Yiannakopoulos Christos, Koukos Christos, Habipis Apostolos, Apostolou Constantinos
School of Physical Education and Sport Science, National and Kapodistrian University, Athens 17237, Attikí, Greece.
Department of Orthopaedic, IASO Hospital, Athens 15123, Attikí, Greece.
World J Orthop. 2025 Jun 18;16(6):106458. doi: 10.5312/wjo.v16.i6.106458.
Shoulder arthroscopy is commonly used for the repair of glenohumeral ligament avulsions or tendon tears. The success of the operation depends on the ability of the ligaments or rotator cuff tendon to heal to their original attachment site. Soft tissue healing can be evaluated with imaging methods or alternatively with second-look arthroscopy.
To investigate shoulder tendon and capsule healing after arthroscopic rotator cuff and instability repair using second-look arthroscopy.
In this study, 24 adult patients with rotator cuff tears (13 patients) or anterior shoulder instability (11 patients) were included. All patients were initially subjected to arthroscopic repair using suture anchors and were re-evaluated with second-look arthroscopy for reasons not related to the original pathology. The second operation was performed in 8 patients due to mild but persistent pain or stiffness, in 3 patients for recalcitrant stiffness, in 5 patients for secondary biceps tenotomy, in 6 patients for persistent acromioclavicular joint pain and in 2 patients for suture anchor prominence causing shoulder grinding. Soft tissue healing was evaluated visually and by probing, whereas clinical outcomes were evaluated using the University of California-Los Angeles (UCLA) and Rowe rating scales.
In almost all patients, complete soft tissue healing occurred at the site of tissue reattachment, either on the glenoid articular surface or the greater humeral tuberosity. The strongest repair, as confirmed by probe palpation, was encountered at the site of suture passage through the soft tissue. All suture material was covered with bursal synovial tissue, with no cases of knot impingement or cartilage fraying. The mean preoperative and postoperative UCLA scores for rotator cuff repair patients were 1354 ± 3205 and 2931 ± 2898, respectively ( < 0.001), whereas for shoulder instability patients, the mean Rowe scores preoperatively and postoperatively were 2591 ± 1338 and 9272 ± 754, respectively ( < 0.001). The use of bioabsorbable implants did not cause synovitis or other tissue reactions.
Soft tissue healing in the shoulder is successful and strongest at the site of suture anchor placement.
肩关节镜检查常用于修复盂肱韧带撕脱或肌腱撕裂。手术的成功取决于韧带或肩袖肌腱愈合至其原始附着部位的能力。软组织愈合情况可通过影像学方法或二次关节镜检查进行评估。
通过二次关节镜检查研究关节镜下肩袖修复和肩关节不稳修复术后肩袖肌腱和关节囊的愈合情况。
本研究纳入24例成年患者，其中肩袖撕裂患者13例，肩关节前不稳患者11例。所有患者最初均采用缝线锚钉进行关节镜修复，并因与原发病理无关的原因接受二次关节镜检查重新评估。二次手术中，8例患者因轻度但持续的疼痛或僵硬接受手术，3例患者因顽固性僵硬接受手术，5例患者因继发性肱二头肌肌腱切断术接受手术，6例患者因肩锁关节持续性疼痛接受手术，2例患者因缝线锚钉突出导致肩部摩擦接受手术。通过视觉观察和探查评估软组织愈合情况，使用加州大学洛杉矶分校（UCLA）和Rowe评分量表评估临床疗效。
几乎所有患者在组织重新附着部位，即关节盂关节面或肱骨大结节处，均实现了完全的软组织愈合。通过探针触诊确认，缝线穿过软组织处的修复最为牢固。所有缝线材料均被滑膜组织覆盖，未出现结扣撞击或软骨磨损的情况。肩袖修复患者术前和术后UCLA评分的平均值分别为13.54±3.205和29.31±2.898（P<0.001），而肩关节不稳患者术前和术后Rowe评分的平均值分别为25.91±13.38和92.72±7.54（P<0.001）。使用生物可吸收植入物未引起滑膜炎或其他组织反应。
肩部软组织愈合成功，且在缝线锚钉置入部位愈合最为牢固。
