Clinical outcomes of arthroscopic single and double row repair in full thickness rotator cuff tears

Background:

There has been a recent interest in the double row repair method for arthroscopic rotator cuff repair following favourable biomechanical results reported by some studies. The purpose of this study was to compare the clinical results of arthroscopic single row and double row repair methods in the full-thickness rotator cuff tears.

Materials and Methods:

22 patients of arthroscopic single row repair (group I) and 25 patients who underwent double row repair (group II) from March 2003 to March 2005 were retrospectively evaluated and compared for the clinical outcomes. The mean age was 58 years and 56 years respectively for group I and II. The average follow-up in the two groups was 24 months. The evaluation was done by using the University of California Los Angeles (UCLA) rating scale and the shoulder index of the American Shoulder and Elbow Surgeons (ASES).

Results:

In Group I, the mean ASES score increased from 30.48 to 87.40 and the mean ASES score increased from 32.00 to 91.45 in the Group II. The mean UCLA score increased from the preoperative 12.23 to 30.82 in Group I and from 12.20 to 32.40 in Group II. Each method has shown no statistical clinical differences between two methods, but based on the sub scores of UCLA score, the double row repair method yields better results for the strength, and it gives more satisfaction to the patients than the single row repair method.

Conclusions:

Comparing the two methods, double row repair group showed better clinical results in recovering strength and gave more satisfaction to the patients but no statistical clinical difference was found between 2 methods.     

肩袖损伤患者关节镜修补术后的预后影响因素分析

目的分析肩袖损伤的患者在接受肩关节镜下肩袖修补手术治疗的预后影响因素。 方法回顾性分析2019年2月至2020年2月于同济大学附属第十人民医院关节外科接受肩关节镜下肩袖修补术治疗肩袖损伤的117例患者的基本资料,术后1年随访手术疗效。 结果预后良好者95例,占81.20%。多因素分析显示,年龄、术前病程、撕裂程度、是否使用富血小板血浆是影响预后的独立因素。 结论患者年龄、术前病程、肩袖撕裂程度、术中是否使用富血小板血浆是影响肩关节镜手术治疗肩袖损伤预后的重要因素。     

关节镜下肩袖修补术后感染的危险因素分析

目的:探讨关节镜下肩袖修补术后感染的危险因素,为降低感染发生提供依据。方法:对2019年1月至2022年1月采用关节镜下肩袖修补治疗的2 591例肩关节镜下肩袖修补术后患者的临床资料进行回顾性分析,其中男1 265例,女1 326例;年龄25～82(51.5±15.6)岁。按照术后是否发生感染分为感染组(n=18)和未感染组(n=2 573),记录两组患者性别、年龄、是否吸烟、有无糖尿病、身体质量指数、术前1个月内是否进行局部封闭、手术时间、是否预防性使用抗生素、是否有内固定置入等,应用单因素Logistic回归分析筛选出术后感染的危险因素,再将有统计学意义的危险因素纳入多因素Logistic回归分析,筛选出关节镜下肩袖修补术后感染的独立危险因素。结果:本组2 591例患者中,术后发生感染18例,感染率为0.69%,单因素分析结果显示性别、年龄、手术时间、预防性使用抗生素、内固定置入是关节镜下肩袖修补术后患者发生感染的危险因素。多因素Logistic分析显示男性(OR=14.227)、年龄≥65岁(OR=34.313)、手术时间≥2h(OR=15.616)、未预防性使用抗生素(OR=4...     

Functional evaluation of patient after arthroscopic repair of rotator cuff tear

BackgroundRotator cuff tear is a common problem either after trauma or after degenerative tear in old age group. Arthroscopic repair is the current concept of rotator cuff repair. Here, we are trying to evaluate the functional outcome after arthroscopic repair of full thickness rotator cuff tear (single row) in Indian population.Materials and methodsTwenty five patients (14 males and 11 females) who underwent arthroscopic repair of full thickness rotator cuff tear at a single institution were included in the study. Postoperatively patient's shoulder was rated according to UCLA score, pain was graded according to the visual analog score. The range of motion was analysed and documented.ResultsThe mean age of the patients were 50.48 years. The preoperative VAS score mode was 7 and post operative VAS was 1 (p value <0.001). The UCLA grading was good in 80% (n = 20), fair in 12% (n = 3), excellent in 8% (n = 2) and poor results were seen in none of the patients.The mean UCLA improved from a score of 15.84 to 30.28 with a p value <0.001. Mean postoperative forward flexion was 161.6°, mean abduction was 147.6° and mean external rotation was 45.4°.ConclusionArthroscopic repair is a good procedure for full thickness rotator cuff tear with minimal complications. The newer double row repair claims to be biomechanically superior with faster healing rates without functional advantages, hence we used a single row repair considering the Indian population and the cost effectiveness of the surgery with good to excellent results.     

肩袖损伤患者术前焦虑状况与肩关节镜术后疼痛的相关性分析

目的 分析肩袖损伤行关节镜下肩袖修复手术的患者术前各因素对术后疼痛的影响.方法 本研究回顾性分析了2018年1月至2019年12月本科室收治的肩袖损伤患者的基本资料,所有患者术前进行视觉模拟评分(visual analogue scale,VAS)、美国肩肘外科协会评分(American shoulder and el...     

关节镜下修复类风湿关节炎病人肩袖损伤的疗效分析

目的 探讨关节镜下修复类风湿关节炎病人肩袖损伤的疗效。方法 回顾性分析2015年3月至2018年7月的17例（20肩）类风湿关节炎病人的病例资料,均行关节镜下肩袖修复术,其中肩袖部分撕裂6例（7肩）,完全撕裂11例（13肩）。收集并比较病人术前及术后1年的疼痛视觉模拟量表（visual analogue scale, VAS）评分。分析病人术前、术后6个月及1年的Constant-Murley肩关节功能评分和美国加利福尼亚大学洛杉矶分校（University of California at Los Angeles, UCLA）肩关节评分。分析病人术前、术后1年的外展、外旋、内旋等肩关节活动度。结果 17例病人术后均随访1年以上。本组术后6个月和1年的UCLA评分分别为（27.15±2.85）分、（30.55±2.11）分,Constant-Murley评分分别为（73.20±4.07）分、（83.35±3.84）分,与术前相比逐步提升,各个时间点的评分比较,差异均有统计学意义（P均＜0.05）。静息和活动状态下的VAS评分由术前的（5.95±2.37）分、（7.35±2.13）分改善至术后的（2.20±1.23）分和（2.40±1.43）分,术前肩关节外展、外旋及内旋活动度由术前的77.30°±18.20°、37.25°±10.03°、35.25°±12.74°改善至术后的131.80°±20.22°、47.85°±7.66°和59.40°±12.12°,差异均有统计学意义（P均＜0.05）。无论是肩袖完全撕裂还是部分撕裂的类风湿关节炎病人,通过关节镜下肩袖修复术后,病人动、静态疼痛及内旋活动度恢复良好;但在肩袖完全撕裂的病人中,术后外展活动度及病人满意度均未见明显改善（P均＞0.05）。结论 关节镜下修复类风湿关节炎病人肩袖损伤能较好地缓解病人疼痛,对于肩袖部分撕裂的病人也能较好地改善肩关节的活动度和术后满意度。     

Outcomes after arthroscopic repair of rotator cuff tears in the setting of mild to moderate glenohumeral osteoarthritis

BACKGROUNDRotator cuff pathology is a very common source of shoulder pain. Similarly, osteoarthritis of the glenohumeral joint can cause shoulder pain and produce similar symptoms. Surgical management can be indicated for both pathologies, however, outcomes data is limited when examining rotator cuff repair (RCR) in the setting of glenohumeral arthritis (GHOA). Thus, this study sought to determine outcomes for patients who undergo RCR in the setting of GHOA.AIMTo evaluate if a relationship exists between outcomes of RCR in the setting of GHOA.METHODSThis was a retrospective analysis of patients who underwent arthroscopic rotator cuff repair with concurrent glenohumeral osteoarthritis between 2010-2017. Patients were stratified based on rotator cuff tear size and glenohumeral osteoarthritis severity. Cohorts were paired 1:1 with patients without glenohumeral osteoarthritis. Patients included had a minimum two year follow-up. Rate of conversion to total shoulder arthroplasty, complication rates following initial surgery, and patient-reported outcome measures were collected.RESULTSA total of 142 patients were included. The number of patients that required total shoulder arthroplasty within two years after index surgery was low. 2/71 (2.8%) patients with GHOA, and 1/71 (1.4%) without GHOA. Following rotator cuff repair, both groups showed favorable patient-reported outcomes.CONCLUSIONPatients with glenohumeral osteoarthritis who underwent arthroscopic rotator cuff repair showed comparable outcomes to patients without glenohumeral osteoarthritis.     

关节镜下肩袖损伤缝合技术研究进展

关节镜下肩袖修补术已非常普遍.许多单排锚钉、双排锚钉和经骨隧道修复技术应用于临床,但肩袖修复的最佳方法仍不清楚.生物力学研究证明相比于单排,双排锚钉修复的力度更强,而单排锚钉中的巨大肩袖缝合技术和改良Mason-Allen缝合技术力学性能最佳.临床研究显示双排锚钉修复能改善肩袖愈合率,但各种缝合技术的预后功能评分无明显...     

Factors affecting healing after arthroscopic rotator cuff repair

Rotator cuff repair has been shown to have good long-term results. Unfortunately, a significant proportion of repairs still fail to heal. Many factors, both patient and surgeon related, can influence healing after repair. Older age, larger tear size, worse muscle quality, greater muscle-tendon unit retraction, smoking, osteoporosis, diabetes and hypercholesterolemia have all shown to negatively influence tendon healing. Surgeon related factors that can influence healing include repair construct-single vs double row, rehabilitation, and biologics including platelet rich plasma and mesenchymal stem cells. Double-row repairs are biomechanically stronger and have better healing rates compared with single-row repairs although clinical outcomes are equivalent between both constructs. Slower, less aggressive rehabilitation programs have demonstrated improved healing with no negative effect on final range of motion and are therefore recommended after repair of most full thickness tears. Additionally no definitive evidence supports the use of platelet rich plasma or mesenchymal stem cells regarding improvement of healing rates and clinical outcomes. Further research is needed to identify effective biologically directed augmentations that will improve healing rates and clinical outcomes after rotator cuff repair.     

Magnetic resonance appearance of bioabsorbable anchor screws for double row arthroscopic rotator cuff repairs

Background:

Little is known about the bioabsorbable, anchor related postoperative changes in rotator cuff surgery, which has become more popular recently. The purpose of the present study was to use magnetic resonance imaging (MRI) to analyze the degradation of bioabsorbable anchors and to determine the incidences and characteristics of early postoperative reactions around the anchors and their mechanical failures.

Materials and Methods:

Postoperative MRIs of 200 patients who underwent arthroscopic rotator cuff repair were retrospectively analyzed. The tissue reactions around the bioanchors included fluid accumulations around the anchor, granulation tissue formation and changes in the condition of the surrounding osseous structure. The condition of the bioanchor itself was also examined, including whether the bioanchor failed mechanically. In the case of mechanical failure, the location of the failure was noted. Serial MRIs of 18 patients were available for analysis.

Results:

The total number of medial row bioanchors was 124, while that of the lateral row was 338. A low signal intensity rim suggestive of sclerosis surrounded all lateral row bioanchors. Ninety three lateral row bioanchors (27%) showed a rim with signal intensity similar to or less than that of surrounding bone, which was granulation tissue or foreign body reaction (FBR). Similar signal intensity was seen around nine medial row bioanchors (7%). Fluid accumulation was seen around 4 lateral row bioanchors (1%) and around 14 medial row bioanchors (11%). Five lateral row bioanchors showed the breakage, while there was none in the medial row bioanchors. There were nine cases with a cuff re-tear (4.5%). There was no evidence of affection of glenohumeral articular surfaces or of osteolysis around any bioanchor. In serial MRI, there was no change in appearance of the bioanchors, but the granulation tissue or FBR around four bioanchors and the fluid around one bioanchor showed a decrease in successive MRI.

Conclusion:

This study highlights the normal and adverse reactions to Bioabsorbable anchors that surgeons can expect to see on MRI after rotator cuff repairs.     

关节镜下单排与双排缝合桥修复技术治疗老年肩袖损伤的对照研究

目的关节镜下采取双排与单排缝合桥修复术治疗老年肩袖损伤的效果对比分析。 方法前瞻性收集简阳市人民医院2016年1月至2018年2月期间收治的118例老年肩袖损伤病患者,按随机数字表法分为对照组（关节镜下行单排锚钉固定）与观察组（关节镜下行双排缝合桥修复术）,两组各59例,比较两组不同程度损伤患者手术前后ASES评分、Constant-Murley评分、UCLA评分;并对比两组术后再撕裂发生率。 结果治疗前两组四种撕裂程度Constant-Murley、UCLA、ASES评分差异均无统计学意义（P>0.05）;治疗后两组比较,只有轻度撕裂三种评分差异均无统计学意义（P>0.05）,而巨大、重度、中度撕裂的三种评分两组间差异均具有统计学意义（P<0.05）,观察组显著优于对照组。对照组再撕裂发生率17/59（28.81%）显著高于观察组6/59（10.17%）（χ²=6.535,P=0.011）。 结论老年肩袖损伤采取双排与单排缝合桥术均可行,但双排缝合桥术应用范围较为广泛,且对于患者巨大、重度、中度撕裂改善效果更佳。     

关节镜下肩袖缝合术治疗肩袖全层撕裂的中期疗效观察

目的 探讨关节镜下肩袖缝合术治疗肩袖全层撕裂的手术方法和中期效果.方法 2002年12月至2007年5月对35例肩袖全层撕裂患者行关节镜下肩袖缝合术,30例获得随访,其中男性15例,女性15例;年龄31～74岁,平均55.6岁.左肩3例,右肩27例.全部病例行肩峰下滑囊切除及肩峰成形术.肩袖修复方式:19例应用缝合锚钉行肩袖止点重建,11例联合应用断端缝合及缝合锚钉技术.16例行单排缝合,14例行双排缝合.2012年6月对所有患者进行随访,分别在术前和随访时采用UCLA肩关节评分标准进行评价,评分结果行配对t检验.结果 小型撕裂3例,中型撕裂22例,大型撕裂3例,巨大撕裂2例,随访时间5 ～ 10年,平均78.5个月.UCLA评分从术前的(14.2±3.1)分增至术后(33.6±2.1)分(t=-37.154,P=0.000).其中疼痛评分平均为(2.5±0.9)分比(9.5±1.0)分(t=-24.466,P=0.000),功能评分平均为(4.5±1.5)分比(9.4±1.1)分(t=-18.500,P=0.000),主动前屈角度评分平均为(3.3±1.6)分比(4.9±0.2)分(t=-5.614,P=0.000),前屈肌力评分平均为(3.9±0.5)分比(4.7±0.4)分(t=-6.591,P=0.000),差异均有统计学意义.根据术后随访UCLA评分,优19例,良11例.单排缝合患者术前平均(13.0±3.2)分,术后平均(33.6±1.7)分.双排缝合患者术前平均(15.6±2.4)分,术后平均(33.6±2.6)分,两组患者手术前后评分差异均有统计学意义(t=-33.071和-26.455,P＜0.05).所有患者对手术效果表示满意.结论 关节镜下肩袖缝合治疗肩袖全层撕裂创伤小、恢复快,中期效果令人满意.单排缝合与双排缝合的效果均令人满意.术中应正确识别撕裂的形状,充分松解粘连并采用恰当的缝合方式.     

关节镜下手术治疗老年退行性肩袖撕裂的疗效分析

目的探讨关节镜下手术治疗老年退行性肩袖撕裂的疗效。方法2002年9月-2005年6月，对16例50岁以上肩袖撕裂的患者，采用关节镜下手术治疗。根据肩袖撕裂的大小和形状分成新月形和“U”形，新月形撕裂直接采用Mitek（GⅡ）铆钉腱骨缝合的方法，“U”形撕裂采用对边缝合后加用Mitek（GⅡ）铆钉固定的方法。结果16例患者均获得随访，随访时间为12～2，4个月，平均15个月。术前、术后的功能情况采用UCLA肩关节评分系统进行疗效评价：优8例，良7例，可1例，优良率为93．5％。术后无明显的并发症，两种修补方法疗效相同。结论关节镜下手术创伤小、出血少、术后恢复快，且能最大程度地恢复肩关节的功能，是治疗老年人肩峰撞击肩袖撕裂的首选术式。     

肩袖损伤关节镜下缝合修复术后再撕裂的风险因素分析

目的研究肩袖损伤肩关节镜下缝合术后发生再撕裂的风险因素，为术前评估术后再撕裂风险的大小及手术方式提供临床参考。 方法回顾性分析2015年1月至2019年1月624例在本科因"肩袖全层撕裂"住院并接受肩关节镜下肩袖缝合修复术患者的临床资料。使用二元Logistic回归分析方法研究术后肩袖再撕裂的风险因素。 结果病程>3个月、术前撕裂范围>3 cm、单排固定方式、脂肪浸润程度较高（Goutallier3级及以上）、糖尿病史及术后外伤均为术后肩袖再撕裂的高风险因素（P<0.05）。患者年龄、性别、是否优势肩、吸烟史、是否从事竞技运动等与肩袖术后再撕裂无明显相关（P>0.05）。 结论病程长、术前撕裂范围大、单排固定方式、肌肉脂肪浸润程度较高、糖尿病史及术后外伤均可能造成术后肩袖发生再撕裂。