Gonzalez-Morgado Diego, Ardebol Javier, Kilic Ali Ihsan, Noble Matthew B, Galasso Lisa A, Menendez Mariano E, Denard Patrick J
Oregon Shoulder Institute, Medford, Oregon, USA.
Orthopaedic Surgery Department, Hospital Universitari Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
Orthop J Sports Med. 2024 Oct 9;12(10):23259671241280736. doi: 10.1177/23259671241280736. eCollection 2024 Oct.
Restoring shoulder strength after arthroscopic rotator cuff repair (ARCR) is critical, but there is limited understanding as to what patients consider satisfactory postoperative strength.
To determine the Patient Acceptable Symptom State (PASS) values for the Constant score strength parameter and internal rotation (IR) strength in patients who underwent ARCR for rotator cuff tears involving the subscapularis (SSC) muscle and evaluate for associations between preoperative and intraoperative patient characteristics with PASS achievement.
Case-control study; Level of evidence, 3.
A retrospective analysis was conducted on prospectively collected data for 278 patients with an SSC tear (isolated or combined) who underwent ARCR and had minimum 2-year follow-up data. Functional outcomes (patient-reported outcomes, range of motion, Constant strength, and IR strength) were assessed preoperatively and at the latest follow-up. The overall, male, and female PASS values for postoperative strength measures were evaluated using receiver operating characteristic analysis. Correlation and logistic regression analyses were used to evaluate the relationship between preoperative variables and PASS achievement for Constant and IR strengths.
The mean follow-up time was 72.8 months. The overall, male, and female PASS values were 9.9 lb (4.5 kg), 14.5 lb (6.6 kg), and 8.5 lb (3.9 kg), respectively, for Constant strength and 15.2 lb (6.9 kg), 20.7 lb (9.4 kg), and 12.1 lb (5.5 kg), respectively, for IR strength. Older age, high fatty infiltration of the SSC tendon (Goutallier grades 3 and 4), and failure of SSC healing correlated negatively with PASS attainment for the strength measures. High fatty infiltration of the supraspinatus and infraspinatus muscles correlated negatively with Constant strength. Decreased coracohumeral distance (CHD) and larger SSC tears correlated negatively with achieving PASS for IR strength. Workers' compensation, high supraspinatus and SSC fatty infiltration, and the use of knotted suture anchors were predictors of not achieving the overall Constant strength PASS, while lower SSC fatty infiltration and high CHD were predictors of achieving the overall IR strength PASS.
This study established the PASS values for Constant and IR strengths for patients after ARCR involving the SSC tendon. Workers' compensation, high supraspinatus and SSC fatty infiltration, and the use of knotted suture anchors were predictors of not achieving the overall Constant strength PASS, while lower SSC fatty infiltration and high CHD were predictors of achieving the overall IR strength PASS.
关节镜下肩袖修补术（ARCR）后恢复肩部力量至关重要，但对于患者认为满意的术后力量程度，人们了解有限。
确定肩胛下肌（SSC）肌腱撕裂接受ARCR治疗的患者，其Constant评分力量参数和内旋（IR）力量的患者可接受症状状态（PASS）值，并评估术前和术中患者特征与达到PASS之间的关联。
病例对照研究；证据等级，3级。
对前瞻性收集的278例SSC撕裂（孤立或合并）且接受ARCR治疗并有至少2年随访数据的患者数据进行回顾性分析。术前和最新随访时评估功能结局（患者报告结局、活动范围、Constant力量和IR力量）。使用受试者工作特征分析评估术后力量测量的总体、男性和女性PASS值。采用相关性和逻辑回归分析评估术前变量与Constant和IR力量达到PASS之间的关系。
平均随访时间为72.8个月。Constant力量的总体、男性和女性PASS值分别为9.9磅（4.5千克）、14.5磅（6.6千克）和8.5磅（3.9千克），IR力量的PASS值分别为15.2磅（6.9千克）、20.7磅（9.4千克）和12.1磅（5.5千克）。年龄较大、SSC肌腱脂肪浸润程度高（Goutallier分级3级和4级）以及SSC愈合失败与力量测量达到PASS呈负相关。冈上肌和冈下肌脂肪浸润程度高与Constant力量呈负相关。喙肱距离（CHD）减小和SSC撕裂较大与IR力量达到PASS呈负相关。工伤赔偿、冈上肌和SSC脂肪浸润程度高以及使用打结缝合锚钉是未达到总体Constant力量PASS的预测因素，而较低的SSC脂肪浸润程度和较高的CHD是达到总体IR力量PASS的预测因素。
本研究确定了涉及SSC肌腱的ARCR术后患者Constant和IR力量的PASS值。工伤赔偿、冈上肌和SSC脂肪浸润程度高以及使用打结缝合锚钉是未达到总体Constant力量PASS的预测因素，而较低的SSC脂肪浸润程度和较高的CHD是达到总体IR力量PASS的预测因素。
