Takahashi Ryosuke, Sagami Ryosuke, Harada Yohei, Kajita Yukihiro
Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Ichinomiya City, Aichi, Japan.
Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima UniversityHiroshima City, Hiroshima, Japan.
JSES Rev Rep Tech. 2024 Aug 30;4(4):774-778. doi: 10.1016/j.xrrt.2024.08.002. eCollection 2024 Nov.
This study aimed to evaluate the efficacy of pre-emptive middle glenohumeral ligament (MGHL) release during arthroscopic rotator cuff repair (ARCR) of small- to medium-sized tears to prevent postoperative stiffness.
Patients who underwent ARCR of small- to medium-sized tears were enrolled and allocated into 2 groups retrospectively: the pre-emptive MGHL release group (MGHL+ group, n = 34) and pre-emptive MGHL nonrelease group (MGHL- group, n = 32). The rotator interval and coracohumeral ligament release were performed in all patients with or without MGHL release in both groups. Clinical outcomes including the range of motion; Constant Shoulder score; and the University of California, Los Angeles score preoperatively and at 3 months, 6 months, and 12 months postoperatively and complications were assessed and compared between the 2 groups. The integrity of the repaired tendon was assessed at the 12-month follow-up using magnetic resonance imaging.
The MGHL+ group showed a significantly higher external rotation; Constant Shoulder score; and the University of California, Los Angeles score than the MGHL- group at 6 months postoperatively ( = .03, <.001, .01, respectively). The range of motion and functional scores were not significantly different between the groups at 3 and 12 months postoperatively ( > .05). The retear rate, postoperative stiffness, and postoperative instability were not significantly different between the groups (all, > .05).
Pre-emptive MGHL release in ARCR of small- to medium-sized tears could be an effective method to prevent early postoperative shoulder stiffness but does not significantly change the overall clinical outcome after ARCR.
本研究旨在评估在关节镜下修复中小型肩袖撕裂时，预先松解中盂肱韧带（MGHL）对预防术后僵硬的疗效。
回顾性纳入接受中小型肩袖撕裂关节镜修复术的患者，并将其分为两组：预先松解MGHL组（MGHL+组，n = 34）和未预先松解MGHL组（MGHL-组，n = 32）。两组患者无论是否松解MGHL，均进行了旋转间隙和喙肱韧带松解。评估并比较两组患者术前、术后3个月、6个月和12个月的临床结果，包括活动范围、Constant肩关节评分、加州大学洛杉矶分校（UCLA）评分以及并发症情况。在12个月随访时，使用磁共振成像评估修复肌腱的完整性。
术后6个月时，MGHL+组的外旋角度、Constant肩关节评分和UCLA评分均显著高于MGHL-组（分别为P = 0.03、P < 0.001、P = 0.01）。术后3个月和12个月时，两组间的活动范围和功能评分无显著差异（均P > 0.05）。两组间的再撕裂率、术后僵硬和术后不稳定情况均无显著差异（均P > 0.05）。
在中小型肩袖撕裂的关节镜修复术中预先松解MGHL可能是预防术后早期肩关节僵硬的有效方法，但不会显著改变关节镜修复术后的整体临床结果。
