Gedikbas Mete, Ozturk Tahir, Erpala Fırat, Zengin Eyup Cagatay
Department of Orthopaedics and Traumatology, Turhal State Hospital, Tokat, Turkey.
Department of Orthopaedics and Traumatology, School of Medicine, Gaziosmanpasa University, Tokat, Turkey.
Orthop J Sports Med. 2022 Sep 9;10(9):23259671221120662. doi: 10.1177/23259671221120662. eCollection 2022 Sep.
The literature comparing open and arthroscopic repair of subscapularis tendon (ST) tears is insufficient.
To compare the clinical results of open versus arthroscopic repair of ST tears with or without concomitant supraspinatus tears.
Retrospective cohort study.
We retrospectively evaluated 70 patients treated for isolated ST tears and ST tears with concomitant supraspinatus tendon tears at a single center between 2011 and 2019. Patients were divided into 2 groups: those who underwent open ST repairs (group O) and those with an arthroscopic ST repair (group A). Range of motion (ROM), liftoff and belly-press tests, and Constant-Murley (CM) scores were included in the pre- and postoperative functional evaluations. The minimal clinically important difference was calculated using the anchor-based method for changes in CM score. Tear size was evaluated according to the Lafosse classification. The categorical data were assessed using the Pearson chi-square, Fisher exact, and Fisher-Freeman-Halton tests. The parametric and nonparametric data were evaluated using the Student test and Mann-Whitney test, respectively. The dependent groups (for nonnormally distributed data) were evaluated using the Wilcoxon signed rank test.
Group O included 34 patients, and group A included 36 patients. The mean age was 62.9 years, and the mean follow-up period was 66.7 months. Even though group O exhibited a significantly better preoperative CM score (53.7 ± 4.6 vs 48.9 ± 6.8 [mean ± SD]; = .001), group A had a significantly better postoperative CM score (88.7 ± 4.7 vs 84.6 ± 2.9; < .001). Our measurements revealed a minimal clinically important difference of 11.5 points for the CM score. Group A had significantly greater postoperative ROM in abduction (153° vs 143.9°; = .005) and forward elevation (159.1° vs 149.7°; = .005), as well as significantly greater postoperative improvement in positive belly-press test results ( = .028). Complications occurred in 4 patients in group O and in 1 patient in group A.
The study findings indicated that arthroscopic ST repair was more advantageous than open repair in terms of ROM and functional outcomes.
比较肩胛下肌腱（ST）撕裂的开放修复和关节镜修复的文献不足。
比较ST撕裂伴或不伴冈上肌腱撕裂时开放修复与关节镜修复的临床结果。
回顾性队列研究。
我们回顾性评估了2011年至2019年在单一中心接受孤立性ST撕裂和伴冈上肌腱撕裂的ST撕裂治疗的70例患者。患者分为两组：接受开放ST修复的患者（O组）和接受关节镜ST修复的患者（A组）。术前和术后功能评估包括活动范围（ROM）、抬起和腹部按压试验以及Constant-Murley（CM）评分。使用基于锚定的方法计算CM评分变化的最小临床重要差异。根据Lafosse分类评估撕裂大小。分类数据采用Pearson卡方检验、Fisher精确检验和Fisher-Freeman-Halton检验进行评估。参数数据和非参数数据分别采用Student检验和Mann-Whitney检验进行评估。相关组（对于非正态分布数据）采用Wilcoxon符号秩检验进行评估。
O组包括34例患者，A组包括36例患者。平均年龄为62.9岁，平均随访期为66.7个月。尽管O组术前CM评分显著更高（53.7±4.6 vs 48.9±6.8[平均值±标准差]；P =.001），但A组术后CM评分显著更高（88.7±4.7 vs 84.6±2.9；P <.001）。我们的测量显示CM评分的最小临床重要差异为11.5分。A组术后外展ROM（153° vs 143.9°；P =.005）和前屈ROM（159.1° vs 149.7°；P =.005）显著更大，腹部按压试验阳性结果的术后改善也显著更大（P =.028）。O组有4例患者发生并发症，A组有1例患者发生并发症。
研究结果表明，在ROM和功能结果方面，关节镜ST修复比开放修复更具优势。
