Hsu Kai-Lan, Kuan Fa-Chuan, Chen Yueh, Hong Chih-Kai, Chuang Hao-Chun, Su Pei-Fang, Chen Chin-Chun, Su Wei-Ren
Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Orthopedics, Kaohsiung Veterans General Hospital Tainan Branch, Tainan, Taiwan.
Arthroscopy. 2025 Mar 27. doi: 10.1016/j.arthro.2025.03.041.
To (1) investigate the relationship between repair tension and radiologic outcomes and (2) identify cutoff values of associated factors that predict both radiologic and clinical outcomes after arthroscopic subscapularis (SSC) repair.
This retrospective study included patients who underwent SSC repair and completed a 2-year follow-up between September 2020 and March 2022. Intraoperative evaluations examined the retraction length, repaired tendon, and Lafosse classification. Magnetic resonance imaging was performed before surgery and at 6 months postoperatively to evaluate the severity of the tear, fatty infiltration, and healing status of the SSC and supraspinatus. Functional scores and internal rotation strength were measured before surgery and at 6, 12, and 24 months postoperatively. Multiple logistic regression was performed to identify variables associated with poor healing, with receiver operating characteristic curves determining cutoff values.
A total of 67 patients were included. The mean SSC repair tension was 3.72 ± 1.48 kg. Poor healing was observed in 25.4% of the patients, with significant differences in age (P = .004), repair tension (P = .002), retraction length (P = .033), and Lafosse classification (P = .035) observed between the adequate and poor healing groups. Multiple logistic regression revealed significantly increased odds ratios for poor SSC healing in patients older than 65 years and patients with repair tension exceeding 4 kg.
Poor SSC healing is associated with advanced age, increased repair tension, greater retraction length, and more severe Lafosse classification. Patients older than 65 years and those with repair tension exceeding 4 kg are at a significantly higher risk of poor SSC healing. Furthermore, patients with poor SSC healing exhibit significantly reduced internal rotation strength at 24 months postoperatively. However, no significant decline was observed in shoulder function scores or achievement of the minimal clinically important difference.
Level III, retrospective cohort study.
（1）研究修复张力与影像学结果之间的关系；（2）确定关节镜下肩胛下肌（SSC）修复术后预测影像学和临床结果的相关因素的临界值。
这项回顾性研究纳入了在2020年9月至2022年3月期间接受SSC修复并完成2年随访的患者。术中评估包括回缩长度、修复的肌腱和Lafosse分类。术前及术后6个月进行磁共振成像，以评估撕裂的严重程度、脂肪浸润以及SSC和冈上肌的愈合情况。术前及术后6、12和24个月测量功能评分和内旋力量。进行多因素逻辑回归以确定与愈合不良相关的变量，并通过受试者工作特征曲线确定临界值。
共纳入67例患者。SSC修复的平均张力为3.72±1.48kg。25.4%的患者愈合不良，愈合良好组与愈合不良组在年龄（P = 0.004）、修复张力（P = 0.002）、回缩长度（P = 0.033）和Lafosse分类（P = 0.035）方面存在显著差异。多因素逻辑回归显示，65岁以上患者和修复张力超过4kg的患者SSC愈合不良的比值比显著增加。
SSC愈合不良与年龄较大、修复张力增加、回缩长度更大以及Lafosse分类更严重有关。65岁以上患者和修复张力超过4kg的患者SSC愈合不良风险显著更高。此外，SSC愈合不良的患者术后24个月内旋力量显著降低。然而，肩部功能评分或最小临床重要差异的达成情况未观察到显著下降。
III级，回顾性队列研究。
