Yuan Tao, Yang Shaoqiang, Qian Hong, Lai Chengteng, Jiang Hui, Meng Jia, Zhao Jianning, Bao Nirong
Department of Orthopedics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Department of Orthopedics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
J Shoulder Elbow Surg. 2023 Jan;32(1):24-32. doi: 10.1016/j.jse.2022.06.018. Epub 2022 Aug 7.
The current surgical techniques for repairing Ellman Ⅲ partial articular supraspinatus tendon avulsion (PASTA) is mainly tear completion followed by repair and in situ transtendon repair, and both techniques have been proven to have good clinical effects. In situ transtendon repair is more widely used because of its high performance in preserving the integrity of the bursal side supraspinatus tendon. However, there is still some scope for improvement. Our purpose was to compare the clinical outcomes of the all-inside repair technique and in situ transtendon repair for Ellman III PASTA.
A retrospective comparative study was conducted on 56 patients who suffered from Ellman Ⅲ PASTA and underwent rotator cuff repair; 28 patients were treated with the all-inside technique (group A), and 28 patients were treated with the transtendinous technique (group B). All patients were followed up for at least 2 years. The visual analog scale (VAS), Constant, and American Shoulder and Elbow Surgeons (ASES) scores were used to evaluate the patient's shoulder joint function before surgery, 1 month and 3 months after surgery, and at the last time of follow-up.
Group A showed superiority in pain and functional improvement 1 month after the operation: the VAS score, 2.8 ± 0.3 in group A vs. 4.7 ± 0.4 in group B (P = .042); Constant score, 73 ± 5 in group A vs. 60 ± 6 in group B (P = .038); and ASES score, 75 ± 5 in group A vs. 58 ± 7 in group B (P = .043), whereas there was no statistical difference in group B. However, 3 months after surgery and at the last follow-up, the VAS, Constant, and ASES scores in both groups were significantly improved (P < .01), and there was no significant statistical difference between the groups (P > .05). Magnetic resonance imaging showed that the repaired rotator cuff tendon-bone healed well; at the last follow-up, all patients were in good function, the pain was completely relieved, and no revision was performed in both groups.
Arthroscopic repair of Ellman Ⅲ PASTA provided satisfactory functional improvements and pain relief regardless of the all-inside and in situ transtendon repair techniques. However, the all-inside repair technique is more beneficial due to its dual function in preserving the intact bursa and avoidance of uneven tension of the articular side, which is advantageous to early postoperative rehabilitation.
目前修复埃尔曼Ⅲ型部分关节面冈上肌腱撕脱（PASTA）的手术技术主要是完成撕裂后进行修复和原位经肌腱修复，这两种技术均已被证明具有良好的临床效果。原位经肌腱修复因其在保留滑囊侧冈上肌腱完整性方面表现出色而应用更为广泛。然而，仍有一些改进空间。我们的目的是比较全内修复技术和原位经肌腱修复技术治疗埃尔曼Ⅲ型PASTA的临床效果。
对56例患有埃尔曼Ⅲ型PASTA并接受肩袖修复的患者进行回顾性比较研究；28例患者采用全内技术治疗（A组），28例患者采用经肌腱技术治疗（B组）。所有患者均随访至少2年。采用视觉模拟量表（VAS）、康斯坦特评分以及美国肩肘外科医师（ASES）评分，在术前、术后1个月和3个月以及末次随访时评估患者的肩关节功能。
术后1个月，A组在疼痛和功能改善方面表现更优：A组VAS评分为2.8±0.3，B组为4.7±0.4（P = 0.042）；A组康斯坦特评分为73±5，B组为60±6（P = 0.038）；A组ASES评分为75±5，B组为58±7（P = 0.043），而B组无统计学差异。然而，术后3个月及末次随访时，两组的VAS、康斯坦特和ASES评分均显著改善（P < 0.01），且两组间无显著统计学差异（P > 0.05）。磁共振成像显示修复的肩袖肌腱 - 骨愈合良好；末次随访时，所有患者功能良好，疼痛完全缓解，两组均未进行翻修手术。
无论采用全内修复技术还是原位经肌腱修复技术，关节镜下修复埃尔曼Ⅲ型PASTA均能提供令人满意的功能改善和疼痛缓解。然而，全内修复技术因其在保留完整滑囊和避免关节侧张力不均方面的双重作用而更具优势，这有利于术后早期康复。
