Clinics in Shoulder and Elbow

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

DOI QR Code

The Radiologic and Clinical Changes after Open Complete Repair of Massive Rotator Cuff Tears

개방적 완전 봉합술로 치료한 광범위 회전근 개 파열 환자에서 치료 전후의 방사선학적 및 임상적 소견의 변화

  • Moon, Eun-Sun (Department of Orthopedic Surgery, Chonnam National University Hospital) ;
  • Choi, Min-Sun (Department of Orthopedic Surgery, Chonnam National University Hospital) ;
  • Kim, Myung-Sun (Department of Orthopedic Surgery, Chonnam National University Hospital) ;
  • Kong, Il-Kyu (Department of Orthopedic Surgery, Chonnam National University Hospital) ;
  • Kim, Byoung-Jin (Department of Orthopedic Surgery, Chonnam National University Hospital)
  • 문은선 (전남대학교 의과대학 정형외과학교실) ;
  • 최민선 (전남대학교 의과대학 정형외과학교실) ;
  • 김명선 (전남대학교 의과대학 정형외과학교실) ;
  • 공일규 (전남대학교 의과대학 정형외과학교실) ;
  • 김병진 (전남대학교 의과대학 정형외과학교실)
  • Published : 2009.12.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study evaluated the preoperative and postoperative radiologic findings of patients with complete repairs after massive rotator cuff tears along with the incidence of re-tear and the clinical outcomes. Materials and methods: This study evaluated 33 cases who had open complete repairs for massive rotator cuff tears and these patients were followed up for more than 24 months. The clinical evaluation was performed according to the shoulder joint function test of the American Shoulder and Elbow Surgeons (ASES), and the degree of arthritis related to the massive rotator cuff tears was evaluated using the Hamada classification. Results: The ASES scores improved from 37.6 preoperatively to 85.6 postoperatively. The mean preoperative acromio-humeral interval (AHI) score was 6.5 mm, which increased to 9.3 mm immediately after surgery, and there was a decreased to 6.5 mm noted at the last follow up. The lower radiology stages of arthritis according to the classification showed better preoperative and postoperative results. Conclusion: An open complete repair as the surgical treatment for a massive rotator cuff tear showed satisfactory results for pain relief and an improvement in the shoulder joint function though re-tear after surgery.

목적: 광범위 회전근 개 파열에 대해 개방적 완전 봉합이 가능하였던 환자들을 대상으로 수술 전, 후의 방사선학적 소견의 변화와 진행 정도를 회전근 개 재파열 정도 및 임상적 결과와 함께 비교 분석하고자 하였다. 대상 및 방법: 광범위 회전근 개 파열에 대해 개방적 완전 봉합술을 시행 받고 24개월 이상 추시가 가능하였던 33예를 대상으로 하였다. 임상적 평가는 American Shoulder and Elbow Surgeons(ASES)의 견관절 기능 평가법을 기준으로 하였으며, 광범위 회전근 개 파열과 관련한 관절염의 정도는 Hamada의 분류법을 기준으로 하였다. 결과: ASES 점수는 수술 전 평균 37.6점에서 85.6점으로 호전되었다. 수술 전 acromiohumeral interval (AHI)은 평균 6.5 mm였으며, 수술 직후 평균 9.3 mm로 증가하였으나, 최종 추시에서 평균 6.5 mm로 다시 감소되는 소견을 보였다. Hamada 분류법에 따른 관절염의 방사선학적 단계는 수술 전과 수술 후 모두 그 단계가 낮을수록 보다 좋은 임상적 결과를 보였다. 결론: 광범위 회전근 개 파열에 대한 수술적 치료로서 개방적 완전 봉합술은 비록 수술 후 재파열이 발생하더라도 임상적으로는 통증 경감과 견관절 기능 향상 면에서 상당히 만족할만한 결과를 보였다.

Keywords

References

  1. Ahn BW, Yoon JH, Jung SW, Jo JI, Kwag WS, Wang KT: Open Repair of Massive Rotator Cuff Tears. J Korean Shoulder Elbow Soc, 9: 20-26, 2006. https://doi.org/10.5397/CiSE.2006.9.1.020
  2. Bennett WF: Arthroscopic repair of massive rotator cuff tears: A prospective cohort with 2- to 4-year follow- up. Arthroscopy, 19: 380-390, 2003. https://doi.org/10.1053/jars.2003.50131
  3. Boes MT, McCann PD, Dines DM: Diagnosis and management of massive rotator cuff tears: The surgeon's dilemma. AAOS Instr Course Lect, 55: 45-57, 2006.
  4. Burkhart SS: Arthroscopic treatment of massive rotator cuff tears. Clin Orthop Relat Res, 390: 107-118, 2001. https://doi.org/10.1097/00003086-200109000-00013
  5. Burkhart SS: Arthroscopic treatment of massive rotator cuff tears: Clinical results and biomechanical rationale. Clin Orthop Relat Res, 267: 45-56, 1991.
  6. Cofield RH: Current Concepts Review. Rotator cuff disease of the shoulder. J Bone Joint Surg Am, 67: 974-979, 1985.
  7. 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.
  8. Gazielly DF, Gleyze P, Montagnon C: Functional and anatomical results after rotator cuff repair. Clin Orthop Relat Res, 304: 43-53, 1994.
  9. 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.
  10. Goutallier D, Postel JM, Radier C, Bernageau J, Zilber S: Long-term functional and structural outcome in patients with intact repairs 1 year after open transosseous rotator cuff repair. J Shoulder Elbow Surg, 18: 521-528, 2009. https://doi.org/10.1016/j.jse.2008.11.006
  11. Goutallier D, Postel JM, Van Driessche S, Godefroy D, Radier C: Tension-free cuff repairs with excision of macroscopic tendon lesions and muscular advancement: Results in a prospective series with limited fatty muscular degeneration. J Shoulder Elbow Surg, 15: 164-172, 2006. https://doi.org/10.1016/j.jse.2005.07.008
  12. Grana WA, Teague B, King M, Reeves RB: An analysis of rotator cuff repair. Am J Sports Med, 22: 585-588, 1994. https://doi.org/10.1177/036354659402200503
  13. Green A: Chronic massive rotator cuff tears: Evaluation and management. J Am Acad Orthop Surg, 11: 321-331, 2003.
  14. 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.
  15. Harryman DT 2nd, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA 3rd: Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am, 73: 982-989, 1991.
  16. Hawkins RJ, Misamore GW, Hobeika PE: Surgery for full-thickness rotator-cuff tears. J Bone Joint Surg Am, 67: 1349-1355, 1985.
  17. Iannotti JP, Bernot MP, Kuhlman JR, Kelley MJ, Williams GR: Postoperative assessment of shoulder function: A prospective study of full-thickness rotator cuff tears. J Shoulder Elbow Surg, 5: 449-457, 1996. https://doi.org/10.1016/S1058-2746(96)80017-6
  18. Iannotti JP: Full-thickness rotator cuff tears: Factors affecting surgical outcome. J Am Acad Orthop Surg, 2: 87-95, 1994.
  19. 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
  20. Jost B, Pfirrmann CW, Gerber C, Switzerland Z: Clinical outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am, 82: 304-314, 2000. https://doi.org/10.1302/0301-620X.82B2.10931
  21. 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
  22. Montgomery TJ, Yerger B, Savoie FH 3rd: Management of rotator cuff tears: A comparison of arthroscopic debridement with open surgical repair. J Shoulder Elbow Surg, 3: 70-78, 1994. https://doi.org/10.1016/S1058-2746(09)80113-4
  23. Nich C, Mutschler C, Vandenbussche E, Augereau B: Long-term Clinical and MRI Results of Open Repair of the Supraspinatus Tendon. Clin Orthop Relat Res, 467: 2613-2622, 2009. https://doi.org/10.1007/s11999-009-0917-4
  24. Noh HK, Wang JH, Kim DH, Park JW, Kim JG, Park JH: Correlation of Clinical Outcome and Cuff Integrity after Open Repair in Large and Massive Rotator Cuff Tears. J Korean Shoulder Elbow Soc, 10: 65-72, 2007. https://doi.org/10.5397/CiSE.2007.10.1.065
  25. Post M, Silver R, Singh M: Rotator cuff tear. Diagnosis and treatment. Clin Orthop Relat Res, 173: 78-91, 1983.
  26. Rockwood CA Jr, Burkhead WZ: Management of Patients with Massive Rotator Cuff Defects by Acromioplasty and Rotator Cuff Debridement. Orthrop Trans, 12: 190-191, 1988.
  27. Rokito AS, Cuomo F, Gallagher MA, Zuckerman JD: Long-term functional outcome of repair of large and massive chronic tears of the rotator cuff. J Bone Joint Surg Am, 81: 991-997, 1999. https://doi.org/10.1302/0301-620X.81B6.8940
  28. Rokito AS, Zuckerman JD, Gallagher MA, Cuomo F: Strength after surgical repair of the rotator cuff. J Shoulder Elbow Surg, 5: 12-17, 1996. https://doi.org/10.1016/S1058-2746(96)80025-5
  29. Thomazeau H, Rolland Y, Lucas C, Duval JM, Langlais F: Atrophy of the supraspinatus belly. Assessment by MRI in 55 patients with rotator cuff pathology. Acta Orthop Scand, 67: 264-268, 1996. https://doi.org/10.3109/17453679608994685
  30. Weiner DS, Macnab I: Superior migration of the humeral head. A radiologic aid in the diagnosis of tears of the rotator cuff. J Bone Joint Surg Br, 52: 524-527, 1970.