Department of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Medical College of Hallym University, Dongtan, Republic of Korea.
Division of Sports Medicine, Department of Physical Medicine and Rehabilitation, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea.
Am J Sports Med. 2023 Sep;51(11):2804-2814. doi: 10.1177/03635465231187033. Epub 2023 Aug 7.
Most outcome studies on subscapularis (SSC) tendon tears have focused on large SSC tears rather than partial SSC tendon tears. Therefore, the optimal treatment for partial SSC tendon tears more than half of the first facet of the entire SSC footprint has not yet been clearly defined.
To prospectively investigate the clinical and radiological results between the arthroscopic repair group and the debridement group in SSC partial tear (Yoo and Rhee classification, type 2B: SSC tendon tears of more than half of the entire first facet).
Randomized controlled trial; Level of evidence, 1.
A total of 65 patients with SSC tendon type 2B tears were randomized to arthroscopic debridement (n = 33) or arthroscopic repair (n = 32). Clinical evaluation of the patients was performed on the day before surgery and 6 months, 1 year, 2 years, and 5 years postoperatively using active range of motion measurements and other validated scores (pain visual analog scale scores, function visual analog scale scores, Constant score, American Shoulder and Elbow Surgeons score). In addition, SSC muscle strength was measured using instruments in the belly-press position. Magnetic resonance imaging (upper and lower SSC muscle diameters, Goutallier grades) was performed on the day before operation as well as 6 months and 2 years postoperatively.
There were no clinically or statistically significant differences between the arthroscopic debridement and arthroscopic repair groups with respect to active range of motion, pain visual analog scale scores, function visual analog scale scores, Constant scores, or American Shoulder and Elbow Surgeons scores. There was a statistically significant increase in SSC muscle strength in the repair group compared with the debridement group at 5 years postoperatively ( = .013). Magnetic resonance imaging assessment was also not significantly different between the 2 groups.
There were no differences in the patient-reported outcomes of patients with partial SSC tears treated with either arthroscopic debridement or repair, although there was an increase in SSC muscle strength associated with repair, the clinical importance of which may warrant further research.
NCT03183466 (ClinicalTrials.gov identifier).
大多数关于肩胛下肌（SSC）肌腱撕裂的结局研究都集中在较大的 SSC 撕裂上，而不是部分 SSC 肌腱撕裂。因此，对于超过 SSC 整个第一面一半的部分 SSC 肌腱撕裂的最佳治疗方法尚未明确界定。
前瞻性研究关节镜下修复组与清创组在肩胛下肌部分撕裂（Yoo 和 Rhee 分类，2B 型：SSC 肌腱撕裂超过整个第一面的一半）中的临床和影像学结果。
随机对照试验；证据水平，1 级。
共有 65 例 SSC 肌腱 2B 型撕裂患者被随机分为关节镜下清创组（n = 33）或关节镜下修复组（n = 32）。在术前、术后 6 个月、1 年、2 年和 5 年，采用主动活动范围测量和其他经过验证的评分（疼痛视觉模拟评分、功能视觉模拟评分、Constant 评分、美国肩肘外科医生评分）对患者进行临床评估。此外，还采用腹部按压位的仪器测量 SSC 肌肉力量。术前及术后 6 个月和 2 年均行磁共振成像（上下 SSC 肌肉直径、Goutallier 分级）检查。
在关节镜下清创和关节镜下修复组之间，主动活动范围、疼痛视觉模拟评分、功能视觉模拟评分、Constant 评分或美国肩肘外科医生评分均无临床或统计学显著差异。修复组术后 5 年 SSC 肌肉力量较清创组有统计学显著增加（ =.013）。两组的磁共振成像评估也无显著差异。
对于部分 SSC 撕裂患者，关节镜下清创或修复治疗的患者报告结果无差异，尽管修复后 SSC 肌肉力量增加，但临床重要性可能需要进一步研究。
NCT03183466（ClinicalTrials.gov 标识符）。
