Mundakkal Arun, Raju Aebel, Vijayachandran Nair Ayyappan, Yoo Yon-Sik, Nambiar Radhesh, Sait Azad, Thankappan Ajayakumar, Khan Prince Shanavas
Department of Orthopaedic Surgery, Aster MIMS, Calicut, Kerala, India.
Department of Orthopaedic Surgery, Apollo Adlux Hospital, Angamaly, Kerala, India.
JSES Int. 2024 Apr 1;8(4):791-797. doi: 10.1016/j.jseint.2024.02.015. eCollection 2024 Jul.
Contracted subscapularis tears, especially Lafosse grade 3 and 4, pose a significant challenge in surgical repair due to the need for extensive release of retracted tendon and the risk of cut-through due to poor tissue quality. The posterior viewing portal may hinder adequate visualization and extensive release of retracted tendons, particularly in addressing the bursal surface of the tears. Tension-free robust repair is critical to prevent retears and for achieving successful outcomes for these massive and complex retracted tears. This study investigates the clinical outcomes of the Lasso-Loop technique with an anterolateral viewing portal, aiming to enhance tendon release, improve footprint fixation, and optimize tissue grip, particularly in cases of chronic retracted Lafosse 3 and 4 tears. This innovation also eliminates the need for arthroscope switching and serves as a crucial measure for averting axillary nerve injuries during the procedure.
The study included 40 patients with isolated subscapularis or combined anterosuperior rotator cuff tears (Lafosse grade 3 and 4) that underwent arthroscopic subscapularis repair using a Lasso-Loop technique through an anterolateral viewing portal. Evaluations were conducted both preoperatively and at predefined postoperative intervals: 6 weeks, 3 months, 6 months, 1 year, and 2 years. The evaluations in this study encompassed a comprehensive range of clinical assessments, which included a complete range of movements, specialized tests for subscapularis muscle functionality (specifically the lift-off test and belly press test), the utilization of the University of California at Los Angeles and Oxford shoulder scoring systems, and a postoperative ultrasonography conducted at the 6-month mark to assess the presence of any retear. Clinical outcomes were compared with that of the opposite normal shoulder.
There was considerable improvement in the active painless range of motion postoperatively. During the 2-year follow-up, the positive belly press test decreased from 50% (n = 20) to 2.5% (n = 1), while the positive lift-off test decreased from 100% (n = 40) to 5% (n = 2). The modified University of California at Los Angeles score increased significantly from 10.15 preoperatively to 30.17 at 2 years postoperatively ( value = .001). Oxford's Shoulder Score increased significantly from 15.6 preoperatively to 40.64 at 2 years postoperatively ( value = .001).
This technique has produced positive functional outcomes, in cases categorized as massive subscapularis tears and chronic tears indicating the superiority over other conventional techniques of subscapularis repair described in the literature.
肩胛下肌挛缩性撕裂，尤其是拉福斯3级和4级撕裂，由于需要广泛松解回缩的肌腱以及因组织质量差而存在切割风险，给手术修复带来了重大挑战。后视图门可能会妨碍对回缩肌腱的充分可视化和广泛松解，尤其是在处理撕裂的滑囊面时。无张力的牢固修复对于防止再次撕裂以及实现这些巨大而复杂的回缩性撕裂的成功治疗结果至关重要。本研究调查了采用前外侧视图门的套索环技术的临床结果，旨在增强肌腱松解、改善足迹固定并优化组织抓持，特别是在慢性回缩性拉福斯3级和4级撕裂的病例中。这一创新还消除了关节镜切换的需要，并作为在手术过程中避免腋神经损伤的关键措施。
该研究纳入了40例孤立性肩胛下肌或合并前上肩袖撕裂（拉福斯3级和4级）的患者，这些患者通过前外侧视图门采用套索环技术进行了关节镜下肩胛下肌修复。在术前以及术后预定的时间间隔（6周、3个月、6个月、1年和2年）进行评估。本研究中的评估包括一系列全面的临床评估，其中包括全范围活动、肩胛下肌功能的专门测试（特别是抬离试验和腹部按压试验）、使用加利福尼亚大学洛杉矶分校和牛津肩部评分系统，以及在6个月时进行术后超声检查以评估是否存在再次撕裂。将临床结果与对侧正常肩部进行比较。
术后主动无痛活动范围有显著改善。在2年的随访期间，阳性腹部按压试验从50%（n = 20）降至2.5%（n = 1），而阳性抬离试验从100%（n = 40）降至5%（n = 2）。改良的加利福尼亚大学洛杉矶分校评分从术前的10.15显著提高到术后2年的30.17（P值 = .001）。牛津肩部评分从术前的15.6显著提高到术后2年的40.64（P值 = .001）。
对于归类为巨大肩胛下肌撕裂和慢性撕裂的病例，该技术产生了积极的功能结果，表明其优于文献中描述的其他传统肩胛下肌修复技术。
