Chen Yu-Sheng, Kuan Fa-Chuan, Su Wei-Ren, Hong Chih-Kai, Chen Yueh, Hsu Kai-Lan
Department of Orthopedics, Taipei Municipal Hospital YangMing Branch, Taipei, Taiwan.
Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
J Orthop Surg Res. 2025 Jun 3;20(1):562. doi: 10.1186/s13018-025-05975-x.
The treatment of massive anterior L-shaped rotator cuff tears (RCTs) remains challenging. This study focused on restoration of humeral head coverage by superiorly repositioning the rotator interval tissue. The study aimed (1) to present the short-term clinical and radiological outcomes of arthroscopic partial repair combined with rotator interval shift and (2) to identify risk factors associated with failure in restoring superior humeral head coverage.
A retrospective review was conducted on arthroscopic rotator cuff repairs performed by a single surgeon between January 2018 and December 2022. Patients with irreparable anterior L-shaped tears who underwent partial repair and rotator interval shift and had a follow-up of 2 years were included. The measured outcomes included range of motion, pain, and functional scores. Humeral head coverage was evaluated using magnetic resonance imaging (MRI) at 6 months postoperation, and patients were classified as either healed or having a retear. Logistic regression analysis was conducted to identify factors associated with retears.
The study included 45 patients (19 men and 26 women) with an average age of 66.53 ± 6.70 years. After 2 years, significant improvements were observed in forward elevation (from 77.73 ± 40.96 to 156.11 ± 25.89), abduction (from 82.89 ± 43.78 to 161.33 ± 22.90), American Shoulder and Elbow Surgeons scores (from 43.24 ± 15.77 to 83.16 ± 10.27), and Constant-Murley scores (from 44.98 ± 15.76 to 86.38 ± 10.02; all p < 0.001). Visual analog scale pain scores also decreased (from 7.09 ± 2.35 to 1.29 ± 1.70). MRI results at 6 months showed that 30 of 45 patients (66.7%) had healed, while the retear rate was 33.3%. The acromiohumeral interval (AHI) was identified as the only factor significantly associated with retear. The odds ratio for predicting retear in patients with a preoperative AHI of < 5.0 mm was 5.50. (95% CI: 1.43-21.10, p = 0.013).
Arthroscopic partial repair combined with rotator interval shift is an effective treatment option for irreparable anterior L-shaped RCTs, demonstrating favorable short-term clinical and radiological outcomes. However, patients with a preoperative AHI of less than 5 mm are at greater risk of retear, potentially leading to reduced postoperative range of motion.
Level IV, case series.
巨大前侧L形肩袖撕裂（RCTs）的治疗仍然具有挑战性。本研究聚焦于通过向上重新定位旋转间隙组织来恢复肱骨头覆盖。该研究旨在（1）呈现关节镜下部分修复联合旋转间隙移位的短期临床和影像学结果，以及（2）确定与恢复肱骨头上方覆盖失败相关的危险因素。
对2018年1月至2022年12月期间由单一外科医生进行的关节镜下肩袖修复手术进行回顾性研究。纳入接受部分修复和旋转间隙移位且随访2年的不可修复前侧L形撕裂患者。测量的结果包括活动范围、疼痛和功能评分。术后6个月使用磁共振成像（MRI）评估肱骨头覆盖情况，患者被分类为愈合或再次撕裂。进行逻辑回归分析以确定与再次撕裂相关的因素。
该研究纳入了45例患者（19例男性和26例女性），平均年龄为66.53±6.70岁。2年后，前屈上举（从77.73±40.96提升至156.11±25.89）、外展（从82.89±43.78提升至161.33±22.90）、美国肩肘外科医生评分（从43.24±15.77提升至83.16±10.27）和Constant-Murley评分（从44.98±15.76提升至86.38±10.02；所有p<0.001）均有显著改善。视觉模拟量表疼痛评分也有所下降（从7.09±2.35降至1.29±1.70）。术后6个月的MRI结果显示，45例患者中有30例（66.7%）已愈合，而再次撕裂率为33.3%。肩峰下间隙（AHI）被确定为与再次撕裂显著相关的唯一因素。术前AHI<5.0 mm的患者再次撕裂的预测比值比为5.50（95%CI：1.43 - 21.10，p = 0.013）。
关节镜下部分修复联合旋转间隙移位是不可修复前侧L形RCTs的有效治疗选择，显示出良好的短期临床和影像学结果。然而，术前AHI小于5 mm的患者再次撕裂的风险更高，可能导致术后活动范围减小。
IV级，病例系列。
