Green Clare K, Scanaliato John P, Sandler Alexis B, Adler Adam, Dunn John C, Parnes Nata
School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia, USA.
Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, El Paso, Texas, USA.
Orthop J Sports Med. 2023 Oct 16;11(10):23259671231202282. doi: 10.1177/23259671231202282. eCollection 2023 Oct.
While concomitant full-thickness rotator cuff tears and glenoid osteochondral defects are relatively uncommon in younger patients, military patients represent a unique opportunity to study this challenging injury pattern.
PURPOSE/HYPOTHESIS: To compare the outcomes of young, active-duty military patients who underwent isolated arthroscopic rotator cuff repair (ARCR) with those who underwent ARCR plus concurrent glenoid microfracture (ARCR+Mfx). It was hypothesized that ARCR+Mfx would produce significant improvements in patient-reported outcome measures.
Cohort study; Level of evidence, 3.
This was a retrospective analysis of consecutive active-duty military patients from a single base who underwent ARCR for full-thickness rotator cuff tears between January 2012 and December 2020. All patients were <50 years and had minimum 2-year follow-up data. Patients who underwent ARCR+Mfx were compared with those who underwent isolated ARCR based on the visual analog scale (VAS) for pain, Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons (ASES) shoulder score, and range of motion.
A total of 88 patients met the inclusion criteria for this study: 28 underwent ARCR+Mfx and 60 underwent isolated ARCR. The mean final follow-up was 74.11 ± 33.57 months for the ARCR+Mfx group and 72.87 ± 11.46 months for the ARCR group ( = .80). There were no differences in baseline patient characteristics or preoperative outcome scores between groups. Postoperatively, both groups experienced statistically significant improvements in all outcome scores ( < .0001 for all). However, the ARCR+Mfx group had significantly worse VAS pain (1.89 ± 2.22 vs 1.03 ± 1.70; = .05), SANE (85.46 ± 12.99 vs 91.93 ± 12.26; = .03), and ASES (86.25 ± 14.14 vs 92.85 ± 12.57; = .03) scores. At the final follow-up, 20 (71.43%) patients in the ARCR+Mfx group and 53 (88.33%) patients in the ARCR group were able to remain on unrestricted active-duty military service ( = .05).
Concomitant ARCR+Mfx led to statistically and clinically significant improvements in patient-reported outcome measures at the midterm follow-up. However, patients who underwent ARCR+Mfx had significantly worse outcomes and were less likely to return to active-duty military service than those who underwent isolated ARCR. The study findings suggest that ARCR+Mfx may be a reasonable option for young, active patients who are not candidates for arthroplasty.
虽然在年轻患者中，肩袖全层撕裂合并盂骨软骨缺损相对不常见，但军事患者为研究这种具有挑战性的损伤模式提供了独特的机会。
目的/假设：比较接受单纯关节镜下肩袖修复术（ARCR）的年轻现役军事患者与接受ARCR联合同期盂微骨折术（ARCR+Mfx）的患者的治疗效果。假设ARCR+Mfx能使患者报告的结局指标有显著改善。
队列研究；证据等级，3级。
这是一项对来自单一基地的连续现役军事患者的回顾性分析，这些患者在2012年1月至2020年12月期间因肩袖全层撕裂接受了ARCR。所有患者年龄均小于50岁，且有至少2年的随访数据。根据疼痛视觉模拟量表（VAS）、单项评估数字评分（SANE）、美国肩肘外科医师学会（ASES）肩部评分和活动范围，将接受ARCR+Mfx的患者与接受单纯ARCR的患者进行比较。
共有88例患者符合本研究的纳入标准：28例接受了ARCR+Mfx，60例接受了单纯ARCR。ARCR+Mfx组的平均最终随访时间为74.11±33.57个月，ARCR组为72.87±11.46个月（P=0.80）。两组患者的基线特征和术前结局评分无差异。术后，两组所有结局评分均有统计学意义的改善（所有P均<0.0001）。然而，ARCR+Mfx组的VAS疼痛评分（1.89±2.22对1.03±1.70；P=0.05）、SANE评分（85.46±12.99对91.93±12.26；P=0.03）和ASES评分（86.25±14.14对92.85±12.57；P=0.03）明显更差。在最终随访时，ARCR+Mfx组的20例（71.43%）患者和ARCR组的53例（88.33%）患者能够继续 unrestricted 现役军事服务（P=0.05）。
在中期随访中，ARCR+Mfx在患者报告的结局指标方面导致了统计学和临床意义上的显著改善。然而，接受ARCR+Mfx的患者结局明显更差，且比接受单纯ARCR的患者重返现役军事服务的可能性更小。研究结果表明，ARCR+Mfx可能是不适宜进行关节置换术的年轻活跃患者的合理选择。
