Department of Orthopaedic Surgery, College of Medicine, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea.
Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, Republic of Korea.
Knee Surg Sports Traumatol Arthrosc. 2023 May;31(5):1910-1918. doi: 10.1007/s00167-022-07112-1. Epub 2022 Aug 16.
Large retracted anterior L-shaped tear characterized by a retracted supraspinatus tendon to the glenoid level combined with a relatively preserved infraspinatus tendon is one of the challenging tear patterns in achieving complete repair to the anatomic footprint. The purpose of this study was to evaluate clinical outcomes and tendon integrity of rotator cuff repair combined with anterior cable reconstruction using the proximal biceps tendon in patients with large retracted anterior L-shaped rotator cuff tear.
This study prospectively enrolled patients who underwent arthroscopic anterior cable reconstruction using the proximal biceps tendon for large retracted anterior L-shaped rotator cuff tears between 2018 and 2020 with a minimum 2-year follow-up. The anterior portion of the rotator cable was reconstructed using tenotomized proximal biceps tendon fixed with two suture anchors at the footprint. The retracted supraspinatus tendon was repaired on the biceps tendon without undue tension. The proximal portion of the infraspinatus tendon was repaired with the biceps tendon-supraspinatus tendon complex. Clinical outcomes was assessed during the follow-up period. Tendon integrity and retear size were evaluated by postoperative MRI.
A total of 32 consecutive patients were included. The ASES score was significantly improved from 66.6 ± 16.6 preoperatively to 94.1 ± 6.1 postoperatively (P < 0.001), and the VAS for pain was significantly relieved from 2.8 ± 1.9 preoperatively to 0.5 ± 0.4 postoperatively (P < 0.001). All patients were satisfied postoperatively regardless of tendon integrity (P = 0.015). Postoperative ROM was increased continuously during the follow-up period (P < 0.001). The Popeye sign was found in 4 patients (12.5%). Six patients (18.7%) had rotator cuff retears. However, the ASES score of patients with retear was significantly improved from 72.8 ± 13.3 preoperatively to 91.1 ± 6.7 postoperatively (P < 0.001). Relative changes in the retear size compared with the primary tear size were -56.8 ± 14.4% for the anteroposterior diameter and - 70.6 ± 6.1% for the mediolateral diameter.
Rotator cuff repair combined with anterior cable reconstruction using the proximal biceps tendon provided satisfactory clinical and radiological outcomes for large retracted anterior L-shaped tears. Anterior cable reconstruction using the proximal biceps tendon is a sound surgical option for the patients with large retracted anterior rotator cuff tear.
IV.
大型回缩性前 L 型撕裂的特征为回缩的冈上肌腱至肩胛盂水平，同时相对保留冈下肌腱，是实现解剖学足印完全修复的具有挑战性的撕裂模式之一。本研究的目的是评估采用肱二头肌近端肌腱进行前侧缆索重建治疗大型回缩性前 L 型肩袖撕裂患者的临床结果和肩袖肌腱完整性。
本研究前瞻性纳入了 2018 年至 2020 年间接受关节镜下前侧缆索重建治疗大型回缩性前 L 型肩袖撕裂的患者，所有患者均至少随访 2 年。使用 Tenotomy 的肱二头肌近端肌腱在足印处使用两个缝线锚钉重建前侧肩袖缆索的前部分。无明显张力地修复回缩的冈上肌腱。将冈下肌腱与肱二头肌肌腱复合体修复近侧部分。在随访期间评估临床结果。术后 MRI 评估肌腱完整性和再撕裂大小。
共纳入 32 例连续患者。ASES 评分从术前的 66.6±16.6 显著提高至术后的 94.1±6.1（P<0.001），疼痛 VAS 从术前的 2.8±1.9 显著减轻至术后的 0.5±0.4（P<0.001）。所有患者术后均满意，与肌腱完整性无关（P=0.015）。术后 ROM 在随访期间持续增加（P<0.001）。4 例（12.5%）患者出现 Popeye 征。6 例（18.7%）患者发生肩袖再撕裂。然而，再撕裂患者的 ASES 评分从术前的 72.8±13.3 显著提高至术后的 91.1±6.7（P<0.001）。再撕裂大小与原发性撕裂大小的相对变化分别为前后径-56.8±14.4%和横径-70.6±6.1%。
采用肱二头肌近端肌腱进行肩袖修复联合前侧缆索重建为大型回缩性前 L 型撕裂提供了满意的临床和影像学结果。对于大型回缩性前肩袖撕裂患者，采用肱二头肌近端肌腱进行前侧缆索重建是一种合理的手术选择。
IV 级。
