Shibata Terufumi, Izaki Teruaki, Miyake Satoshi, Shibata Yozo, Yamamoto Takuaki
Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan.
Department of Orthopaedic Surgery, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
J Shoulder Elbow Surg. 2023 May;32(5):909-916. doi: 10.1016/j.jse.2023.01.016. Epub 2023 Feb 14.
The purpose of this study was to investigate the efficacy of bone marrow stimulation (BMS) on the repair integrity of the rotator cuff insertion treated with arthroscopic knotless suture bridge (K-SB) rotator cuff repair. We hypothesized that BMS during K-SB repair can improve the healing of the rotator cuff insertion.
Sixty patients who underwent arthroscopic K-SB repair of full-thickness rotator cuff tears were randomly allocated to 2 treatment groups. Patients in the BMS group underwent K-SB repair augmented with BMS at the footprint. Patients in the control group underwent K-SB repair without BMS. Cuff integrity and retear patterns were evaluated by postoperative magnetic resonance imaging. The clinical outcomes included the Japanese Orthopaedic Association score, University of California at Los Angeles score, Constant-Murley score, and Simple Shoulder Test.
Clinical and radiological evaluations were completed in 60 patients at 6 months postoperatively, in 58 patients at 1 year postoperatively, and in 50 patients at 2 years postoperatively. Both treatment groups showed significant improvements in the clinical outcome from baseline to the 2-year follow-up, but no significant differences were found between the 2 groups. At 6 months postoperatively, the retear rate at the tendon insertion was 0.0% (0 of 30) in the BMS group and 3.3% (1 of 30) in the control group (P = .313). The retear rate at the musculotendinous junction was 26.7% (8 of 30) in the BMS group and 13.3% (4 of 30) in the control group (P = .197). All retears in the BMS group occurred at the musculotendinous junction, and the tendon insertion was preserved. There was no significant difference in the overall retear rate or retear patterns between the 2 treatment groups during the study period.
No significant differences were detected in the structural integrity or retear patterns regardless of the use of BMS. The efficacy of BMS for arthroscopic K-SB rotator cuff repair was not proven in this randomized controlled trial.
本研究旨在探讨骨髓刺激（BMS）对关节镜下无结缝线桥（K-SB）修复肩袖止点修复完整性的疗效。我们假设在K-SB修复过程中进行BMS可改善肩袖止点的愈合。
60例行关节镜下全层肩袖撕裂K-SB修复的患者被随机分为2个治疗组。BMS组患者在足迹处接受K-SB修复并辅以BMS。对照组患者接受无BMS的K-SB修复。通过术后磁共振成像评估肩袖完整性和再撕裂模式。临床结果包括日本骨科协会评分、加利福尼亚大学洛杉矶分校评分、Constant-Murley评分和简单肩关节测试。
60例患者在术后6个月、58例患者在术后1年、50例患者在术后2年完成了临床和影像学评估。两个治疗组从基线到2年随访的临床结果均有显著改善，但两组之间未发现显著差异。术后6个月，BMS组肌腱止点处的再撕裂率为0.0%（30例中的0例），对照组为3.3%（30例中的1例）（P = 0.313）。BMS组肌腱-肌肉交界处的再撕裂率为26.7%（30例中的8例），对照组为13.3%（30例中的4例）（P = 0.197）。BMS组所有再撕裂均发生在肌腱-肌肉交界处，肌腱止点得以保留。在研究期间，两个治疗组之间的总体再撕裂率或再撕裂模式无显著差异。
无论是否使用BMS，在结构完整性或再撕裂模式方面均未检测到显著差异。本随机对照试验未证实BMS对关节镜下K-SB肩袖修复的疗效。
