Department of Orthopaedics, Helsingborg Hospital, Helsingborg, Sweden; Department of Clinical Sciences Lund/Clinical Sciences Helsingborg, Lund University, Lund, Sweden.
Department of Orthopaedics in Linköping and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
J Shoulder Elbow Surg. 2023 Oct;32(10):2074-2081. doi: 10.1016/j.jse.2023.03.027. Epub 2023 May 12.
Healing failure after rotator cuff repair is a challenging problem. Acute, trauma-related tears are considered a separate entity and are often treated surgically. The aim of this study was to identify factors associated with healing failure in previously asymptomatic patients with trauma-related rotator cuff tears treated with early arthroscopic repair.
This study included 62 consecutively recruited patients (23% women; median age, 61 years; age range, 42-75 years) with acute symptoms in a previously asymptomatic shoulder and a magnetic resonance imaging-verified full-thickness rotator cuff tear after shoulder trauma. All patients were offered, and underwent, early arthroscopic repair, during which a biopsy specimen was harvested from the supraspinatus tendon and analyzed for signs of degeneration. Of the patients, 57 (92%) completed 1-year follow-up and underwent assessment of repair integrity on magnetic resonance images according to the Sugaya classification. Risk factors for healing failure were investigated using a causal-relation diagram where age, body mass index, tendon degeneration (Bonar score), diabetes mellitus, fatty infiltration (FI), sex, smoking, tear location regarding integrity of the rotator cable, and tear size (number of ruptured tendons and tendon retraction) were included and analyzed.
Healing failure at 1 year was identified in 37% of patients (n = 21). A high degree of FI of the supraspinatus muscle (P = .01), a tear location including disruption of rotator cable integrity (P = .01), and old age (P = .03) were associated with healing failure. Tendon degeneration as determined by histopathology was not associated with healing failure at 1-year follow-up (P = .63).
Older age, increased FI of the supraspinatus muscle, and a tear including disruption of the rotator cable increased the risk of healing failure after early arthroscopic repair in patients with trauma-related full-thickness rotator cuff tears.
肩袖修复后愈合失败是一个具有挑战性的问题。急性、创伤相关的肩袖撕裂被认为是一种单独的疾病实体，通常需要手术治疗。本研究的目的是确定与经早期关节镜修复的创伤相关肩袖全层撕裂的先前无症状患者愈合失败相关的因素。
本研究纳入了 62 例连续招募的患者（23%为女性；中位年龄 61 岁；年龄范围为 42-75 岁），这些患者在肩部创伤后出现先前无症状的肩部急性症状和经磁共振成像证实的全层肩袖撕裂。所有患者均接受早期关节镜修复，并从冈上肌腱采集活检标本，进行退变分析。其中 57 例（92%）患者完成了 1 年随访，并根据 Sugaya 分类进行了磁共振成像修复完整性评估。使用因果关系图来研究愈合失败的危险因素，其中包括年龄、体重指数、肌腱退变（Bonar 评分）、糖尿病、脂肪浸润（FI）、性别、吸烟、撕裂部位（与肩袖缆线完整性有关）和撕裂大小（撕裂肌腱数量和肌腱回缩），并进行分析。
1 年时，37%的患者（n=21）出现愈合失败。较高的冈上肌 FI（P=0.01）、撕裂部位包括肩袖缆线完整性中断（P=0.01）和年龄较大（P=0.03）与愈合失败相关。组织病理学确定的肌腱退变与 1 年随访时的愈合失败无关（P=0.63）。
在经早期关节镜修复的创伤相关肩袖全层撕裂患者中，年龄较大、冈上肌 FI 增加以及包括肩袖缆线完整性中断的撕裂增加了愈合失败的风险。
