Wuhan Fourth Hospital, Wuhan, China.
Orthop Surg. 2024 May;16(5):1117-1126. doi: 10.1111/os.14039. Epub 2024 Mar 14.
To compare the clinical outcomes of a modified arthroscopic triple-row (TR) repair technique with the suture bridge (SB) repair technique in treating L-shaped delaminated rotator cuff tears. Various surgical techniques for L-shaped delaminated rotator cuff tears have been reported, many of which aid in increasing the contact area and pressure of the rotator cuff. However, there is still debate over which technique yields superior results.
From January 2017 to March 2020, 61 cases of L-shaped delaminated rotator cuff tears were included in this study. Of these, 34 cases underwent the modified arthroscopic triple-row repair technique, while 27 cases were addressed with the suture bridge repair technique. Functional assessment was conducted using the American Shoulder and Elbow Surgeons (ASES) score, the University of California Los Angeles (UCLA) shoulder score, the Constant score (CS), and the visual analogue scale (VAS) score. Magnetic Resonance Imaging (MRI) assessments for rotator cuff healing were performed at the 24-month postoperative mark. Statistical evaluations were conducted using SPSS for Windows (Version 25.0, IBM, Armonk, NY, USA), employing the Wilcoxon signed-rank test to compare preoperative and postoperative data and ROM differences, and the Mann-Whitney U test for statistical differences in clinical outcome scores between the two groups. A p-value of less than 0.05 was considered statistically significant.
Comparative analysis of the preoperative and final follow-up scores revealed a substantial enhancement in shoulder function, as indicated by the ASES, UCLA, CS, and VAS scores, with statistical significance (p < 0.001). At both the preoperative stage and final follow-up, no notable differences were observed in ASES, UCLA, CS, and VAS scores between the two groups. However, the TR repair group exhibited lower VAS scores than the SB group at 1 and 3 months postoperatively. Active range of motion (ROM) showed significant improvement in both groups. No significant differences in ROM were noted between the two groups either before the surgery or at the final follow-up.
The study demonstrates that both the modified arthroscopic TR and SB techniques for L-shaped delaminated cuff tears yield satisfactory outcomes, with no significant differences in overall clinical performance. Notably, early postoperative pain management appears more effective with the modified TR technique, suggesting its potential for enhanced early recovery experiences. This technique's design, promoting securer fixation and optimal contact conditions, is implied to facilitate superior long-term healing, warranting further investigation into its long-term benefits.
比较改良关节镜三排（TR）修复技术与缝合桥（SB）修复技术治疗 L 形分层肩袖撕裂的临床效果。各种治疗 L 形分层肩袖撕裂的手术技术已有报道，其中许多技术有助于增加肩袖的接触面积和压力。然而，哪种技术效果更好仍存在争议。
本研究纳入了 2017 年 1 月至 2020 年 3 月的 61 例 L 形分层肩袖撕裂患者。其中 34 例采用改良关节镜三排修复技术，27 例采用缝合桥修复技术。采用美国肩肘外科医生（ASES）评分、加州大学洛杉矶分校（UCLA）评分、Constant 评分（CS）和视觉模拟评分（VAS）对功能进行评估。术后 24 个月行磁共振成像（MRI）评估肩袖愈合情况。采用 SPSS for Windows（版本 25.0，IBM，Armonk，NY，USA）进行统计学分析，采用 Wilcoxon 符号秩检验比较术前和术后数据及 ROM 差异，采用 Mann-Whitney U 检验比较两组间临床疗效评分的统计学差异。p 值小于 0.05 为差异有统计学意义。
比较术前和末次随访时的评分，发现 ASES、UCLA、CS 和 VAS 评分均有显著提高，差异有统计学意义（p<0.001）。术前和末次随访时，两组间 ASES、UCLA、CS 和 VAS 评分差异无统计学意义。但 TR 修复组术后 1、3 个月 VAS 评分低于 SB 组。两组的主动活动范围（ROM）均有显著改善。术前和末次随访时，两组间 ROM 差异均无统计学意义。
本研究表明，改良关节镜 TR 和 SB 技术治疗 L 形分层肩袖撕裂均能获得满意的效果，总体临床疗效无显著差异。值得注意的是，改良 TR 技术在术后早期疼痛管理方面似乎更有效，提示其可能有助于促进早期康复体验。该技术的设计促进了更牢固的固定和更优的接触条件，提示其可能有利于更好的长期愈合，值得进一步研究其长期益处。
