Godshaw Brian M, Hughes Jonathan D, Boden Stephanie Ann, Lin Albert, Lesniak Bryson P
Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Ochsner Sports Medicine Institute, New Orleans, Louisiana, USA.
Orthop J Sports Med. 2022 Oct 25;10(10):23259671221126551. doi: 10.1177/23259671221126551. eCollection 2022 Oct.
The role of tear etiology in outcomes after rotator cuff repair is not well understood.
PURPOSE/HYPOTHESIS: The purpose of this study was to determine the difference in outcomes after rotator cuff repair based on tear etiology. We hypothesized that traumatic rotator cuff tears will have greater improvements in functional outcome measures and range of motion (ROM) than atraumatic tears.
Cohort study; Level of evidence, 3.
We conducted a chart review of 221 consecutive patients who underwent arthroscopic rotator cuff repair; prospectively collected preoperative and minimum 2-year postoperative data were evaluated. Shoulder ROM, strength, and standard shoulder physical examination findings were recorded pre- and postoperatively. Outcome measures included visual analog scale for pain, Subjective Shoulder Value (SSV), 10-item Patient-Reported Outcomes Measurement Information System (PROMIS-10; physical and mental components), and American Shoulder and Elbow Surgeons (ASES) form.
Of the 221 patients, 73 had traumatic tears and 148 had atraumatic/degenerative tears. There were no differences in age, body mass index, or Charlson Comorbidity Index between groups. Patients in the atraumatic cohort had significantly longer duration of symptoms before presentation (18 vs 7 months; < .01). Preoperatively, the traumatic cohort had less motion to forward flexion (mean ± SD; 138° ± 43.7° vs 152° ± 29.8°; = .02). Postoperatively, both groups experienced significant improvements in visual analog scale and SSV scores ( < .001 each). However, only the traumatic cohort demonstrated improvements in ASES and PROMIS-10 physical component scores. Patients with traumatic rotator cuff tears had lower preoperative SSV and less motion than those with atraumatic tears, but they had greater improvements in SSV (40.6% ± 39.0% vs 29.2% ± 39.7%; = .005) and forward flexion (21.6° ± 48.6° vs 2.3° ± 48.2°; < .001), as well as strength in forward flexion, external rotation, and internal rotation ( < .001, = .003, and = .002, respectively).
Patients with traumatic rotator cuff tears have worse preoperative symptoms and more functional deficits but experience greater improvements in ROM, strength, and perceived shoulder function than those with degenerative/atraumatic tears.
肩袖修复术后泪液病因对预后的作用尚未完全明确。
目的/假设：本研究的目的是确定基于泪液病因的肩袖修复术后预后差异。我们假设创伤性肩袖撕裂在功能预后指标和活动范围（ROM）方面的改善将大于非创伤性撕裂。
队列研究；证据等级，3级。
我们对221例连续接受关节镜下肩袖修复的患者进行了病历回顾；对前瞻性收集的术前和至少术后2年的数据进行了评估。记录术前和术后的肩部ROM、力量以及标准的肩部体格检查结果。预后指标包括疼痛视觉模拟量表、主观肩关节评分（SSV）、10项患者报告结局测量信息系统（PROMIS - 10；身体和心理成分）以及美国肩肘外科医师（ASES）表格。
221例患者中，73例为创伤性撕裂，148例为非创伤性/退行性撕裂。两组在年龄、体重指数或Charlson合并症指数方面无差异。非创伤性队列患者就诊前症状持续时间明显更长（18个月对7个月；P <.01）。术前，创伤性队列患者前屈活动度较小（平均值±标准差；138°±43.7°对152°±29.8°；P =.02）。术后，两组患者的视觉模拟量表和SSV评分均有显著改善（均P <.001）。然而，只有创伤性队列患者的ASES和PROMIS - 10身体成分评分有所改善。创伤性肩袖撕裂患者术前SSV较低且活动度小于非创伤性撕裂患者，但他们在SSV（40.6%±39.0%对29.2%±39.7%；P =.005）和前屈（21.6°±48.6°对2.3°±48.2°；P <.001）方面的改善更大，以及在前屈、外旋和内旋力量方面（分别为P <.001、P =.003和P =.002）。
创伤性肩袖撕裂患者术前症状更严重且功能缺陷更多，但与退行性/非创伤性撕裂患者相比，在ROM、力量和感知的肩部功能方面改善更大。
