Kim Hyoung Bok, Kim Seong Hun
Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
Clin Shoulder Elb. 2025 Mar;28(1):60-67. doi: 10.5397/cise.2024.00689. Epub 2025 Feb 14.
This study compared the clinical and radiological outcomes of chronic retracted rotator cuff tears where complete footprint coverage cannot be achieved, using two treatments: footprint medialization with bone marrow stimulation and conventional incomplete repair.
This retrospective study included 87 patients who underwent arthroscopic rotator cuff repair with incomplete footprint coverage. The included patients were divided into group 1 (54 patients with footprint medialization and bone marrow stimulation) and group 2 (33 patients with conventional repair). Medialization and bone marrow stimulation were performed if the tendon did not cover a footprint of ≥1 cm2. Clinical outcomes, including a visual analog scale for pain score, range of motion, American Shoulder and Elbow Surgeons score, Constant-Murley score, and patient satisfaction, were evaluated preoperatively and at follow-up. Radiological healing was assessed using magnetic resonance imaging or computed tomography arthrography at 6 months and ultrasound at 2 years.
Both groups showed significant improvements in clinical outcomes from preoperative levels. Group 1 demonstrated better outcomes in all measures at the final follow-up than group 2. Active range of motion improved significantly in both groups, with no significant postoperative differences. At 2 years postoperatively, group 1 had a significantly lower retear rate (14.8%) than group 2 (36.4%) (P=0.020).
In this study, the group that underwent footprint medialization and bone marrow stimulation for chronic retracted rotator cuff tears, in which complete footprint coverage was not possible, exhibited a lower retear rate and better clinical outcomes than the group that underwent conventional incomplete repair, with a minimum follow-up period of 2 years. Level of evidence: III.
本研究比较了两种治疗方法对无法实现完全足迹覆盖的慢性回缩性肩袖撕裂的临床和影像学结果，这两种治疗方法分别是足迹内移联合骨髓刺激和传统不完全修复。
这项回顾性研究纳入了87例行关节镜下肩袖修复且足迹覆盖不完全的患者。纳入的患者被分为1组（54例行足迹内移联合骨髓刺激的患者）和2组（33例行传统修复的患者）。如果肌腱覆盖的足迹面积小于1平方厘米，则进行内移和骨髓刺激。评估术前和随访时的临床结果，包括视觉模拟疼痛评分、活动范围、美国肩肘外科医师评分、Constant-Murley评分和患者满意度。在6个月时使用磁共振成像或计算机断层扫描关节造影评估影像学愈合情况，在2年时使用超声评估。
两组的临床结果均较术前有显著改善。在最终随访时，1组在所有测量指标上的结果均优于2组。两组的主动活动范围均有显著改善，术后无显著差异。术后2年，1组的再撕裂率（14.8%）显著低于2组（36.4%）（P=0.020）。
在本研究中，对于无法实现完全足迹覆盖的慢性回缩性肩袖撕裂，接受足迹内移联合骨髓刺激的组比接受传统不完全修复的组表现出更低的再撕裂率和更好的临床结果，最短随访期为2年。证据等级：III级。
