.1 and 6.0 ± 1.2 mm, respectively; = .017). On T2-weighted MRI, a low signal intensity in the articular layer was more common in group 2 ( = .046).
En masse repair using the suture bridge technique and the knotless layer-by-layer technique were both effective. Regarding tendon healing, no significant differences were seen in retear rates. However, superior results in terms of the Constant score, tendon thickness, and signal intensity in the articular layer were observed using the knotless layer-by-layer technique.
由于肩袖肌腱的关节层比滑囊层更容易回缩，因此在修复分层撕裂的肩袖肌腱时，重要的是要将各层解剖学地修复。
比较无结分层修复与常规整块修复分层撕裂的肩袖肌腱全层撕裂的临床疗效和肌腱完整性。
队列研究；证据水平，3 级。
我们回顾性分析了 174 例接受关节镜下缝合桥修复的分层撕裂肩袖肌腱连续患者的数据。仅纳入 115 例中等至大型肩袖撕裂伴分层撕裂的患者。33 例采用无结分层技术（组 2）治疗的患者与采用缝合桥技术整块修复的患者（组 1）按倾向评分 1:1 匹配。通过磁共振成像（MRI）测量肌腱厚度。采用 T2 加权 MRI 评估滑囊层、关节层和腱内层的信号变化。
与术前相比，两组术后的功能评分均有显著改善。在最终随访时，组 2 的 Constant 评分明显高于组 1（分别为 91.4±6.0 和 84.3±16.4； =.005）。两组均有 1 例再撕裂，再撕裂率为 3%。组 2 的肌腱比组 1 厚（分别为 6.9±1.1 和 6.0±1.2 mm； =.017）。在 T2 加权 MRI 上，组 2 的关节层低信号更常见（ =.046）。
采用缝合桥技术的整块修复与无结分层修复技术均有效。就肌腱愈合而言，两种方法的再撕裂率无显著差异。然而，无结分层修复技术在 Constant 评分、肌腱厚度和关节层信号强度方面的结果更优。
