Department of Orthopaedic and Trauma Surgery, University Hospital Basel, Basel, Switzerland.
Investigation performed at University Hospital Basel, Basel and the Schulthess Klinik, Zurich, Switzerland.
Am J Sports Med. 2024 Feb;52(2):441-450. doi: 10.1177/03635465231219253. Epub 2024 Jan 23.
Arthroscopic rotator cuff repair (ARCR) is among the most commonly performed orthopaedic procedures. Several factors-including age, sex, and tear severity-have been identified as predictors for outcome after repair. The influence of the tear etiology on functional and structural outcome remains controversial.
To investigate the influence of tear etiology (degenerative vs traumatic) on functional and structural outcomes in patients with supraspinatus tendon tears.
Cohort study; Level of evidence, 2.
Patients undergoing ARCR from 19 centers were prospectively enrolled between June 2020 and November 2021. Full-thickness, nonmassive tears involving the supraspinatus tendon were included. Tears were classified as degenerative (chronic shoulder pain, no history of trauma) or traumatic (acute, traumatic onset, no previous shoulder pain). Range of motion, strength, the Subjective Shoulder Value, the Oxford Shoulder Score (OSS), and the Constant-Murley Score (CMS) were assessed before (baseline) and 6 and 12 months after ARCR. The Subjective Shoulder Value and the OSS were also determined at the 24-month follow-up. Repair integrity after 12 months was documented, as well as additional surgeries up to the 24-month follow-up. Tear groups were compared using mixed models adjusted for potential confounding effects.
From a cohort of 973 consecutive patients, 421 patients (degenerative tear, n = 230; traumatic tear, n = 191) met the inclusion criteria. The traumatic tear group had lower mean baseline OSS and CMS scores but significantly greater score changes 12 months after ARCR (OSS, 18 [SD, 8]; CMS, 34 [SD,18] vs degenerative: OSS, 15 [SD, 8]; CMS, 22 [SD, 15]) ( < .001) and significantly higher 12-month overall scores (OSS, 44 [SD, 5]; CMS, 79 [SD, 9] vs degenerative: OSS, 42 [SD, 7]; CMS, 76 [SD, 12]) (≤ .006). At the 24-month follow-up, neither the OSS (degenerative, 44 [SD, 6]; traumatic, 45 [SD, 6]; = .346) nor the rates of repair failure (degenerative, 14 [6.1%]; traumatic 12 [6.3%]; = .934) and additional surgeries (7 [3%]; 7 [3.7%]; = .723) differed between groups.
Patients with degenerative and traumatic full-thickness supraspinatus tendon tears who had ARCR show satisfactory short-term functional results. Although patients with traumatic tears have lower baseline functional scores, they rehabilitate over time and show comparable clinical results 1 year after ARCR. Similarly, degenerative and traumatic rotator cuff tears show comparable structural outcomes, which suggests that degenerated tendons retain healing potential.
关节镜下肩袖修复术（ARCR）是最常进行的矫形手术之一。已经确定了一些因素，包括年龄、性别和撕裂严重程度，这些因素是修复后结果的预测因素。撕裂病因对功能和结构结果的影响仍存在争议。
研究肩袖肌腱撕裂患者撕裂病因（退行性与外伤性）对功能和结构结果的影响。
队列研究；证据水平，2 级。
从 2020 年 6 月至 2021 年 11 月，从 19 个中心前瞻性招募接受 ARCR 的患者。纳入全层、非巨大撕裂累及冈上肌腱。撕裂分为退行性（慢性肩部疼痛，无创伤史）或外伤性（急性、创伤性发作，无先前肩部疼痛）。在 ARCR 前（基线）和 6 个月和 12 个月后评估关节活动度、力量、主观肩部价值、牛津肩部评分（OSS）和 Constant-Murley 评分（CMS）。在 24 个月的随访时还确定了主观肩部价值和 OSS。记录 12 个月后的修复完整性，以及到 24 个月随访时的其他手术。使用混合模型比较撕裂组，模型调整了潜在的混杂影响。
从连续 973 例患者中，421 例患者（退行性撕裂，n=230；外伤性撕裂，n=191）符合纳入标准。外伤性撕裂组的基线 OSS 和 CMS 评分较低，但 ARCR 后 12 个月时的评分变化显著更大（OSS，18[SD，8]；CMS，34[SD，18]与退行性撕裂：OSS，15[SD，8]；CMS，22[SD，15]）（<.001），12 个月时的总体评分更高（OSS，44[SD，5]；CMS，79[SD，9]与退行性撕裂：OSS，42[SD，7]；CMS，76[SD，12]）（≤.006）。在 24 个月的随访时，OSS（退行性撕裂，44[SD，6]；外伤性撕裂，45[SD，6]；=0.346）和修复失败率（退行性撕裂，14[6.1%]；外伤性撕裂，12[6.3%]；=0.934）以及额外手术（退行性撕裂，7[3%]；外伤性撕裂，7[3.7%]；=0.723）之间没有差异。
接受 ARCR 的退行性和外伤性全层冈上肌腱撕裂患者具有令人满意的短期功能结果。尽管外伤性撕裂患者的基线功能评分较低，但随着时间的推移，他们会康复，并在 ARCR 后 1 年显示出可比的临床结果。同样，退行性和外伤性肩袖撕裂显示出可比的结构结果，这表明退行性肌腱保留了愈合潜力。
