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가설 설정
- The purpose of this study was to evaluate and compare the clinical and structural outcomes of open and arthroscopic repairs for massive rotator cuff tears and to correlate the clinical outcomes of the respective repair techniques with respect to rotator cuff integrity. We hypothesized that there would be no significant differences in postoperative clinical outcomes and in the retear rate between the open and arthroscopic repair group.
제안 방법
- All procedures were performed by the senior author with the patient in a 30° beach chair position under general anesthesia.
- All patients underwent a physical examination 1 day before the operation. Postoperative evaluation was performed regularly on an outpatient basis (at 3 weeks, 6 weeks, 3 months, 6 months, 9 months, and 12 months postoperatively and at the last follow-up visit), and the results of the last follow-up examination were analyzed. Preoperative and postoperative subjective pain scores were measured using the visual analog scale (VAS).
- The purpose of this study was to evaluate and compare the clinical and structural outcomes of open and arthroscopic repairs for massive rotator cuff tears and to correlate the clinical outcomes of the respective repair techniques with respect to rotator cuff integrity. We hypothesized that there would be no significant differences in postoperative clinical outcomes and in the retear rate between the open and arthroscopic repair group.
- Nevertheless, if the open repair group showed more favorable results, open repair may be considered to have stronger advantages. The strength of this study was that reliable and validated MRIs were used to measure the postoperative structural outcome. Another strength is that this study is a rare and noteworthy piece of literature comparing and analyzing clinical results and repair integrity after open and arthroscopic repairs of less mobile and severely retracted massive rotator cuff tears.
- Using the Banana Suture Lasso (Arthrex, Naples, FL, USA) through the ‘Three Sister’ portals (anterior subclavian portal, modified Neviaser portal, and posterior infraspinous portal),15) one end of each fiber wire pair was shuttled through the torn cuff edge, and standard arthroscopic rotator cuff repair was performed.
대상 데이터
- A total of 102 patients (102 shoulders) who underwent surgical repair of a massive rotator cuff tear and routine follow-up magnetic resonance imaging (MRI) at least 6 months after surgery from February 2006 to January 2010 were enrolled in this study. Patients with partial or small, medium, and largesized rotator cuff tears, acromioclavicular arthritis requiring distal clavicle resection, advanced glenohumeral arthritis, or rotator cuff tears and a worker’s compensation claim were excluded from the study.
- 5-T scanner (Signa; GE Medical Systems, Milwaukee, WI, USA) using routine pulse sequences. The images were reviewed by an experienced senior radiologist who was informed that the patients had undergone surgery for rotator cuff repair but was blinded to the size and location of the tear that had been repaired. Continuity and retear of the tendon were assessed on MRIs according to established criteria.
데이터처리
- An independent t-test was used for comparison of the UCLA, Constant, and VAS scores and the deltoid muscle thickness between the open and arthroscopic repair groups. A paired t-test was used for comparison of the preoperative and postoperative UCLA, Constant, and VAS scores between the two groups. Significance was set at α=0.
- An independent t-test was used for comparison of the UCLA, Constant, and VAS scores and the deltoid muscle thickness between the open and arthroscopic repair groups. A paired t-test was used for comparison of the preoperative and postoperative UCLA, Constant, and VAS scores between the two groups.
이론/모형
- Postoperative evaluation was performed regularly on an outpatient basis (at 3 weeks, 6 weeks, 3 months, 6 months, 9 months, and 12 months postoperatively and at the last follow-up visit), and the results of the last follow-up examination were analyzed. Preoperative and postoperative subjective pain scores were measured using the visual analog scale (VAS). For shoulder range of motion (ROM), forward flexion, external rotation at the side, and internal rotation to the posterior were assessed before and after the operation.
- External and internal rotations were tested with the shoulder in a neutral position and the elbow in 90° flexion. The Constant score12) and shoulder rating scale of the University of California at Los Angeles (UCLA)13) were used for clinical assessment.
성능/효과
- 7%). A statistically significant improvement in the Constant and UCLA scores was observed in both groups, however the difference in the scores between the two groups was not statistically significant (p=0.128 and 0.087, respectively).
- 2 kg during internal rotation. At the last follow-up examination, the muscle strength had changed to 4.2, 6.0, and 8.5 kg, respectively, but the differences were not statistically significant compared with the preoperative results (p=0.221, 0.814, and 0.981, respectively). No statistically significant differences in the muscle strengths at the last follow-up examination were observed between the two groups (p=0.
- 001, respectively). At the last follow-up, the two groups did not show statistically significant differences in VAS scores at rest and during motion (p=0.194 and 0.145, respectively) (Table 2).
- In the open repair group, the muscle strength for forward flexion, external rotation, and internal rotation increased from the preoperative mean of 5.8, 7.1, and 8.6 kg, respectively, to 5.1, 6.7, and 9.3 kg, respectively, at the last follow-up examination, but no statistically significant differences were observed when compared with the preoperative strengths (p=0.246, 0.372, and 0.445, respectively). In the arthroscopic repair group, the preoperative muscle strength was 5.
- 5%). The arthroscopic repair group had 12 excellent (18.8%), 42 good (65.6%), 7 fair (10.9%), and 3 poor results (4.7%). A statistically significant improvement in the Constant and UCLA scores was observed in both groups, however the difference in the scores between the two groups was not statistically significant (p=0.
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