Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, No.5, Fusing St., Gueishan District, Taoyuan City, 333, Taiwan.
Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
BMC Musculoskelet Disord. 2023 Feb 28;24(1):154. doi: 10.1186/s12891-023-06256-6.
Transosseous-equivalent suture-bridge (TOE-SB) and independent double-row (IDR) repair techniques were developed to treat rotator cuff tears. The study was designed to prove that both TOE-SB and IDR techniques provided comparable clinical results and retear rate for medium to massive posterosuperior rotator cuff tears, while the surgical time and number of suture anchor used were less in the IDR group.
Level of evidence: level III, Retrospective comparative study.
Patients with medium to massive posterosuperior rotator cuff tears receiving arthroscopic TOE-SB and IDR between November 2016 to October 2019 were retrospectively enrolled. All patients were confirmed to have grade ≤ 2 fatty infiltration in the muscles of the torn tendons. Revision, concomitant subscapularis tear, acromiohumeral distance < 7 mm, glenohumeral osteoarthritis, partial repair, incomplete repair, partial thickness, or irreparable posterosuperior cuff tear were excluded. Surgical time, number of suture anchor used for the surgery, pre-operative, and post-operative clinical scores such as Constant-Murley score, subjective shoulder value (SSV), and visual analog scale (VAS) were compared. The retear rates between groups were evaluated by ultrasound.
Thirty-five IDR and thirty-five TOE-SB repairs were enrolled. The IDR technique required much fewer anchors than TOE-SB did to complete the cuff repair. The mean operation time in IDR and TOE-SB group were 86(18.23), and 114(18.7) (min), respectively (P < 0.01). The mean number of anchors used to complete the cuff repair was 2(0.17) in IDR and 3(0.61) in TOE-SB (P < 0.01). The Constant-Murley score improved from 34.9 ± 6.6 to 80.6 ± 9.4 in the IDR group, and 37.4 ± 6 to 81.9 ± 4.6 in the TOE-SB group (both P < 0.001). SSV improved from 24.6 ± 9.6 to 79.3 ± 10.6 in the IDR, and 27.9 ± 9 to 82.9 ± 6.9 in the TOE-SB group (both P < 0.001). VAS improved from 7.9 ± 0.6 to 1.5 ± 0.7 in the IDR, and 8 ± 0.5 to 1.3 ± 0.6 in the TOE-SB group (both P < 0.001) at final follow-up. No significant difference was found between the retear rates (14.3% in the IDR vs. 17.1% in the TOE-SB, respectively) in the 2-year follow-up.
Both IDR and TOE-SB group provided comparable clinical results and retear rates for medium to massive posterosuperior rotator cuff tears. The surgical time and number of anchors used were less in the IDR group than in the TOE-SB group.
经皮等长缝线桥接技术（TOE-SB）和独立双排固定技术（IDR）是为治疗肩袖全层撕裂而开发的。本研究旨在证明 TOE-SB 和 IDR 两种技术对于中到大的肩袖后上部分全层撕裂均能提供相似的临床结果和再撕裂率，同时 IDR 组的手术时间和缝线锚钉使用数量更少。
证据水平：III 级，回顾性比较研究。
回顾性纳入 2016 年 11 月至 2019 年 10 月间接受关节镜下 TOE-SB 和 IDR 治疗的中到大的肩袖后上部分全层撕裂患者。所有患者均证实撕裂肌腱肌肉的脂肪浸润程度为≤2 级。排除翻修、同时合并肩胛下肌撕裂、肩峰肱骨头间距<7mm、肩肱关节炎、部分修复、不完全修复、部分厚度或不可修复的肩袖后上部分撕裂。比较手术时间、手术中使用的缝线锚钉数量、术前和术后临床评分，如 Constant-Murley 评分、主观肩价值（SSV）和视觉模拟评分（VAS）。通过超声评估两组的再撕裂率。
35 例 IDR 和 35 例 TOE-SB 修复术。IDR 技术比 TOE-SB 技术完成肩袖修复所需的锚钉少得多。IDR 和 TOE-SB 组的平均手术时间分别为 86（18.23）和 114（18.7）（min）（P<0.01）。完成肩袖修复所需的平均锚钉数量分别为 IDR 组 2（0.17）和 TOE-SB 组 3（0.61）（P<0.01）。IDR 组的 Constant-Murley 评分从 34.9±6.6 提高到 80.6±9.4，TOE-SB 组从 37.4±6 提高到 81.9±4.6（均 P<0.001）。SSV 从 IDR 组的 24.6±9.6 提高到 79.3±10.6，TOE-SB 组从 27.9±9 提高到 82.9±6.9（均 P<0.001）。IDR 组的 VAS 从 7.9±0.6 改善到 1.5±0.7，TOE-SB 组从 8±0.5 改善到 1.3±0.6（均 P<0.001）。在 2 年的随访中，两组的再撕裂率均无显著差异（IDR 组为 14.3%，TOE-SB 组为 17.1%）。
IDR 和 TOE-SB 两组对于中到大的肩袖后上部分全层撕裂均能提供相似的临床结果和再撕裂率。IDR 组的手术时间和缝线锚钉使用数量均少于 TOE-SB 组。
