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Debridement or Tuberoplasty for Massive Rotator Cuff Tear

광범위 회전근 개 파열에 대한 변연절제술 및 결절성형술

  • Cho, Nam-Su (Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Kyung Hee University East-West Neo Medical Center) ;
  • Oh, Hyun-Sup (Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, Kyung Hee University East-West Neo Medical Center) ;
  • Rhee, Yong-Girl (Department of Orthopaedic Surgery, Kyung Hee University School of Medicine)
  • 조남수 (경희대학교 동서신의학병원 정형외과학교실) ;
  • 오현섭 (경희대학교 동서신의학병원 정형외과학교실) ;
  • 이용걸 (경희대학교 의과대학 정형외과학교실)
  • Received : 2010.05.10
  • Accepted : 2010.06.16
  • Published : 2010.06.15

Abstract

Purpose: The purpose of this article was to review the effectiveness of arthroscopic debridement and tuberoplasty, and to evaluate the clinical and radiologic results of our series for irreparable massive rotator cuff tears in the elderly. Materials and Methods: We reviewed articles that focused on the treatment options and decision making for irreparable massive rotator cuff tears. In particular, we summarized the reported results of arthroscopic debridement and tuberoplasty for irreparable massive rotator cuff tears in the elderly. Among consecutive patients who had arthroscopic tuberoplasty for irreparable massive rotator cuff tears in our series, thirty-two patients available for clinical and radiological evaluation at a mean follow-up of 29 months (range, 13-52 months) were enrolled and reviewed for the analysis. Results: At the last follow-up, the range of active forward flexion increased significantly with excellent pain relief and improvement in the ability to perform the activities of daily living. However, the group with less than 2 mm in preoperative acromiohumeral distance showed inferior postoperative results. Conclusion: Arthroscopic tuberoplasty may be an alternative option in irreparable massive rotator cuff tears for pain relief and improvement of range of motion. However, good results can not be expected if the acromiohumeral distance is less than 2 mm preoperatively and decreases postoperatively, or when the preoperative range of motion is less than $90^{\circ}$ on flexion and abduction.

목적: 광범위 회전근 개 파열에 대한 여러 가지 수술 방법 중 고령의 봉합이 불가능한 파열에 대해 시행하는 단순 변연절제술 및 결절성형술에 대해 알아보고자 하였다. 대상 및 방법: 봉합 불가능한 광범위 회전근 개 파열에 대한 여러 수술 방법 및 치료 방법의 선택에 대하여 문헌을 검토하고 정리하였다. 특히 고령의 봉합이 불가능한 광범위 회전근 개 파열에 시행할 수 있는 단순 변연절제술 및 결절성형술에 대해 연구 발표된 논문을 조사하여 요약하고 정리하였다. 또한 본 저자들의 교실에서 회전근 개의 심한 퇴축으로 도저히 봉합이 불가능하였던 32예를 대상으로 시행된 관절경적 결절성형술의 수술 방법을 소개하고 임상적 및 방사선학적 결과를 분석하였으며 그 결과에 미치는 요인들을 조사하였다. 결과: 평균 29개월 (13~52개월) 추시한 결과 통계적으로 의미있는 통증의 감소와 능동적 거상 운동 범위의 증가를 확인할 수 있었으며 기능적 향상을 얻을 수 있었다. 하지만 수술 전 견봉-상완 간격이 2 mm 미만으로 좁았던 경우에는 수술 후 불량한 결과를 보였다. 결론: 광범위 파열의 관절경적 치료에 있어, 일단 회전근 개 유리술 후 봉합이 가능한 경우는 최대한 봉합술을 시도해 볼 수 있으며, 봉합이 불가능한 광범위 파열의 경우에는 무리하게 일차 복원술을 시도하기 보다는 수술 전 통증은 있으나 90도 이상 능동적 전방 거상이 가능하고 방사선 사진상 견봉과 상완골 두 사이 간격이 2 mm 미만으로 좁아지지 않은 경우에는 견봉성형술을 포함한 관절경적 결절성형술을 고려해 보아야 할 것이다.

Keywords

References

  1. Adamson GJ, Tibone JE: Ten-year assessment of primary rotator cuff repairs. J Shoulder and Elbow Surg, 2: 57-63, 1993. https://doi.org/10.1016/1058-2746(93)90001-W
  2. Bennett WF: Arthroscopic repair of full-thickness supraspinatus tears (small-to-medium): A prospective study with 2- to 4-year follow-up. Arthroscopy, 19: 249-256, 2003. https://doi.org/10.1053/jars.2003.50083
  3. Bishop J, Klepps S, Lo IK, Bird J, Gladstone JN, Flatow EL: Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study. J Shoulder Elbow Surg, 15: 290-299, 2006. https://doi.org/10.1016/j.jse.2005.09.017
  4. Blevins FT, Warren RF, Cavo C, Altchek DW, Dines D, Palletta G, Wickiewicz TL: Arthroscopic assisted rotator cuff repair: results using a mini-open deltoid splitting approach. Arthroscopy, 12: 50-59, 1996. https://doi.org/10.1016/S0749-8063(96)90219-4
  5. Burkhart SS, Athanasiou KA, Wirth MA: Margin convergence: a method of reducing strain in massive rotator cuff tears. Arthroscopy, 12: 335-338, 1996. https://doi.org/10.1016/S0749-8063(96)90070-5
  6. 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
  7. Burkhart SS: Arthroscopic treatment of massive rotator cuff tears. Clinical results and biomechanical rationale. Clin Orthop Relat Res, 267: 45-56, 1991.
  8. Burkhart SS: Arthroscopic debridement and decompression for selected rotator cuff tears. Clinical results, pathomechanics, and patient selection based on biomechanical parameters. Orthop Clin North Am, 24: 111-123, 1993.
  9. Cofield RH: Subscapular muscle transposition for repair of chronic rotator cuff tears. Surg Gynecol Obstet, 154: 667-672, 1982.
  10. Debeyre J, Patie D, Elmelik E: Repair of Ruptures of the Rotator Cuff of the Shoulder. J Bone Joint Surg Br, 47: 36-42, 1965.
  11. 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
  12. 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
  13. Frankle M, Siegal S, Pupello D, Saleem A, Mighell M, Vasey M: The Reverse Shoulder Prosthesis for glenohumeral arthritis associated with severe rotator cuff deficiency. A minimum two-year follow-up study of sixty patients. J Bone Joint Surg Am, 87: 1697-1705, 2005. https://doi.org/10.2106/JBJS.D.02813
  14. 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.
  15. Gerber C, Fuchs B, Hodler J: The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am, 82: 505-515, 2000.
  16. Gerber C: Latissimus dorsi transfer for the treatment of irreparable tears of the rotator cuff. Clin Orthop Relat Res, 275: 152-160, 1992.
  17. Goldberg BA, Nowinski RJ, Matsen FA 3rd: Outcome of nonoperative management of full-thickness rotator cuff tears. Clin Orthop Relat Res, 382: 99-107, 2001. https://doi.org/10.1097/00003086-200101000-00015
  18. Goutallier D, Postel JM, Gleyze P, Leguilloux P, Van Driessche S: Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg, 12: 550-554, 2003. https://doi.org/10.1016/S1058-2746(03)00211-8
  19. Grammont PM, Baulot E: Delta shoulder prosthesis for rotator cuff rupture. Orthopedics, 16: 65-68, 1993.
  20. Harryman DT, 2nd, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA: Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am, 73: 982-989, 1991.
  21. Jones CK, Savoie FH 3rd: Arthroscopic repair of large and massive rotator cuff tears. Arthroscopy, 19: 564-571, 2003. https://doi.org/10.1016/S0749-8063(03)00169-5
  22. Karas SE, Giachello TL: Subscapularis transfer for reconstruction of massive tears of the rotator cuff. J Bone Joint Surg Am, 78: 239-245, 1996.
  23. Kempf JF, Gleyze P, Bonnomet F, Walch G, Mole D, Frank A, Beaufils P, Levigne C, Rio B, Jaffe A: A multicenter study of 210 rotator cuff tears treated by arthroscopic acromioplasty. Arthroscopy, 15: 56-66, 1999.
  24. Levy HJ, Gardner RD, Lemak LJ: Arthroscopic subacromial decompression in the treatment of full-thickness rotator cuff tears. Arthroscopy, 7: 8-13, 1991. https://doi.org/10.1016/0749-8063(91)90071-5
  25. 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
  26. McLaughlin HL: Lesions of the musculotendinous cuff of the shoulder. The exposure and treatment of tears with retraction. 1944. Clin Orthop Relat Res, 304: 3-9, 1994.
  27. McLaughlin HL: Repair of major cuff ruptures. Surg Clin North Am, 43: 1535-1540, 1963.
  28. Melillo AS, Savoie FH 3rd, Field LD: Massive rotator cuff tears: debridement versus repair. Orthop Clin North Am, 28: 117-124, 1997. https://doi.org/10.1016/S0030-5898(05)70269-8
  29. Montgomery TJ, Yerger B, Savoie FH 3rd: Management of rotator cuff tears. A comparison of arthroscopic debridement and surgical repair. J Shoulder Elbow Surg, 3: 70-78, 1994. https://doi.org/10.1016/S1058-2746(09)80113-4
  30. Musil D, Sadovsky′P: [Massive tears of the rotator cuff--comparison of mini-open and arthroscopic techniques. Part 2. Arthroscopic repair]. Acta Chir Orthop Traumatol Cech, 74: 318-325, 2007.
  31. Ozaki J, Fujimoto S, Masuhara K, Tamai S, Yoshimoto S: Reconstruction of chronic massive rotator cuff tears with synthetic materials. Clin Orthop Relat Res, 202: 173-183, 1986.
  32. Pearl ML, Romeo AA, Wirth MA, Yamaguchi K, Nicholson GP, Creighton RA: Decision making in contemporary shoulder arthroplasty. Instr Course Lect, 54: 69-85, 2005.
  33. Post M, Silver R, Singh M: Rotator cuff tear: Diagnosis and treatment. Clin Orthop Relat Res, 173: 78-91, 1983.
  34. Rebuzzi E, Coletti N, Schiavetti S, Giusto F: Arthroscopic rotator cuff repair in patients older than 60 years. Arthroscopy, 21: 48-54, 2005. https://doi.org/10.1016/j.arthro.2004.09.019
  35. Rockwood CA Jr, Williams GR Jr, Burkhead WZ Jr: De′bridement of degenerative, irreparable lesions of the rotator cuff. J Bone Joint Surg Am, 77: 857-866, 1995.
  36. Scheibel M, Lichtenberg S, Habermeyer P: Reversed arthroscopic subacromial decompression for massive rotator cuff tears. J Shoulder Elbow Surg, 13: 272-278, 2004. https://doi.org/10.1016/j.jse.2004.01.007
  37. Tauro JC: Arthroscopic rotator cuff repair: analysis of technique and results at 2- and 3-year follow-up. Arthroscopy, 14: 45-51, 1998. https://doi.org/10.1016/S0749-8063(98)70119-7
  38. Verhelst L, Vandekerckhove PJ, Sergeant G, Liekens K, Van Hoonacker P, Berghs B: Reversed arthroscopic subacromial decompression for symptomatic irreparable rotator cuff tears: Mid-term followup results in 34 shoulders. J Shoulder Elbow Surg, 2010 Jan 5. [Epub ahead of print]
  39. Warner JJ, Parsons IM 4th: Latissimus dorsi tendon transfer: a comparative analysis of primary and salvage reconstruction of massive, irreparable rotator cuff tears. J Shoulder Elbow Surg, 10: 514-521, 2001. https://doi.org/10.1067/mse.2001.118629
  40. Warner JJ: Management of massive irreparable rotator cuff tears: the role of tendon transfer. Instr Course Lect, 50: 63-71, 2001.
  41. Wolf EM, Pennington WT, Agrawal V: Arthroscopic side-to-side rotator cuff repair. Arthroscopy, 21: 881-887, 2005.
  42. Zvijac JE, Levy HJ, Lemak LJ: Arthroscopic subacromial decompression in the treatment of full thickness rotator cuff tears: a 3- to 6-year follow-up. Arthroscopy, 10: 518-523, 1994. https://doi.org/10.1016/S0749-8063(05)80006-4

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