Soule Silvia, Clinker Christopher, Presson Angela P, Zhang Chong, Joyce Christopher, Tashjian Robert Z, Chalmers Peter N
Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
Division of Epidemiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA.
JSES Int. 2025 Jan 31;9(3):715-719. doi: 10.1016/j.jseint.2024.12.023. eCollection 2025 May.
Rotator cuff tendon injuries often necessitate surgical intervention to restore function and alleviate pain. The integrity of the tendon-specifically its quality, the extent of tendon loss, and the presence of delamination-may influence postoperative outcomes. The purpose of this study was to evaluate the association between these tendon characteristics and patient-reported outcomes (PROs) after rotator cuff tendon repair.
A retrospective chart review was performed for patients who underwent rotator cuff repair by a single surgeon at an academic institution between 2016 and 2022. This author recorded tendon quality, tendon loss, and tendon delamination on every single case immediately after it was performed. Tendon quality was graded as poor when sutures pulled through the tendon. Tendon loss was graded based upon tendon length remaining. PRO collected preoperatively and at a minimum of two-years postoperatively included the American Shoulder and Elbow Surgeons (ASES) score and the Subjective Shoulder Value (SSV) score.
Of 424 patients (441 shoulders) who met inclusion criteria, 2-year outcomes were available for 77% (339/441). The cohort was 57 ± 10 years, had 39% female, with an average body mass index of 30 ± 5.7. Supraspinatus/infraspinatus tears were full thickness in 59% (202/339) and partial thickness in 34% (117/339), with 7% (23/339) having isolated subscapularis tears. PROs changed from ASES 51 ± 19, SSV 45 ± 20, and visual analog scale 4.7 ± 2.3 preoperatively to ASES 89 ± 15, SSV 89 ± 15, and visual analog scale 0.85 ± 1.6 postoperatively. Tendon quality was good in 83% (282/339), fair in 13% (44/339), and poor in 4% (13/339). Tendon loss was minimal in 86% (291/339) and substantial in 14% (48/339). Delamination was present in 16% (55/339). Multivariable analysis showed that poor tendon quality and substantial tendon loss (<16 mm tendon length remaining) were independently associated with worse postoperative ASES scores ( = .019 and .005, respectively).
Substantial tendon loss and poor tendon quality should be considered as poor prognostic indicators in rotator cuff repair outcomes. In those patients with poor tendon quality or substantial tendon loss, surgeons could consider augmentation.
肩袖肌腱损伤常常需要手术干预来恢复功能并减轻疼痛。肌腱的完整性——特别是其质量、肌腱缺损程度以及分层情况——可能会影响术后结果。本研究的目的是评估这些肌腱特征与肩袖肌腱修复术后患者报告结局（PROs）之间的关联。
对2016年至2022年间在一所学术机构由同一位外科医生进行肩袖修复的患者进行回顾性病历审查。作者在每例手术完成后立即记录肌腱质量、肌腱缺损和肌腱分层情况。当缝线穿过肌腱时，肌腱质量被评为差。根据剩余肌腱长度对肌腱缺损进行分级。术前及术后至少两年收集的PROs包括美国肩肘外科医生（ASES）评分和主观肩部价值（SSV）评分。
在符合纳入标准的424例患者（441个肩部）中，77%（339/441）有2年的随访结果。该队列的平均年龄为57±10岁，女性占39%，平均体重指数为30±5.7。冈上肌/冈下肌撕裂为全层撕裂的占59%（202/339），部分层撕裂的占34%（117/339），孤立的肩胛下肌撕裂占7%（23/339）。PROs从术前的ASES 51±19、SSV 45±20和视觉模拟量表4.7±2.3，变为术后的ASES 89±15、SSV 89±15和视觉模拟量表0.85±1.6。肌腱质量良好的占83%（282/339），中等的占13%（44/339），差的占4%（13/339）。肌腱缺损最小的占86%（291/339），严重的占14%（48/339）。16%（55/339）存在分层。多变量分析显示，肌腱质量差和严重的肌腱缺损（剩余肌腱长度<16mm）与术后较差的ASES评分独立相关（分别为P = .019和.005）。
严重的肌腱缺损和较差的肌腱质量应被视为肩袖修复结果的不良预后指标。对于肌腱质量差或肌腱缺损严重的患者，外科医生可考虑进行增强手术。
