Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Faculty of Medicine, Universitas Trisakti, St. Carolus Hospital, Jakarta, Indonesia.
J Shoulder Elbow Surg. 2024 Sep;33(9):1990-1998. doi: 10.1016/j.jse.2024.01.025. Epub 2024 Feb 28.
This study aimed to investigate the correlation between rotator cuff stump classification and postoperative outcomes after superior capsular reconstruction (SCR).
A total of 75 patients who underwent SCR between June 2013 and May 2021 were included in this study. Based on stump classification using the signal intensity ratio of the tendon rupture site to the deltoid muscle in the coronal view of preoperative T2-weighted, fat-suppressed magnetic resonance imaging scans, the patients were classified into types 1, 2, and 3 with ratios of <0.8, 0.8-1.3, and >1.3 (44, 17, and 14 patients, respectively). The American Shoulder and Elbow Surgeons (ASES), Constant, and visual analog scale (VAS) scores for pain and range of motion were evaluated at a minimum of 1 year of follow-up postoperatively. The acromiohumeral distance and rotator cuff arthropathy according to the Hamada classification were assessed on plain radiography. The graft integrity was evaluated by magnetic resonance imaging at 3 and 12 months postoperatively and annually thereafter.
Clinical and radiological outcomes were significantly improved after SCR. In comparison with type 2 and 3 patients, type 1 patients had significantly higher ASES scores (type 1, 2, and 3 = 84 ± 10, 75 ± 15, and 76 ± 14; all P = .014), Constant scores (type 1, 2, and 3 = 65 ± 5, 61 ± 9, and 56 ± 13; all P = .005), and forward flexion (type 1, 2, and 3 = 155 ± 10, 154 ± 15, and 145 ± 13; all P = .013). However, these statistical differences between groups were below the established minimum clinically important difference values for the ASES and Constant scores after rotator cuff repair. The graft failure rate after surgery was lower in the type 1 group than that in the other 2 groups; however, the difference was not statistically significant (P = .749).
Patients with stump classification type 1 showed significantly better functional scores (ASES and VAS scores) and forward flexion; however, the clinical importance of these differences may be limited. Stump classification may be useful for predicting postoperative clinical outcomes.
本研究旨在探讨肩袖残端分类与肩袖上囊重建（SCR）术后结果之间的相关性。
本研究共纳入 75 例 2013 年 6 月至 2021 年 5 月间接受 SCR 的患者。根据术前冠状位 T2 加权脂肪抑制磁共振成像扫描中肌腱断裂部位与三角肌的信号强度比，将患者分为 1 型、2 型和 3 型，比值分别为<0.8、0.8-1.3 和>1.3（44、17 和 14 例）。术后至少随访 1 年，采用美国肩肘外科医师协会（ASES）评分、Constant 评分和视觉模拟评分（VAS）评估疼痛和活动度。在平片上评估肩峰肱距和根据 Hamada 分类的肩袖关节炎。术后 3 个月和 12 个月以及此后每年通过磁共振成像评估移植物完整性。
SCR 后临床和影像学结果均显著改善。与 2 型和 3 型患者相比，1 型患者的 ASES 评分明显更高（1 型、2 型和 3 型分别为 84±10、75±15 和 76±14；均 P=0.014）、Constant 评分（1 型、2 型和 3 型分别为 65±5、61±9 和 56±13；均 P=0.005）和前屈（1 型、2 型和 3 型分别为 155±10、154±15 和 145±13；均 P=0.013）。然而，这些组间的统计学差异低于肩袖修复后 ASES 和 Constant 评分的既定最小临床重要差异值。术后移植物失败率在 1 型组低于其他 2 组，但差异无统计学意义（P=0.749）。
残端分类为 1 型的患者功能评分（ASES 和 VAS 评分）和前屈明显更好，但这些差异的临床意义可能有限。残端分类可用于预测术后临床结果。
