{"title":"肱骨喙突距离的改善可独立预测关节镜下上睑囊重建移植物撕裂术后的更好疗效。","authors":"Hui Ben, Erica Kholinne, Jia Guo, Seung Min Ryu, Jian Loong Ling, Kyoung Hwan Koh, In-Ho Jeon","doi":"10.1016/j.arthro.2024.08.017","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>To identify independent factors responsible for poor outcomes after a graft tear after arthroscopic superior capsular reconstruction (ASCR).</p><p><strong>Methods: </strong>Patients who underwent ASCR for massive rotator cuff tears between January 2013 and July 2021were reviewed. On the basis of the achievement of the minimal clinically important differences for clinical outcome measures at the final follow-up, patients were divided into the good outcome (GO) and poor outcome (PO) groups. The minimal clinically important differences were calculated as the value equal to one-half of the standard deviation of the changes in outcome scores between the preoperative baseline and the latest follow-up. Pre- and final follow-up variables included demographics, American Shoulder and Elbow Surgeons score, Constant score, visual analog scale score, and range of motion. Preoperative and postoperative 1-year radiologic variables were analyzed using magnetic resonance imaging, including anteroposterior and mediolateral tear sizes, subscapularis tear, acromiohumeral distance (AHD), and degree of fatty degeneration. Logistic regression analysis was performed to identify the significant predictors of poor outcomes.</p><p><strong>Results: </strong>A total of 33 patients who underwent ASCR presented with graft tears, which were confirmed by postoperative 1-year magnetic resonance imaging, and had a minimum follow-up duration of 2 years after surgery were enrolled. The GO group demonstrated significantly greater improvements in functional outcomes compared with the PO group (American Shoulder and Elbow Surgeons score: 83.5 ± 11.8 vs 64.0 ± 20.4, P = 0.004; Constant: 67.6 ± 5.7 vs 57.1 ± 9.8, P < .001; and visual analog scale score: 0.9 ± 1.2 vs 2.4 ± 2.0, P = .026). The postoperative 1-year AHD showed significant improvement in the GO group (3.1 ± 1.2 vs 6.1 ± 1.4, P < .001) but no change in the PO group (3.4 ± 1.3 vs 4.2 ± 0.9, P = .074) postoperatively. Multivariate logistic regression analysis indicated that a decreased postoperative 1-year AHD (odds ratio, 0.145; P = .019) was associated with a poor outcome after a graft tear.</p><p><strong>Conclusions: </strong>A narrow postoperative 1-year AHD was identified as the most important independent risk factor indicating poor clinical outcomes after a graft tear post-ASCR, which was related to a larger tear and loss of integrity between the grafts and infraspinatus at 1-year postoperatively.</p><p><strong>Level of evidence: </strong>Level IV, therapeutic case series.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4000,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Improved Acromiohumeral Distance Independently Predicts Better Outcomes After Arthroscopic Superior Capsular Reconstruction Graft Tears.\",\"authors\":\"Hui Ben, Erica Kholinne, Jia Guo, Seung Min Ryu, Jian Loong Ling, Kyoung Hwan Koh, In-Ho Jeon\",\"doi\":\"10.1016/j.arthro.2024.08.017\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>To identify independent factors responsible for poor outcomes after a graft tear after arthroscopic superior capsular reconstruction (ASCR).</p><p><strong>Methods: </strong>Patients who underwent ASCR for massive rotator cuff tears between January 2013 and July 2021were reviewed. On the basis of the achievement of the minimal clinically important differences for clinical outcome measures at the final follow-up, patients were divided into the good outcome (GO) and poor outcome (PO) groups. The minimal clinically important differences were calculated as the value equal to one-half of the standard deviation of the changes in outcome scores between the preoperative baseline and the latest follow-up. Pre- and final follow-up variables included demographics, American Shoulder and Elbow Surgeons score, Constant score, visual analog scale score, and range of motion. Preoperative and postoperative 1-year radiologic variables were analyzed using magnetic resonance imaging, including anteroposterior and mediolateral tear sizes, subscapularis tear, acromiohumeral distance (AHD), and degree of fatty degeneration. Logistic regression analysis was performed to identify the significant predictors of poor outcomes.</p><p><strong>Results: </strong>A total of 33 patients who underwent ASCR presented with graft tears, which were confirmed by postoperative 1-year magnetic resonance imaging, and had a minimum follow-up duration of 2 years after surgery were enrolled. The GO group demonstrated significantly greater improvements in functional outcomes compared with the PO group (American Shoulder and Elbow Surgeons score: 83.5 ± 11.8 vs 64.0 ± 20.4, P = 0.004; Constant: 67.6 ± 5.7 vs 57.1 ± 9.8, P < .001; and visual analog scale score: 0.9 ± 1.2 vs 2.4 ± 2.0, P = .026). The postoperative 1-year AHD showed significant improvement in the GO group (3.1 ± 1.2 vs 6.1 ± 1.4, P < .001) but no change in the PO group (3.4 ± 1.3 vs 4.2 ± 0.9, P = .074) postoperatively. Multivariate logistic regression analysis indicated that a decreased postoperative 1-year AHD (odds ratio, 0.145; P = .019) was associated with a poor outcome after a graft tear.</p><p><strong>Conclusions: </strong>A narrow postoperative 1-year AHD was identified as the most important independent risk factor indicating poor clinical outcomes after a graft tear post-ASCR, which was related to a larger tear and loss of integrity between the grafts and infraspinatus at 1-year postoperatively.</p><p><strong>Level of evidence: </strong>Level IV, therapeutic case series.</p>\",\"PeriodicalId\":55459,\"journal\":{\"name\":\"Arthroscopy-The Journal of Arthroscopic and Related Surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.4000,\"publicationDate\":\"2024-08-28\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Arthroscopy-The Journal of Arthroscopic and Related Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.arthro.2024.08.017\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.arthro.2024.08.017","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
目的:确定导致关节镜上关节囊重建术(ASCR)后移植物撕裂不良后果的独立因素:回顾性分析2013年1月至2021年7月期间因肩袖大面积撕裂而接受ASCR的患者。根据最终随访时临床结局指标的最小临床重要差异,将患者分为良好结局(GO)组和不良结局(PO)组。最小临床重要差异的计算方法是,术前基线与最近一次随访之间结果评分变化的标准差的二分之一。术前和最终随访变量包括人口统计学、美国肩肘外科医生(ASES)评分、康斯坦茨评分、视觉模拟量表(VAS)评分、活动范围、术前和术后1年的放射学变量(包括前后(AP)和内外侧(ML)撕裂大小、肩胛下撕裂、肩峰肱骨距离(AHD)和脂肪变性程度)。为确定不良预后的重要预测因素,进行了逻辑回归分析:共有33名接受ASCR手术的患者出现移植物撕裂,并经术后1年磁共振成像(MRI)证实,且术后随访时间至少为2年。与 PO 组相比,GO 组的功能结果改善明显(ASES:83.5±11.8 vs. 64.0±20.4,P = 0.004;Constant:67.6±5.7 vs. 57.1±9.8,P 结论:GO 组术后 1 年的 AH 值较 PO 组窄:术后1年AHD变窄被认为是ASCR术后移植物撕裂后临床效果不佳的最重要的独立风险因素,这与术后1年移植物和冈下肌之间撕裂面积增大和完整性丧失有关:证据等级:IV 级。
Improved Acromiohumeral Distance Independently Predicts Better Outcomes After Arthroscopic Superior Capsular Reconstruction Graft Tears.
Purpose: To identify independent factors responsible for poor outcomes after a graft tear after arthroscopic superior capsular reconstruction (ASCR).
Methods: Patients who underwent ASCR for massive rotator cuff tears between January 2013 and July 2021were reviewed. On the basis of the achievement of the minimal clinically important differences for clinical outcome measures at the final follow-up, patients were divided into the good outcome (GO) and poor outcome (PO) groups. The minimal clinically important differences were calculated as the value equal to one-half of the standard deviation of the changes in outcome scores between the preoperative baseline and the latest follow-up. Pre- and final follow-up variables included demographics, American Shoulder and Elbow Surgeons score, Constant score, visual analog scale score, and range of motion. Preoperative and postoperative 1-year radiologic variables were analyzed using magnetic resonance imaging, including anteroposterior and mediolateral tear sizes, subscapularis tear, acromiohumeral distance (AHD), and degree of fatty degeneration. Logistic regression analysis was performed to identify the significant predictors of poor outcomes.
Results: A total of 33 patients who underwent ASCR presented with graft tears, which were confirmed by postoperative 1-year magnetic resonance imaging, and had a minimum follow-up duration of 2 years after surgery were enrolled. The GO group demonstrated significantly greater improvements in functional outcomes compared with the PO group (American Shoulder and Elbow Surgeons score: 83.5 ± 11.8 vs 64.0 ± 20.4, P = 0.004; Constant: 67.6 ± 5.7 vs 57.1 ± 9.8, P < .001; and visual analog scale score: 0.9 ± 1.2 vs 2.4 ± 2.0, P = .026). The postoperative 1-year AHD showed significant improvement in the GO group (3.1 ± 1.2 vs 6.1 ± 1.4, P < .001) but no change in the PO group (3.4 ± 1.3 vs 4.2 ± 0.9, P = .074) postoperatively. Multivariate logistic regression analysis indicated that a decreased postoperative 1-year AHD (odds ratio, 0.145; P = .019) was associated with a poor outcome after a graft tear.
Conclusions: A narrow postoperative 1-year AHD was identified as the most important independent risk factor indicating poor clinical outcomes after a graft tear post-ASCR, which was related to a larger tear and loss of integrity between the grafts and infraspinatus at 1-year postoperatively.
Level of evidence: Level IV, therapeutic case series.
期刊介绍:
Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.