不使用缝合锚的关节镜边缘收敛修复术改善了全厚和部分厚肩袖撕裂的临床疗效

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2024-10-01 DOI:10.1016/j.asmr.2024.100955

S. Ali Ghasemi M.D. , Benjamin Murray D.O. , Adam Lencer D.O. , Emily Schueppert D.O. , James Raphael M.D. , Craig Morgan M.D. , Arthur Bartolozzi M.D.

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引用次数: 0

摘要

目的评估不使用缝合锚的关节镜边缘融合技术修复不同类型肩袖撕裂的临床结果评分，并确定撕裂的类型或程度是否会影响术后的临床结果评分。方法回顾性分析2013年至2018年接受不使用缝合锚的关节镜边缘融合修复术治疗肩袖撕裂的患者。纳入的患者均在关节镜下确定为部分或全厚肩袖撕裂，随访时间至少为 20 个月。结果采用美国肩肘外科医生（ASES）肩关节评分、加州大学洛杉矶分校（UCLA）肩关节评分和视觉模拟量表（VAS）评分进行评估。采用双尾分布配对 t 检验来确定术前评分与最终随访评分之间的统计学意义（P <.05）。相关性测试和线性回归分析用于确定各种临床变量与结果之间的相关性。结果共有 38 名患者被纳入分析：12 名患者为部分厚度撕裂，26 名患者为全厚度撕裂。术后平均随访时间为 33.9 个月（22.2-94.5 个月），最短随访时间为 22 个月。患者的平均年龄为 62 ± 15.1 岁。ASES、UCLA 和 VAS 评分的最小临床重要差异值分别为 9.68、2.92 和 1.13。ASES（从术前的 29.3 ± 18.3 到术后的 93.7 ± 8.3，P = .001）、UCLA（从 14.3 ± 6.2 到 32.8 ± 2.6，P = .001）和 VAS（从 7.37 ± 1.8 到 0.63 ± 1.02，P = .001）临床结果评分均有明显改善。然而，Patte 3期回缩（ASES评分P = .033，UCLA评分P = .020）或U形撕裂（ASES评分P = .047，UCLA评分P = .050）患者的临床结果评分明显低于回缩程度较轻或撕裂形状不同的患者。结论不使用缝合锚的关节镜边缘收敛技术可能是肩袖部分或全厚撕裂患者的合适选择。

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Arthroscopic Margin Convergence Repair Without Suture Anchors Improves Clinical Outcomes for Full- and Partial-Thickness Rotator Cuff Tears

Purpose

To evaluate the clinical outcome scores of an arthroscopic margin convergence technique without the use of suture anchors to repair different types of rotator cuff tears and to determine whether the type or extent of the tear has an effect on clinical outcome scores after this procedure.

Methods

Patients receiving arthroscopic margin convergence repair without suture anchors for rotator cuff tears from 2013 to 2018 were retrospectively analyzed. Arthroscopically determined partial- or full-thickness rotator cuff tears with a minimum follow-up period of 20 months were included. Outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) shoulder score; University of California, Los Angeles (UCLA) shoulder score; and visual analog scale (VAS) score. A 2-tailed distribution paired t test was used to determine statistical significance (P < .05) between preoperative scores and scores at final follow-up. Correlation tests and linear regression analysis were used to determine the correlation between various clinical variables and outcomes. A cohort-specific minimal clinically important difference analysis was performed for each outcome score, calculated as one-half of the standard deviation of the delta score.

Results

A total of 38 patients were included for analysis: 12 with partial-thickness tears and 26 with full-thickness tears. The mean postoperative follow-up period was 33.9 months (range, 22.2-94.5 months), with a minimum follow-up period of 22 months. The mean age of the patients was 62 ± 15.1 years. The minimal clinically important difference values for the ASES, UCLA, and VAS scores were 9.68, 2.92, and 1.13, respectively. There were significant improvements in the ASES (from 29.3 ± 18.3 preoperatively to 93.7 ± 8.3 postoperatively, P = .001), UCLA (from 14.3 ± 6.2 to 32.8 ± 2.6, P = .001), and VAS (from 7.37 ± 1.8 to 0.63 ± 1.02, P = .001) clinical outcome scores. However, patients with either Patte stage 3 retraction (P = .033 for ASES score and P = .020 for UCLA score) or U-shaped tears (P = .047 for ASES score and P = .050 for UCLA score) had significantly lower clinical outcome scores than patients with less severe retraction or differently shaped tears.

Conclusions

The arthroscopic margin convergence technique without the use of suture anchors may be a suitable option in patients with partial- or full-thickness rotator cuff tears.