Background:

In shoulders with irreparable massive rotator cuff tears (RCTs) with high-grade fatty degeneration (Goutallier stage 3 or 4) of the supraspinatus tendon and low-grade fatty degeneration (Goutallier stage 1 or 2) of the infraspinatus tendon (ISP), arthroscopic patch grafting (PG) has been reported as superior to partial repair (PR) regarding the ISP retear rate at short-term to midterm follow-up. However, the longer term outcomes are unclear.

Purpose:

To compare clinical and structural outcomes in the PG and PR groups at a minimum of 7 years postoperatively.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

We evaluated 24 patients in the PG group and 24 patients in the PR group. We primarily used the Constant score for clinical outcomes and performed magnetic resonance imaging for structural outcomes in the PG and PR groups. The risk factors for a retear of the ISP were identified by univariate and multivariate (forward stepwise selection method) logistic regression analyses. We primarily compared values at midterm follow-up (<4 years) with values at the final follow-up (minimum 7 years) for each patient.

Results:

The mean midterm and final follow-up times for the PG group were 41.0 and 95.1 months, respectively, compared with 35.7 and 99.3 months, respectively, for the PR group. We found significant differences for the midterm and final follow-up Constant total scores in the PG and PR groups (midterm follow-up: 79.1 vs 69.9, respectively [P = .001]; final follow-up: 76.0 vs 65.3, respectively [P = .006]) and in the Constant strength scores (midterm follow-up: 14.6 vs 8.5, respectively [P < .001]; final follow-up: 13.1 vs 8.3, respectively [P = .001]). Treatment group (PR) was a significant predictor of an ISP retear in the logistic regression analysis (odds ratio, 3.545; P = .043).

Conclusion:

Patients with low-grade massive RCTs treated with PG or PR improved significantly in terms of clinical outcomes at the midterm and final follow-up time points. However, Constant scores were significantly better in the PG group at the final follow-up.

中文翻译：

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不可修复的大到大量肩袖撕裂伴冈下肌腱低度脂肪变性：筋膜自体移植修补程序和部分修复的至少 7 年随访

背景：

肩部有不可修复的大量肩袖撕裂 (RCT)，冈上肌腱高度脂肪变性（Goutallier 3 或 4 期）和冈下肌腱（ISP）低度脂肪变性（Goutallier 1 或 2 期），关节镜检查据报道，在短期到中期随访中，就 ISP 的复发率而言，补片移植 (PG) 优于部分修复 (PR)。然而，长期结果尚不清楚。

目的：

比较术后至少 7 年 PG 和 PR 组的临床和结构结果。

学习规划：

队列研究；证据等级，3。

方法：

我们评估了 PG 组的 24 名患者和 PR 组的 24 名患者。我们主要使用 Constant 评分来评估临床结果，并对 PG 和 PR 组的结构结果进行磁共振成像。通过单变量和多变量（向前逐步选择方法）逻辑回归分析确定了 ISP 后退的风险因素。我们主要比较了每位患者的中期随访（<4 年）值与最终随访（至少 7 年）的值。

结果：

PG 组的平均中期和最终随访时间分别为 41.0 和 95.1 个月，而 PR 组分别为 35.7 和 99.3 个月。我们发现 PG 和 PR 组的中期和最终随访的恒定总分存在显着差异（中期随访：分别为 79.1 对 69.9 [ P = .001]；最终随访：分别为 76.0 对 65.3 [ P = .006]）和恒定强度评分（中期随访：分别为 14.6 对 8.5 [ P < .001]；最终随访：分别为 13.1 对 8.3 [ P = .001]）。在逻辑回归分析中，治疗组 (PR) 是 ISP 复发的重要预测因素（优势比，3.545；P = .043）。

结论：

接受 PG 或 PR 治疗的低级别大规模 RCT 患者在中期和最终随访时间点的临床结果显着改善。然而，在最后的随访中，PG 组的 Constant 评分明显更好。