Department of Orthopaedic Surgery, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
Am J Sports Med. 2023 Jul;51(9):2411-2421. doi: 10.1177/03635465231178294. Epub 2023 Jun 21.
Previous studies have demonstrated several prognostic factors for retear after arthroscopic rotator cuff repair (ARCR). However, studies that histologically evaluate the quality of the torn rotator cuff (RC) tendon and its association with postoperative outcomes are limited.
To investigate factors associated with retear after ARCR using the suture bridge (SB) technique, including the degree of histological degeneration of the RC tendon edge.
Case-control study; Level of evidence, 3.
The authors retrospectively evaluated 187 patients who underwent ARCR for full-thickness tears using the SB technique; intraoperative biopsy samples were taken to assess the degree of histological degeneration using the Bonar score. The cohort was divided into healed (n = 165) and retear (n = 22) groups according to magnetic resonance imaging results obtained ≥6 months postoperatively. The evaluation included preoperative patient data (age, sex, symptom duration, trauma history, history of heavy manual work, smoking habit, hypertension, diabetes mellitus, and hyperlipidemia) and radiological data (Hamada classification, Patte classification, Goutallier classification, and global fatty degeneration index [GFDI]). Additionally, intraoperative data (anteroposterior tear size, Lafosse classification for concomitant subscapularis tendon tear, and long head of biceps injury) and preoperative and postoperative clinical findings (active range of motion, University of California, Los Angeles [UCLA], score) were evaluated.
The retear rate was 11.8%. The retear group had a higher percentage of men ( = .031), higher Bonar score ( < .001), higher mean GFDI value ( = .002), higher rate of tear retraction degree ( = .010), and larger anteroposterior tear size ( = .020) than the healed group. The retear group had lower postoperative internal rotation ( = .031) and lower UCLA score ( < .001). Multivariate logistic regression analysis with a stepwise variable selection revealed anteroposterior tear size (odds ratio [OR], 2.4; 95% CI, 1.3-4.5; = .004) and Bonar score (OR, 1.7; 95% CI, 1.3-2.4; < .001) as independent predictors for a retear.
The results indicate that end-stage severe tendon degeneration might affect retear. Therefore, further investigation on the progression mechanisms of tendon degeneration and development of methods to assess degenerative tissue might improve clinical outcomes after ARCR.
既往研究已经证实了关节镜下肩袖修复（ARCR）后再撕裂的几个预后因素。然而，评估撕裂的肩袖（RC）肌腱质量及其与术后结果关系的研究有限，这些研究仅通过组织学进行评估。
使用缝线桥（SB）技术研究 ARCR 后再撕裂的相关因素，包括 RC 肌腱边缘的组织学退变程度。
病例对照研究；证据等级，3 级。
作者回顾性分析了 187 例采用 SB 技术行全层撕裂 ARCR 的患者，术中取活检样本，采用 Bonar 评分评估组织学退变程度。根据术后≥6 个月的磁共振成像结果，将队列分为愈合组（n = 165）和再撕裂组（n = 22）。评估包括术前患者数据（年龄、性别、症状持续时间、外伤史、重体力劳动史、吸烟习惯、高血压、糖尿病、高脂血症）和影像学数据（Hamada 分级、Patte 分级、Goutallier 分级和整体脂肪变性指数[GFDI]）。此外，还评估了术中数据（前后撕裂大小、合并肩胛下肌腱撕裂的 Lafosse 分级和肱二头肌长头损伤）以及术前和术后的临床发现（主动活动范围、加利福尼亚大学洛杉矶分校[UCLA]评分）。
再撕裂率为 11.8%。与愈合组相比，再撕裂组中男性比例更高（ =.031），Bonar 评分更高（ <.001），平均 GFDI 值更高（ =.002），回缩程度更大（ =.010），前后撕裂大小更大（ =.020）。再撕裂组术后内旋（ =.031）和 UCLA 评分更低（ <.001）。逐步变量选择的多变量逻辑回归分析显示，前后撕裂大小（比值比[OR]，2.4；95%置信区间，1.3-4.5； =.004）和 Bonar 评分（OR，1.7；95%置信区间，1.3-2.4； <.001）是再撕裂的独立预测因素。
结果表明，终末期严重肌腱退变可能影响再撕裂。因此，进一步研究肌腱退变的进展机制和评估退行性组织的方法可能会改善 ARCR 后的临床结果。
