Ghasemi S Ali, Murray Benjamin, Lencer Adam, Schueppert Emily, Raphael James, Morgan Craig, Bartolozzi Arthur
Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.
Navy Medicine Operational Training Command, Pensacola, Florida, U.S.A.
Arthrosc Sports Med Rehabil. 2024 May 25;6(5):100955. doi: 10.1016/j.asmr.2024.100955. eCollection 2024 Oct.
To evaluate the clinical outcome scores of an arthroscopic margin convergence technique without the use of suture anchors to repair different types of rotator cuff tears and to determine whether the type or extent of the tear has an effect on clinical outcome scores after this procedure.
Patients receiving arthroscopic margin convergence repair without suture anchors for rotator cuff tears from 2013 to 2018 were retrospectively analyzed. Arthroscopically determined partial- or full-thickness rotator cuff tears with a minimum follow-up period of 20 months were included. Outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) shoulder score; University of California, Los Angeles (UCLA) shoulder score; and visual analog scale (VAS) score. A 2-tailed distribution paired test was used to determine statistical significance ( < .05) between preoperative scores and scores at final follow-up. Correlation tests and linear regression analysis were used to determine the correlation between various clinical variables and outcomes. A cohort-specific minimal clinically important difference analysis was performed for each outcome score, calculated as one-half of the standard deviation of the delta score.
A total of 38 patients were included for analysis: 12 with partial-thickness tears and 26 with full-thickness tears. The mean postoperative follow-up period was 33.9 months (range, 22.2-94.5 months), with a minimum follow-up period of 22 months. The mean age of the patients was 62 ± 15.1 years. The minimal clinically important difference values for the ASES, UCLA, and VAS scores were 9.68, 2.92, and 1.13, respectively. There were significant improvements in the ASES (from 29.3 ± 18.3 preoperatively to 93.7 ± 8.3 postoperatively, = .001), UCLA (from 14.3 ± 6.2 to 32.8 ± 2.6, = .001), and VAS (from 7.37 ± 1.8 to 0.63 ± 1.02, = .001) clinical outcome scores. However, patients with either Patte stage 3 retraction ( = .033 for ASES score and = .020 for UCLA score) or U-shaped tears ( = .047 for ASES score and = .050 for UCLA score) had significantly lower clinical outcome scores than patients with less severe retraction or differently shaped tears.
The arthroscopic margin convergence technique without the use of suture anchors may be a suitable option in patients with partial- or full-thickness rotator cuff tears.
Level IV, therapeutic case series.
评估不使用缝线锚钉的关节镜下边缘对合技术修复不同类型肩袖撕裂的临床疗效评分，并确定撕裂的类型或范围对该手术后临床疗效评分是否有影响。
回顾性分析2013年至2018年接受不使用缝线锚钉的关节镜下边缘对合修复肩袖撕裂的患者。纳入关节镜检查确定为部分或全层肩袖撕裂且最短随访期为20个月的患者。使用美国肩肘外科医师（ASES）肩部评分、加利福尼亚大学洛杉矶分校（UCLA）肩部评分和视觉模拟量表（VAS）评分评估结果。采用双尾分布配对检验确定术前评分与最终随访评分之间的统计学显著性（P<0.05）。使用相关性检验和线性回归分析确定各种临床变量与结果之间的相关性。对每个疗效评分进行特定队列的最小临床重要差异分析，计算方法为差值评分标准差的一半。
共纳入38例患者进行分析：12例为部分厚度撕裂，26例为全层撕裂。术后平均随访期为33.9个月（范围22.2 - 94.5个月），最短随访期为22个月。患者的平均年龄为62±15.1岁。ASES、UCLA和VAS评分的最小临床重要差异值分别为9.68、2.92和1.13。ASES（从术前的29.3±18.3提高到术后的93.7±8.3，P = 0.001）、UCLA（从14.3±6.2提高到32.8±2.6，P = 0.001）和VAS（从7.37±1.8降低到0.63±1.02，P = 0.001）临床疗效评分均有显著改善。然而，Patte 3期回缩患者（ASES评分P = 0.033，UCLA评分P = 0.020）或U形撕裂患者（ASES评分P = 0.047，UCLA评分P = 0.050）的临床疗效评分显著低于回缩程度较轻或撕裂形状不同的患者。
不使用缝线锚钉的关节镜下边缘对合技术可能是部分或全层肩袖撕裂患者的合适选择。
IV级，治疗性病例系列。
