Clinics in Shoulder and Elbow

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

DOI QR Code

The Use of Arthroscopic UU Stich for Rotator Cuff Tear and Clinical Results

회전근 개 파열의 관절경하 봉합에서 새로운 봉합 방법의 이용

  • Ko, Sang-Hun (Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Shin, Seung-Myeong (Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Choi, Young-Jin (Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Cha, Jae-Ryong (Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Park, Han-Chang (Department of Orthopedic Surgery, Ulsan University Hospital, University of Ulsan College of Medicine)
  • 고상훈 (울산대학교 의과대학 울산대학교병원 정형외과학교실) ;
  • 신승명 (울산대학교 의과대학 울산대학교병원 정형외과학교실) ;
  • 최영진 (울산대학교 의과대학 울산대학교병원 정형외과학교실) ;
  • 차재룡 (울산대학교 의과대학 울산대학교병원 정형외과학교실) ;
  • 박한창 (울산대학교 의과대학 울산대학교병원 정형외과학교실)
  • Received : 2011.05.02
  • Accepted : 2011.06.11
  • Published : 2011.06.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: There are various known methods for arthroscopic rotator cuff repair. The purpose of this retrospective study is to report on the clinical results and anatomical results of UU repair surgery, which is a new repair method. Materials and Methods: We enrolled 156 patients (88 men and 68 women) who underwent UU repair for rotator cuff tears from January 2009 to May 2010 in our hospital. Their average age was 55 years old (range: 38~75 years old) and the average follow-up period was 12 months (range: 6~23 months). For determining the results, we evaluated the VAS for pain, the daily living index (ADL) in the ASES scores, the UCLA and KSS scores, and all these tests were conducted at the first hospital visit and 6 months and 1 year after surgery and at the final follow-up. During the follow-up period, MRI was performed 3 and 6 months after surgery only in the patients who consented to MRI scans to confirm the presence of re-rupture. Results: The average scores of the VAS as a pain indicator decreased from 7.0 before surgery to 2.7 after surgery (p<0.05). The UCLA and KSS scores increased from 22.2 to 32.5 and from 83.7 to 91.5, and the changes was significant (p<0.05). For the active joint range of motion, the average forward flexion was improved from 125 to 175 degrees, the average lateral external rotation was improved from 38 to 58 degrees, and the average abduction was improved from 104 to 169 degrees. Out of a total of 156 patients, re-rupture was observed in 4 cases (3%) of 117 cases (75%) for which MRI was performed (with consent) between 3 and 6 months after surgery. Conclusion: UU repair surgery as arthroscopic repair of rotator cuff tear is a good repair method that shows excellent clinical results and a low re-rupture rate.

목적: 관절경하 회전근 개 봉합술은 여러 가지 봉합술이 알려져 있으나 저자들은 새로운 봉합법인 UU 봉합법의 임상적 결과와 해부학적 결과에 대하여 보고하고자 함이 목적이다. 대상 및 방법: 2009년 1월부터 2010년 5월까지 본원에서 회전근개 파열에 대해 UU 봉합술을 시행한 156명 (남자: 88명, 여자: 68명)의 환자를 대상으로 하였다. 평균 나이는 55세 (38~75세)였으며 추시 관찰 기간은 평균 12개월 (6~23개월)이었다. 결과의 판정은 최초 내원 시점과 6개월, 1년과 최종 추시에 시행한 ASES 점수 중 통증에 대한 VAS, 기능에 대한 일상 (ADL), UCLA 점수 및 KSS 점수로 평가하였다. 추시 기간 중 술 후 3개월에서 6개월 사이에 MRI 촬영에 동의하는 환자에 한하여 MRI를 시행하여 재파열의 유무를 확인하였다. 결과: 통증 지표인 VAS는 술 전 평균 7.0에서 술 후 평균 2.7로 감소하였다 (p<0.05). UCLA 및 KSS score는 각각 22.2에서 32.5로, 83.7에서 91.5로 증가하였으며 통계적으로 유의하였다 (p<0.05). 능동적 관절 운동 범위는 전방 굴곡이 평균 125도에서 175도, 측방 외 회전이 평균 38도에서 58도, 외전이 평균 104도에서 169도로 향상되었다. 전체 환자 156예 중 술 후 3개월에서 6개월 사이에 MRI 촬영에 동의하여 시행한 117예 (75%) 중 재파열은 총 4예 (3%)에서 관찰되었다. 결론: 회전근 개 파열의 관절경하 봉합술로 UU 봉합법은 우수한 임상결과와 낮은 재파열을 보이는 방법이다.

Keywords

References

  1. Uhthoff HK, FRCSC and Sano H. Repair Pathology of failure of the rotator cuff tendon. Orthop Clin N Am. 1997;28:31-41. https://doi.org/10.1016/S0030-5898(05)70262-5
  2. Edwards TB, Walch G, Sirveaux F, et al. Repair of Tears of the Subscapularis. J Bone Joint Surg Am. 2005;87:725-30. https://doi.org/10.2106/JBJS.D.02051
  3. Kim DH, Moon YL, Kim KJ. Partial Tear of Upper Portion of Subscapularis. J Korean Shoulder Elbow Soc. 2005;8:9-13. https://doi.org/10.5397/CiSE.2005.8.1.009
  4. Adams CR, Schoolfield JD, Burkhart SS. The results of arthroscopic subscapularis tendon repairs. Arthroscopy. 2008;24:1381-9. https://doi.org/10.1016/j.arthro.2008.08.004
  5. Gerber C, Schneeberger AG, Perren SM, Nyffeler RW. Experimental rotator cuff repair. A preliminary study. J Bone Joint Surg Am. 1999;81:1281-90.
  6. Ko SH, Cho SD, Park MS, et al. All arthroscopic repairs with biceps incorporation in large, massive sized full thickness rotator cuff tears. J Kor Musculoskeletal Transplantation Soc. 2005;5:112-9.
  7. Cofield RH. Rotator cuff disease of the shoulder. J Bone Joint Surg Am. 1985;67:974-9.
  8. Sugaya H, Maeda K, Matsuki K, Moriishi J. Repair integrity nad functional outcome after arthroscopic double-row rotator cuff repair. Aprospective outcome study. J Bone Joint Surg Am. 2007;89:953-60. https://doi.org/10.2106/JBJS.F.00512
  9. Hawkins RJ, Misamore GW, Hobeika PE. Surgery for full thickness rotator-cuff tears. J Bone Joint Surg Am. 1985;67:1349-55.
  10. 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. 2006;9:181-8. https://doi.org/10.5397/CiSE.2006.9.2.181
  11. Goldgerg, Benjamin A, Lippitt, Steven B, Matsen III and Frederick A. Improvement in comfort and function after cuff repair without acromioplasty. Clin Orthop Relat Res. 2001;390:142-50. https://doi.org/10.1097/00003086-200109000-00017
  12. Ellman H, Hanker G and Bayer M. Repair of the rotator cuff. J Bone Joint Surg Am. 1986;68:1136-44.
  13. Post MN, Sliver R and Manmolan S. Rotator cuff tear : Diagnosis & treatment. Clin Orthop Relat Res. 1983;173:78-91.
  14. Ellman H. Arthroscopic subacromial decompression analysis of one- to three-year results. Arthroscopy. 1987;3:173-81. https://doi.org/10.1016/S0749-8063(87)80061-0
  15. Gartsman GM. Arthroscopic treatment of rotator cuff disease. J Shoulder Elbow Surg. 1995;4:228-41. https://doi.org/10.1016/S1058-2746(05)80056-4
  16. Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am. 2004; 86:219-24.
  17. Ma CB, MacGillivray JD, Clabeaux J, Lee S, Otis JC. Biomechanical evaluation of arthroscopic rotator cuff stitches. J Bone Joint Surg Am. 2004;86:1211-16.
  18. Gerber C. Massive rotator cuff tears. In :lannotti JP, Williams GR (eds): Disorders of the shoulder. Diagnosis and management. 1st ed, Philadelphia, Lippincott Williams & Wilkins Inc; 1999. 57-92.
  19. Goutallie D, Postel FM, Berganeau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;304:78-83.
  20. Goutallier D, Postel JM, Gleyze P Leguillouz 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. 2003;12:550-4. https://doi.org/10.1016/S1058-2746(03)00211-8
  21. Mellado J, 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. Am J Roentgenol. 2005;184:1456-63. https://doi.org/10.2214/ajr.184.5.01841456
  22. Darren J, Ko SH, Park KB, et al. Is the UU Stitch Really Alternative to Modified MA (Mason-Allen) Stitch for Rotator Cuff Repair, -Biomechanical Comparative Study of UU to Modified MA Stitch. J Korean Shoulder Elbow Soc. 2009;12:207-14. https://doi.org/10.5397/CiSE.2009.12.2.207