Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Dongjak-gu, Seoul, Republic of Korea.
Department of Translational Medicine, Seoul National University College of Medicine, Jongno-gu, Seoul, Republic of Korea.
Am J Sports Med. 2024 Jul;52(9):2348-2357. doi: 10.1177/03635465241255944.
The clinical implications of structural integrity have been a subject of long debate. The oversimplified binary categorization of structural integrity into either healing or retear, along with faulty preoperative baselines for comparison, may contribute to the controversy.
To determine how the quality of structural integrity in a repaired cuff tendon affects both clinical and structural outcomes by dividing the patients into groups based on integrity and using the immediate postoperative baseline (time zero).
Cohort study; Level of evidence, 3.
A total of 504 patients with a full-thickness rotator cuff tear who underwent arthroscopic rotator cuff repair and were followed up for at least a year with magnetic resonance imaging (MRI) were included. The quality of structural integrity was graded using the Sugaya classification. To evaluate clinical outcomes, pain, range of motion, strength, functional scores, and overall satisfaction and function were used for within- and between-group analyses at the last follow-up. For the assessment of structural outcomes, the Goutallier classification for fatty infiltration (FI) and the tangent sign, occupation ratio, and normalized cross-sectional area for muscle atrophy (MA) were used. The baselines for these structural measurements were both the preoperative and the time-zero MRI scans.
The mean clinical follow-up period was 31.8 ± 27.5 months, and the MRI follow-up period was 10.9 ± 5.3 months. There were 178 (35.3%), 228 (45.2%), 58 (11.5%), 14 (2.8%), and 26 (5.2%) shoulders with Sugaya grades 1, 2, 3, 4, and 5, respectively. Regardless of structural integrity, all clinical outcomes at a mean follow-up of 31.8 months after repair significantly improved compared with those before repair. Only in shoulders with Sugaya grade 1 did the FI of the supraspinatus muscle improve significantly from baseline. FI of the infraspinatus muscle did not change significantly in those with grades 1 and 2 but worsened in those with grades 3 and 5. MA measured using the occupation ratio improved significantly in shoulders with Sugaya grades 1 and 2 but declined in those with grade 5.
This study established a correlation between improved structural integrity of the repaired cuff tendon and enhanced structural outcomes in rotator cuff muscles. Furthermore, the findings revealed that both FI and MA could be reversed in patients exhibiting high-quality structural integrity. However, these structural improvements were not mirrored in the clinical outcomes.
结构完整性的临床意义一直是一个长期争论的话题。结构完整性过于简单地分为愈合或再撕裂，以及术前基线错误的比较，可能是造成争议的原因。
通过根据完整性将患者分为组，并使用术后即刻基线（时间零），确定修复肩袖肌腱的结构完整性质量如何影响临床和结构结果。
队列研究；证据水平，3 级。
共纳入 504 例全层肩袖撕裂患者，均接受关节镜下肩袖修复，并通过 MRI 随访至少 1 年。使用 Sugaya 分类法评估结构完整性质量。为了评估临床结果，在最后一次随访时使用疼痛、活动范围、力量、功能评分以及整体满意度和功能进行组内和组间分析。为了评估结构结果，使用 Goutallier 分级法评估脂肪浸润（FI）和切线征，以及用于肌肉萎缩（MA）的占有率、归一化截面积。这些结构测量的基线是术前和时间零 MRI 扫描。
平均临床随访时间为 31.8±27.5 个月，MRI 随访时间为 10.9±5.3 个月。Sugaya 分级分别为 1 级、2 级、3 级、4 级和 5 级的肩分别有 178 例（35.3%）、228 例（45.2%）、58 例（11.5%）、14 例（2.8%）和 26 例（5.2%）。无论结构完整性如何，修复后平均 31.8 个月的所有临床结果均显著优于修复前。只有在 Sugaya 分级 1 的肩中，冈上肌的 FI 才从基线显著改善。1 级和 2 级肩的冈下肌 FI 无明显变化，但 3 级和 5 级肩的 FI 恶化。使用占有率测量的 MA 在 Sugaya 分级 1 和 2 的肩中显著改善，但在分级 5 的肩中下降。
本研究建立了修复肩袖肌腱的结构完整性改善与冈上肌和冈下肌结构结果增强之间的相关性。此外，研究结果表明，在具有高质量结构完整性的患者中，FI 和 MA 均可以逆转。然而，这些结构的改善并没有反映在临床结果中。
