Department of Orthopaedic Surgery, Kobe Medical Center, Kobe, Japan.
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
J Shoulder Elbow Surg. 2024 Mar;33(3):e153-e161. doi: 10.1016/j.jse.2023.07.020. Epub 2023 Aug 22.
A high postoperative retear rate after arthroscopic rotator cuff repair (ARCR) of large and massive tears remains a problem. This study evaluated rotator cuff integrity after ARCR with fascia lata graft augmentation for large and massive rotator cuff tears and compared clinical outcomes between patients with intact repairs and retears.
Forty-five patients with rotator cuff tears who could not undergo primary repair due to tendon retraction underwent arthroscopic medialized single-row repair with fascia lata graft augmentation. The patients' minimum follow-up was 2 (2-9) years. Supraspinatus cuff integrity was evaluated postoperatively by magnetic resonance imaging. We compared the clinical outcomes of patients with intact repairs vs. retears based on the University of California-Los Angeles (UCLA), Constant, and Japanese Orthopaedic Association (JOA) scores. We also evaluated their range of motion (ROM) and muscle strength.
Retears were observed in 11 of 45 patients. UCLA, Constant, and JOA scores significantly improved postoperatively compared to preoperatively in the intact repair (all P < .001) and retear (all P < .036) groups. The intact repair group had significantly higher Constant (75.6 [mean] ± 9.9 [SD] vs. 69.8 ± 7.9; P = .026) and JOA (94.4 ± 6.9 vs. 89.8 ± 5.9; P = .041) scores than the retear group. Forward elevation, abduction, and the strengths of abduction and external rotation significantly improved in the intact repair group (all P < .003) but not in the retear group (all P > .05). The intact repair group had significantly higher postoperative forward flexion (165° ± 15° vs. 154° ± 23°; P = .036), abduction (164° ± 17° vs. 151° ± 26°; P = .029), and abduction strength (3.5 ± 2.2 kg vs. 2.3 ± 1.2 kg; P = .017) than the retear group. In the intact repair group (n = 34), Sugaya type I:II ratio differed significantly between postoperative 3 months (2:32) and 24 months (24:10) (P < .001). Repaired tendon thickness did not decrease significantly between 3 months (7.1 mm) and 2 years (6.9 mm) (P = .543).
ARCR with fascia lata graft augmentation of large and massive rotator cuff tears showed a 24.4% retear rate but significantly improved the clinical scores, ROMs, and muscle strength with excellent cuff integrity in the intact repair group. However, the differences in the Constant and UCLA scores between the intact repair and retear groups were under the minimal clinically important difference, and their clinical significance is uncertain. Our results confirm that ARCR with fascia lata graft augmentation improves patients' postoperative outcomes if the repair site is maintained postoperatively.
关节镜下修复（ARCR）大型和巨大肩袖撕裂后的高术后再撕裂率仍然是一个问题。本研究评估了使用阔筋膜移植物增强的 ARCR 治疗大型和巨大肩袖撕裂后的肩袖完整性，并比较了完整修复和再撕裂患者的临床结果。
45 例因肌腱回缩而无法进行初次修复的肩袖撕裂患者接受了关节镜内侧化单排修复联合阔筋膜移植物增强。患者的最低随访时间为 2（2-9）年。术后通过磁共振成像评估肩袖上旋肌的完整性。我们根据加利福尼亚大学洛杉矶分校（UCLA）、常数和日本矫形协会（JOA）评分比较了完整修复与再撕裂患者的临床结果。我们还评估了他们的活动范围（ROM）和肌肉力量。
45 例患者中有 11 例出现再撕裂。与术前相比，完整修复组（均 P <.001）和再撕裂组（均 P <.036）术后 UCLA、常数和 JOA 评分均显著改善。完整修复组的常数（75.6 [平均值] ± 9.9 [标准差] vs. 69.8 ± 7.9；P =.026）和 JOA（94.4 ± 6.9 vs. 89.8 ± 5.9；P =.041）评分明显高于再撕裂组。在完整修复组，前屈、外展和外展及外旋的力量明显改善（均 P <.003），但在再撕裂组无明显改善（均 P >.05）。与再撕裂组相比，完整修复组术后前屈（165° ± 15° vs. 154° ± 23°；P =.036）、外展（164° ± 17° vs. 151° ± 26°；P =.029）和外展力量（3.5 ± 2.2 kg vs. 2.3 ± 1.2 kg；P =.017）明显更高。在完整修复组（n = 34），Sugaya 型 I:II 比值在术后 3 个月（2:32）和 24 个月（24:10）时差异显著（P <.001）。修复肌腱厚度在 3 个月（7.1 mm）和 2 年（6.9 mm）之间无明显下降（P =.543）。
使用阔筋膜移植物增强的 ARCR 治疗大型和巨大肩袖撕裂，再撕裂率为 24.4%，但在完整修复组中，临床评分、ROM 和肌肉力量明显改善，肩袖完整性良好。然而，完整修复组和再撕裂组之间的常数和 UCLA 评分差异低于最小临床重要差异，其临床意义不确定。我们的结果证实，如果术后修复部位得到维持，使用阔筋膜移植物增强的 ARCR 可以改善患者的术后结果。
