Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Clinical Result of Layered Suture Bridge Technique in Arthroscopic Repair for Delaminated Rotator Cuff Tear

회전근 개 층간 분리 파열에서 관절경을 이용한 층상 교량형 봉합술의 임상 결과

  • Choi, Eui-Sung (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University) ;
  • Park, Kyoung-Jin (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University) ;
  • Kim, Yong-Min (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University) ;
  • Kim, Dong-Soo (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University) ;
  • Shon, Hyun-Chul (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University) ;
  • Cho, Byung-Ki (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University) ;
  • Park, Ji-Kang (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University) ;
  • Kim, Dong-Whan (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University) ;
  • Keum, Sang-Wook (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University) ;
  • Cha, Jung-Kwon (Department of Orthopaedic Surgery, College of Medicine, Chungbuk National University)
  • 최의성 (충북대학교 의과대학 정형외과학교실) ;
  • 박경진 (충북대학교 의과대학 정형외과학교실) ;
  • 김용민 (충북대학교 의과대학 정형외과학교실) ;
  • 김동수 (충북대학교 의과대학 정형외과학교실) ;
  • 손현철 (충북대학교 의과대학 정형외과학교실) ;
  • 조병기 (충북대학교 의과대학 정형외과학교실) ;
  • 박지강 (충북대학교 의과대학 정형외과학교실) ;
  • 김동환 (충북대학교 의과대학 정형외과학교실) ;
  • 금상욱 (충북대학교 의과대학 정형외과학교실) ;
  • 차정권 (충북대학교 의과대학 정형외과학교실)
  • Received : 2013.04.17
  • Accepted : 2013.07.29
  • Published : 2013.12.31
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Abstract

Purpose: The purpose of this study was to evaluate the repair integrity and clinical outcomes of delaminated tears following arthroscopic layered suture bridge rotator cuff repair in a prospective fashion. Materials and Methods: A consecutive series of 67 patients with delaminated rotator cuff tears who underwent surgery using the arthroscopic Layered Suture Bridge Technique were followed prospectively. Of 67 shoulders, 26 patients were male and 40 patients were female (one patient had bilateral tears); the mean age was 58.8(40~76) years. The clinical evaluation was performed according to ASES, UCLA, and KSS (Korea Shoulder Scoring System) scores with an average follow up period of 33 months. Repair integrity was estimated using MRI, which was performed six months postoperatively. Results: The average clinical outcome in ASES, UCLA, and KSS scores showed significant improvement at the time of the final follow-up compared to preoperatively, from 50.2 to 92.3, 15 to 31.3, and 54.4 to 90.7, respectively (p<0.001 for all scores). Follow up by MRI showed that 16 shoulders had a type-I; 14, a type-II; five, a type-III; two, a type-IV; one, a type-V re-tear. The overall rate of re-tear (types IV and V) was 7.9%. Conclusion: Use of the Arthroscopic Layered Suture Bridge Technique can result in improved functional and structural outcome in cases of delaminated rotator cuff tear.

목적: 저자들은 회전근 개 파열 중 층간 분리 파열의 새로운 수술 방법인 층상 교량형 봉합술을 고안하고, 이 수술법을 이용하여 치료한 환자들의 임상 결과와 회전근 개 치유 정도에 대해 전향적으로 연구하였다. 대상 및 방법: 회전근 개 전층 파열로 층상 교량형 봉합술을 이용하여 수술한 환자 66명(67예)을 대상으로 하였다. 평균 추시 기간은 33개월이었으며, 임상적 결과의 평가는 수술 전과 수술 후 KSS점수, UCLA점수, ASES점수를 이용하였고, 수술 후 6개월째 자기공명영상 검사를 촬영하였다. 결과: KSS점수, UCLA점수, ASES점수는 각각 54.4점에서 90.7점, 15점에서 31.3점, 50.2점에서 92.3점으로 큰 호전을 보였다. 수술 후 6개월째 자기공명영상 검사를 추적 관찰한 38명의 환자에서 92%의 높은 비율의 해부학적 치유를 보였으며, 재파열(IV, V단계)의 비율은 7.9%였다. 결론: 회전근 개 전층 파열 환자 중 층간 분리 파열의 경우 관절경적 층상 교량형 봉합술을 이용한 수술시 해부학적으로 회전근 개의 우수한 치유 결과를 얻었으며, 임상적, 기능적으로도 우수한 결과를 얻을 수 있었다.

Keywords

References

  1. Mochizuki T, Sugaya H, Uomizu M et al. Humeral insertion of the supraspinatus and infraspinatus. New anatomical findings regarding the footprint of the rotator cuff. Surgical technique. J Bone Joint Surg Am. 2009;91:1-7.
  2. Waltrip RL, Zheng N, Dugas JR, Andrews JR. Rotator cuff repair. A biomechanical. comparison of three techniques. Am J Sports Med. 2003;31:493-7. https://doi.org/10.1177/03635465030310040301
  3. Meier SW, Meier JD, Levy AS. Rotator cuff repair: The effect of double-row fixation versus single-row fixation on three-dimensional repair site. Arthroscopy. 2004;20:E2. https://doi.org/10.1016/S0749-8063(04)01012-6
  4. Shin SJ. Arthroscopic rotator cuff repair: Double row & suture bridge technique. J Korean Shoulder Elbow Soc. 2008;11:82-9. https://doi.org/10.5397/CiSE.2008.11.2.082
  5. Cho NS, Hwang JC, Rhee YG. Clinical results of arthroscopic repair in full-thickness rotator cuff tears. J Korean Orthop Assoc. 2006;41:857-64. https://doi.org/10.4055/jkoa.2006.41.5.857
  6. Yoo JC, Koh KH, Lim TK, et al. Serial structural and functional assessments of rotator cuff repairs: do they differ at 6 and 19 months postoperatively? J Shoulder Elbow Surg. 2012;21:100-5.
  7. Sugaya H, Maeda K, Matsuki K, Motiishi J. Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. A prospective outcome study. J Bone Joint Surg Am. 2007;89:859-66. https://doi.org/10.2106/JBJS.F.00464
  8. Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG. Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am. 2005;87: 1229-40. https://doi.org/10.2106/JBJS.D.02035
  9. 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. https://doi.org/10.2106/00004623-200402000-00002
  10. Fealy S, Kingham TP, Altchek DW. Mini-open rotator cuff repair using a two-row fixation technique: outcomes analysis in patients with small, moderate, and large rotator cuff tears. Arthroscopy. 2002;18:665-70. https://doi.org/10.1053/jars.2002.32589
  11. Lo IK, Burkhart SS. Double-row arthroscopic rotator cuff repair: Re-establishing the footprint of the rotator cuff. Arthroscopy. 2003;19:1035-42. https://doi.org/10.1016/j.arthro.2003.09.036
  12. Sano H, Wakabayashi I, Itoi E. Stress distribution in the supraspinatus tendon with partial-thickness tears: an analysis using two-dimensional finite element model. J Shoulder Elbow Surg. 2006;15:100-5. https://doi.org/10.1016/j.jse.2005.04.003
  13. Kim YS, Kim JM, Bigliani LU, Kim HJ, Jung HW. In vivo strain analysis of the intact supraspinatus tendon by ultrasound speckles tracking imaging. J Orthop Res. 2011;29:1931-7. https://doi.org/10.1002/jor.21470
  14. Toussaint B, Schnaser E, Bosley J, Lefebvre Y, Gobezie R. Early structural and functional outcomes for arthroscopic double-row transosseous-equivalent rotator cuff repair. Am J Sports Med. 2011;39:1217-25. https://doi.org/10.1177/0363546510397725

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