Rokito A S, Zuckerman J D, Gallagher M A, Cuomo F
Hospital for Joint Diseases, Department of Orthopaedic Surgery, New York 10003, USA.
J Shoulder Elbow Surg. 1996 Jan-Feb;5(1):12-7. doi: 10.1016/s1058-2746(96)80025-5.
Forty-two consecutive patients (20 men and 22 women, age range 39 to 78 years) with full-thickness rotator cuff tears underwent a comprehensive isokinetic strength assessment before and at 3-month intervals for 1 year after surgery. All patients underwent acromioplasty and rotator cuff repair and were treated with a standardized postoperative rehabilitation program. Isokinetic strength testing was performed in flexion/extension, abduction/adduction, and external/internal rotation at 60 degrees/sec. The unaffected contralateral shoulder was tested for comparison. Clinical outcomes were assessed with the University of California Los Angeles Shoulder Rating Scale (maximum = 35 points). The average University of California Los Angeles score was 31.2 by 1 year after operation. Patients with small and medium tears had an average rating of 33.5, whereas those with large and massive tears had an average score of 28.3. Strength increased gradually during the first postoperative year. The preoperative mean peak torque was 54%, 45%, and 64% of the uninvolved shoulder in flexion, abduction, and external rotation, respectively; after operation it increased to 78%, 80%, and 79% by 6 months and 84%, 90%, and 91% by 12 months. The greatest improvement in strength consistently occurred during the first 6 months after surgery. Patients also showed marked increases in both work and power. By 12 months after operation mean work had increased to 70% in flexion and abduction and 90% in external rotation of the uninvolved shoulder. Similarly, mean power had increased to 68%, 79%, and 90% of the uninvolved shoulder in flexion, abduction, and external rotation, respectively, by 12 months after operation. Recovery of strength correlated primarily with the size of the tear: for small and medium tears recovery of strength was almost complete during the first year, and for large and massive tears it was much slower and less consistent. By using isokinetic strength evaluation we found that recovery of strength after rotator cuff repair requires at least 1 year of rehabilitation.
42例连续性全层肩袖撕裂患者（20例男性，22例女性，年龄范围39至78岁）在手术前及术后1年每隔3个月接受一次全面的等速肌力评估。所有患者均接受了肩峰成形术和肩袖修复，并接受标准化的术后康复计划治疗。在60度/秒的速度下进行屈伸、外展/内收以及外旋/内旋的等速肌力测试。对未受影响的对侧肩部进行测试以作比较。采用加州大学洛杉矶分校肩评分量表（满分 = 35分）评估临床结果。术后1年时，加州大学洛杉矶分校评分平均为31.2分。中小型撕裂患者的平均评分为33.5分，而大型和巨大型撕裂患者的平均评分为28.3分。术后第一年肌力逐渐增加。术前平均峰值扭矩在屈伸、外展和外旋时分别为未受累肩部的54%、45%和64%；术后6个月时分别增至78%、80%和79%，12个月时分别增至84%、90%和91%。肌力改善最显著的阶段始终是术后的前6个月。患者的功和功率也显著增加。术后12个月时在屈伸和外展时平均功增加至未受累肩部的70%，在外旋时增加至90%。同样，术后12个月时在屈伸、外展和外旋时平均功率分别增加至未受累肩部的68%、79%和90%。肌力恢复主要与撕裂大小相关：中小型撕裂在第一年肌力几乎完全恢复，而大型和巨大型撕裂恢复较慢且不太一致。通过等速肌力评估我们发现，肩袖修复术后肌力恢复至少需要1年的康复时间。
