The American Journal of Sports Medicine ( IF 4.8 ) Pub Date : 2022-06-06 , DOI: 10.1177/03635465221097410 Michael Hackl 1 , Matthias Flury 1 , Christoph Kolling 1 , Wolfgang Nebelung 1 , Christine A Krauss 1 , Nils A Kraemer 1 , Philipp R Heuberer 1 , Brenda Laky 1 , Mathias Wellmann 1 , Marc-Frederic Pastor 1 , Andreas B Imhoff 1 , Sven Reuter 1 , Georg Anderle 1 , Jens D Agneskirchner 1 , Eduard Buess 1
Background:
Retears after rotator cuff repair (RCR) have been associated with poor clinical results. Meaningful data regarding the role of arthroscopic revision RCR are sparse thus far.
Purpose/Hypothesis:
To investigate results after arthroscopic revision RCR. We hypothesized that (1) arthroscopic revision RCR would lead to improved outcomes, (2) the clinical results would be dependent on tendon integrity and (3) tear pattern, tendon involvement, and repair technique would influence clinical and structural results.
Study Design:
Case series; Level of evidence 4.
Methods:
During a 40-month period, 100 patients who underwent arthroscopic revision RCR were prospectively enrolled in this multicenter study. Outcomes were evaluated preoperatively, at 6 months (6M), and at 24 months (24M) using the Constant score (CS), the Oxford Shoulder Score (OSS), and the Subjective Shoulder Value (SSV). Tendon integrity at 2 years was analyzed using magnetic resonance imaging. A total of 13 patients (13%) were lost to follow-up, and 14 patients (14%) had a symptomatic retear before the 24M follow-up.
Results:
All clinical scores improved significantly during the study period (CS: preoperative, 44 ± 16; 6M, 58 ± 22; 24M, 69 ± 19 points; OSS: preoperative, 27 ± 8; 6M, 36 ± 11; 24M, 40 ± 9 points; SSV: preoperative, 43% ± 18%; 6M, 66% ± 24%; 24M, 75% ± 22%) (P < .01). At 2 years, a retear rate of 51.8% (43/83) and a surgical revision rate of 12.6% (11/87) were observed. Mean full-thickness tear size decreased from 5.00 ± 1.61 cm2 to 3.25 ± 1.92 cm2 (P = .041). Although the Sugaya score improved from 4.5 ± 0.9 to 3.7 ± 1.4 (P = .043), tendon integrity did not correlate with better outcome scores. Previous open RCR, involvement of the subscapularis, chondral lesions of Outerbridge grade ≥2, and medial cuff failure were correlated with poorer SSV scores at 2 years (P≤ .047). Patients with traumatic retears had better CS and OSS scores at 2 years (P≤ .039).
Conclusion:
Although arthroscopic revision RCR improved shoulder function, retears were frequent but usually smaller. Patients with retears, however, did not necessarily have poorer shoulder function. Patient satisfaction at 2 years was lower when primary open RCR was performed, when a subscapularis tear or osteoarthritis was present, and when the rotator cuff retear was located at the musculotendinous junction. Patients with traumatic retears showed better functional improvement after revision.
中文翻译:
关节镜下翻修肩袖修复失败开放或关节镜修复的结果:100 例前瞻性多中心研究
背景:
肩袖修复 (RCR) 后的再撕裂与较差的临床结果相关。迄今为止,关于关节镜翻修 RCR 作用的有意义的数据很少。
目的/假设:
研究关节镜下翻修 RCR 后的结果。我们假设(1)关节镜下翻修 RCR 会改善结果,(2)临床结果将取决于肌腱完整性和(3)撕裂模式、肌腱受累和修复技术会影响临床和结构结果。
学习规划:
案例系列;证据级别 4。
方法:
在 40 个月期间,100 名接受关节镜翻修 RCR 的患者被前瞻性纳入这项多中心研究。结果在术前、6 个月 (6M) 和 24 个月 (24M) 使用恒定评分 (CS)、牛津肩部评分 (OSS) 和主观肩部值 (SSV) 进行评估。使用磁共振成像分析 2 年时的肌腱完整性。共有 13 名患者 (13%) 失访,14 名患者 (14%) 在 24M 随访前出现症状性再撕裂。
结果:
在研究期间,所有临床评分均显着改善(CS:术前,44 ± 16;6M,58 ± 22;24M,69 ± 19 分;OSS:术前,27 ± 8;6M,36 ± 11;24M,40 ± 9分;SSV:术前,43% ± 18%;6M,66% ± 24%;24M,75% ± 22%) ( P < .01)。2 年时,再撕裂率为 51.8% (43/83),手术翻修率为 12.6% (11/87)。平均全层撕裂大小从 5.00 ± 1.61 cm 2降低到 3.25 ± 1.92 cm 2 ( P = .041)。虽然菅谷分数从 4.5 ± 0.9 提高到 3.7 ± 1.4 ( P= .043),肌腱完整性与更好的结果得分无关。既往开放式 RCR、肩胛下肌受累、Outerbridge ≥2 级软骨损伤和内侧袖带失败与 2 年时较差的 SSV 评分相关(P ≤ .047)。外伤性再撕裂患者在 2 年时的 CS 和 OSS 评分更好(P ≤ .039)。
结论:
尽管关节镜翻修 RCR 改善了肩部功能,但再次撕裂很常见,但通常较小。然而,再撕裂患者的肩部功能并不一定较差。当进行初次开放式 RCR、存在肩胛下肌撕裂或骨关节炎以及肩袖再撕裂位于肌腱交界处时,患者 2 年的满意度较低。外伤性再撕裂患者在翻修后表现出更好的功能改善。