Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical Result of Arthroscopic Partial Repairs in Massive Rotator Cuff Tears

광범위 회전근 개 파열의 관절경하 부분 봉합술의 임상적 결과

  • Yoo, Jae-Chul (Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ko, Kyung-Hwan (Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Woo, Kyung-Jea (Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 유재철 (성균관대학교 의과대학 삼성서울병원 정형외과학교실) ;
  • 고경환 (성균관대학교 의과대학 삼성서울병원 정형외과학교실) ;
  • 우경제 (성균관대학교 의과대학 삼성서울병원 정형외과학교실)
  • Published : 2009.12.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: With the better understanding of cuff function, partial repair or "force couple repair" for treating massive irreparable rotator cuff tear has gained some popularity. However, there were few reports on the results of partial repair. The purpose of this study was to report the clinical outcome of massive irreparable rotator cuff tears who received arthroscopic force-couple repair or partial repair. Materials and Methods: From June 2005 to Feb 2008, arthroscopic partial repairs were performed for 16 irreparable rotator cuff tears among the 101 large to massive rotator cuff tears that were operated on. Clinical and radiographic evaluation were done at the final follow-up. Results: There were 7 men and 9 women with a mean age of 66.6 years. The mean follow-up period was 27.3 month (range: 15-46). The pain VAS improved from 4.4 ($\pm2.50$) to 2.1 ($\pm2.26$) and the functional VAS improved from 46.9 ($\pm16.64$) to 70.0 ($\pm22.80$). The ASES score improved from 39.0 ($\pm10.80$) to 80.3 ($\pm16.78$) and the KSS score was 81.9 ($\pm16.74$) at the final follow-up. The acromio-humeral distance was 6.6 cm ($\pm1.74$) preoperatively and 6.2 cm ($\pm1.69$) postoperatively without significant change (p=0.3874). The degenerative changes had no statistically progressed (p=0.2663). Conclusion: Partial repair for massive rotator cuff injury patients showed improvement in the clinical score without progression of arthritic change at a mean of 2.3 years follow-up.

목적: 거대 및 광범위 회전근 개 파열은 치료하기 어려운 질환이나 회전근개에 대한 이해가 높아짐에 따라 완전봉합은 불가능하여도 부분 봉합 또는 “force couple repair”를 통해서도 통증 및 기능호전을 가져올 수 있다고 여겨진다. 그러나 이를 뒷받침하는 연구는 부족한 실정이다. 본 연구의 목적은 회전근개의 부분봉합술만을 시행한 환자들에서의 임상결과와 방사선학적 변화를 평가하는 것이다. 대상 및 방법: 2005년 6월에서 2008년 2월까지 거대 범위에서 광범위 회전근 개 파열에 대해 부분 봉합을 시행 받고 1년 이상 추시가 가능하였던 16예를 대상으로 하였다. 평균 추시 기간은 27.3개월 (15~46)이었고 수술 시 평균 연령은 66.6세 (57~76)였으며 성별은 남자가 7명, 여자가 9명 이었다.동통과 기능에 대한 Visual Analogue Scale (VAS)을 수술 전 후에 비교하였으며 견관절 기능 평가는 American Shoulder and Elbow Surgeons (ASES) score와 Korean Shoulder Scoring system (KSS)을 통해 시행하였다. 술 전 및 술 후에 견관절의 방사선검사를 통해 견봉-상완골 간격 및 퇴행성 변화의 진행 여부를 평가하였다. 결과: 동통에 대한 VAS 점수는 술 전 평균 4.4 ($\pm2.50$)에서 2.1 ($\pm2.26$)로 감소하였고 (p=0.0029) 기능에 대한 VAS 점수는 술 전 46.9 ($\pm16.64$)에서 70.0 ($\pm22.80$)로 호전된 양상 관찰되었다 (p=0.0023). 견관절 기능 평가인 ASES 점수는 술 전 평균 39.0 ($\pm10.80$)에서 80.3 ($\pm16.78$)로 증가하였고 (p<0.0001), KSS 점수는 술 후 평균 81.9 ($\pm16.74$)로 관찰되었다. 술 전 6.6 cm ($\pm1.74$)의 견봉-상완골 간격은 술 후 6.2 cm ($\pm1.69$)로 의미 있는 변화가 없었다 (p=0.3874). Hamada classification을 이용한 견관절의 퇴행성 변화 역시 술 전에 비해 술 후에 통계학적으로 진행하지 않았다 (p=0.2663). 만족도에 있어 3명의 환자에서 매우 좋음, 9명의 환자에서 좋음, 3명의 환자가 보통, 그리고 1명의 환자에서 불량을 표시하였다. 또한 추시 기간 동안 추가적인 수술을 시행한 환자는 없었다. 결론: 완전 봉합이 불가능한 광범위 회전근개 파열 환자에 대해서 부분 봉합술 (force couple repair)를 통해서 술 후 평균 2.3년 (15~46개월)에 좋은 임상결과를 가져올 수 있었으며, 견봉-상완골 간격도 의미 있는 변화가 없었으며 관절와 상완관절의 퇴행성 변화 역시 통계학적으로 진행하지 않았다.

Keywords

References

  1. Agresti A, Wiley J: Categorical data analysis, Wiley New York, 1990.
  2. Burkhart SS, Nottage WM, Ogilvie-Harris DJ, Kohn HS, Pachelli A: Partial repair of irreparable rotator cuff tears. Arthroscopy, 10: 363-370, 1994. https://doi.org/10.1016/S0749-8063(05)80186-0
  3. Davidson JF, Burkhart SS, Richards DP, Campbell SE: Use of preoperative magnetic resonance imaging to predict rotator cuff tear pattern and method of repair. Arthroscopy, 21: 1428, 2005.
  4. Duralde XA, Bair B: Massive rotator cuff tears: the result of partial rotator cuff repair. J Shoulder Elbow Surg, 14: 121-127, 2005. https://doi.org/10.1016/j.jse.2004.06.015
  5. Edwards TB, Walch G, Nove-Josserand L, et al.: Arthroscopic debridement in the treatment of patients with isolated tears of the subscapularis. Arthroscopy, 22: 941-946, 2006. https://doi.org/10.1016/j.arthro.2006.05.009
  6. Edwards TB, Williams MD, Labriola JE, Elkousy HA, Gartsman GM, O'Connor DP: Subscapularis insufficiency and the risk of shoulder dislocation after reverse shoulder arthroplasty. J Shoulder Elbow Surg, 18:892-896, 2009. https://doi.org/10.1016/j.jse.2008.12.013
  7. Elhassan B, Endres NK, Higgins LD, Warner JJ: Massive irreparable tendon tears of the rotator cuff: salvage options. Instr Course Lect, 57: 153-166, 2008.
  8. Elhassan B, Ozbaydar M, Massimini D, Diller D, Higgins L, Warner JJ: Transfer of pectoralis major for the treatment of irreparable tears of subscapularis: does it work- J Bone Joint Surg Br, 90: 1059-1065, 2008. https://doi.org/10.1302/0301-620X.90B8.20659
  9. Fenlin JM, Jr., Chase JM, Rushton SA, Frieman BG: Tuberoplasty: creation of an acromiohumeral articulation-a treatment option for massive, irreparable rotator cuff tears. J Shoulder Elbow Surg, 11: 136- 142, 2002. https://doi.org/10.1067/mse.2002.121764
  10. Galatz LM, Connor PM, Calfee RP, Hsu JC, Yamaguchi K: Pectoralis major transfer for anterior-superior subluxation in massive rotator cuff insufficiency. J Shoulder Elbow Surg, 12: 1-5, 2003. https://doi.org/10.1067/mse.2003.128137
  11. Gartsman GM: Massive, irreparable tears of the rotator cuff. Results of operative debridement and subacromial decompression. J Bone Joint Surg Am, 79: 715- 721, 1997.
  12. Gerber C, Maquieira G, Espinosa N: Latissimus dorsi transfer for the treatment of irreparable rotator cuff tears. J Bone Joint Surg Am, 88: 113-120, 2006. https://doi.org/10.2106/JBJS.E.00282
  13. Gerber C, Pennington SD, Nyffeler RW: Reverse total shoulder arthroplasty. J Am Acad Orthop Surg, 17: 284-295, 2009.
  14. Glanzmann MC, Flury M, Simmen BR: Reverse shoulder arthroplasty as salvage procedure after deltoid muscle flap transfer for irreparable rotator cuff tear: a case report. J Shoulder Elbow Surg, 18: e1-2, 2009.
  15. Hamada K, Fukuda H, Mikasa M, Kobayashi Y: Roentgenographic findings in massive rotator cuff tears. A long-term observation. Clin Orthop Relat Res, 254: 92-96, 1990.
  16. John M, Pap G, Angst F, et al.: Short-term results after reversed shoulder arthroplasty (Delta III) in patients with rheumatoid arthritis and irreparable rotator cuff tear. Int Orthop, 2009.
  17. Jost B, Puskas GJ, Lustenberger A, Gerber C: Outcome of pectoralis major transfer for the treatment of irreparable subscapularis tears. J Bone Joint Surg Am, 85: 1944-1951, 2003.
  18. Kim JY, Kang KS, Tae SK: Primary Repair in Tears Affecting Two or More Rotator Cuff Tendons. J Korean Shoulder Elbow Soc, 10: 160-166, 2007 https://doi.org/10.5397/CiSE.2007.10.2.160
  19. Klinger HM, Steckel H, Ernstberger T, Baums MH: Arthroscopic debridement of massive rotator cuff tears: negative prognostic factors. Arch Orthop Trauma Surg, 125: 261-266, 2005. https://doi.org/10.1007/s00402-004-0738-6
  20. Ko SH, Cho SD, Gwak CY, Eo J, Yoo CH, Choe SW: Use of Massive Cuff Stitch in Arthroscopic Repair of Rotator Cuff Tears. J Korean Shoulder Elbow Soc, 9: 181-188, 2006. https://doi.org/10.5397/CiSE.2006.9.2.181
  21. Liem D, Lengers N, Dedy N, Poetzl W, Steinbeck J, Marquardt B: Arthroscopic debridement of massive irreparable rotator cuff tears. Arthroscopy, 24: 743- 748, 2008. https://doi.org/10.1016/j.arthro.2008.03.007
  22. Liem D, Marquardt B, Witt KA, Steinbeck J: [Shoulder arthroplasty: biomechanics and design]. Orthopade, 36: 1027-1036, 2007. https://doi.org/10.1007/s00132-007-1156-6
  23. Ling HY, Angeles JG, Horodyski MB: Biomechanics of latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears. Clin Biomech, 24: 261-266, 2009. https://doi.org/10.1016/j.clinbiomech.2008.12.002
  24. Lo IK, Burkhart SS: Arthroscopic repair of massive, contracted, immobile rotator cuff tears using single and double interval slides: technique and preliminary results. Arthroscopy, 20: 22-33, 2004. https://doi.org/10.1016/j.arthro.2003.11.013
  25. Mellado JM, Calmet J, Olona M, et al.: Surgically repaired massive rotator cuff tears: MRI of tendon integrity, muscle fatty degeneration, and muscle atrophy correlated with intraoperative and clinical findings. AJR Am J Roentgenol, 184: 1456-1463, 2005. https://doi.org/10.2214/ajr.184.5.01841456
  26. Moore DR, Cain EL, Schwartz ML, Clancy WG, Jr.: Allograft reconstruction for massive, irreparable rotator cuff tears. Am J Sports Med, 34: 392-396, 2006. https://doi.org/10.1177/0363546505281237
  27. Moser M, Jablonski MV, Horodyski M, Wright TW: Functional outcome of surgically treated massive rotator cuff tears: a comparison of complete repair, partial repair, and debridement. Orthopedics, 30: 479- 482, 2007.
  28. Pearsall AWt, Madanagopal SG, Karas SG: Transfer of the latissimus dorsi as a salvage procedure for failed debridement and attempted repair of massive rotator cuff tears. Orthopedics, 30: 943-949, 2007.
  29. Rockwood CA, Jr., Williams GR, Jr., Burkhead WZ, Jr.: Debridement of degenerative, irreparable lesions of the rotator cuff. J Bone Joint Surg Am, 77: 857-866, 1995.
  30. Wierks C, Skolasky RL, Ji JH, McFarland EG: Reverse total shoulder replacement: intraoperative and early postoperative complications. Clin Orthop Relat Res, 467: 225-234, 2009. https://doi.org/10.1007/s11999-008-0406-1
  31. Yamaguchi K, Sher JS, Andersen WK, et al.: Glenohumeral motion in patients with rotator cuff tears: a comparison of asymptomatic and symptomatic shoulders. J Shoulder Elbow Surg, 9: 6-11, 2000. https://doi.org/10.1016/S1058-2746(00)90002-8
  32. Yoo JC, Ahn JH, Yang JH, Koh KH, Choi SH, Yoon YC: Correlation of arthroscopic repairability of large to massive rotator cuff tears with preoperative magnetic resonance imaging scans. Arthroscopy, 25: 573-582, 2009. https://doi.org/10.1016/j.arthro.2008.12.015
  33. Yoo JC, Kim JH, Lee YS, Park JH, Kang HJ: Arthroscopic double mattress repair in incomplete subscapularis tears. Orthopedics, 31: 851-854, 2008. https://doi.org/10.3928/01477447-20080901-39
  34. Zingg PO, Jost B, Sukthankar A, Buhler M, Pfirrmann CW, Gerber C: Clinical and structural outcomes of nonoperative management of massive rotator cuff tears. J Bone Joint Surg Am, 89: 1928-1934, 2007. https://doi.org/10.2106/JBJS.F.01073

Cited by

  1. A Mid-Term Reults of Arthroscopic Versus Open Repair for Large and Massive Rotator Cuff Tears vol.14, pp.2, 2011, https://doi.org/10.5397/CiSE.2011.14.2.222