Galasso Olimpio, Mercurio Michele, Gasparini Giorgio, Cosentino Orlando, Massarini Alessandro, Orlando Nicola, Castricini Roberto
Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, Mater Domini" University Hospital, Catanzaro, Italy.
Division of Orthopaedic and Trauma Surgery, "Villa Maria Cecilia Hospital", Cotignola, Italy.
JSES Int. 2023 Dec 8;8(2):299-303. doi: 10.1016/j.jseint.2023.11.010. eCollection 2024 Mar.
Although interest in studies evaluating the outcomes of rotator cuff repair is steadily increasing, the results and tendon integrity after arthroscopic rotator cuff repair in elderly patients have only been minimally investigated. The aim of this study was to evaluate clinical outcomes and repair integrity in patients over 65 years of age who underwent arthroscopic repair of full-thickness rotator cuff tears.
A retrospective study was conducted with the following inclusion criteria: (1) elective shoulder arthroscopy for rotator cuff repair for full-thickness posterosuperior tears; (2) age over 65 years at surgery; and (3) participation in 24 months of follow-up. Preoperatively, the range of motion (ROM) and the Constant-Murley Score (CMS) and at follow-up, the ROM, the 12-Item Short Form Survey, the American Shoulder and Elbow Surgeons, and the CMS were evaluated; an ultrasonographic assessment of tendon integrity was performed according to the adapted Sugaya classification.
The final sample consisted of 110 patients with an average age of 69.2 ± 3.5 years. The mean duration of nonoperative management before surgery was 2.6 ± 0.8 months. The mean period of preoperative physical therapy was 0.6 ± 0.9 months. ROM and CMS showed statistically significant improvement (all < .001) after a mean follow-up time of 54.5 ± 22.3 months. The ultrasonographic assessment showed tendon integrity (types I and II) in 75% of cases; 21% were type III repair, and rotator cuff retear (types IV and V) was recorded in 4% of cases. All scores directly correlated with the integrity of the tendon. In the multivariate analysis, higher postoperative CMS was associated with male sex ( < .001, β = -6.085) and lower age ( = .004, β = -0.533). Higher postoperative American Shoulder and Elbow Surgeons were associated with lower age ( = .020, β = -0.414). Higher postoperative 12-Item Short Form Survey physical component score and mental component score were associated with lower age ( = .013, β = -0.550 and < .001, β = -0.520, respectively) and shorter preoperative physical therapy period ( = .013, β = -2.075 and = .006, β = -1.093, respectively).
A significant ROM and CMS recovery and a rotator cuff integrity rate of 75% can be expected in patients over 65 years of age who undergo arthroscopic repair for full-thickness rotator cuff tears. Better functional, physical, and mental health outcomes correlate with rotator cuff integrity and are predicted by male sex and a shorter period of preoperative physical therapy.
尽管评估肩袖修复结果的研究兴趣在稳步增加，但老年患者关节镜下肩袖修复后的结果和肌腱完整性仅得到了极少的研究。本研究的目的是评估65岁以上接受关节镜下全层肩袖撕裂修复患者的临床结果和修复完整性。
进行了一项回顾性研究，纳入标准如下：（1）因全层后上肩袖撕裂行择期肩关节镜下肩袖修复；（2）手术时年龄超过65岁；（3）参与24个月的随访。术前评估活动范围（ROM）和Constant-Murley评分（CMS），随访时评估ROM、12项简短问卷调查、美国肩肘外科医师协会评分和CMS；根据改良的Sugaya分类对肌腱完整性进行超声评估。
最终样本包括110例患者，平均年龄69.2±3.5岁。术前非手术治疗的平均持续时间为2.6±0.8个月。术前物理治疗的平均时间为0.6±0.9个月。平均随访54.5±22.3个月后，ROM和CMS显示出统计学上的显著改善（均P<0.001）。超声评估显示75%的病例肌腱完整（I型和II型）；21%为III型修复，4%的病例记录有肩袖再撕裂（IV型和V型）。所有评分均与肌腱完整性直接相关。多因素分析中，术后较高的CMS与男性（P<0.001，β=-6.085）和较低年龄（P=0.004，β=-0.533）相关。术后较高的美国肩肘外科医师协会评分与较低年龄相关（P=0.020，β=-0.414）。术后较高的12项简短问卷调查身体成分评分和精神成分评分与较低年龄（分别为P=0.013，β=-0.550和P<0.001，β=-0.520）和较短的术前物理治疗时间相关（分别为P=0.013，β=-2.075和P=0.006，β=-1.093）。
对于65岁以上接受关节镜下全层肩袖撕裂修复的患者，可预期ROM和CMS有显著恢复，肩袖完整率达75%。更好的功能、身体和心理健康结果与肩袖完整性相关，并可通过男性性别和较短的术前物理治疗时间预测。
