Clinics in Shoulder and Elbow

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

DOI QR Code

Massive Rotator Cuff Tear Repair

광범위 회전근 개 파열의 봉합술

  • Shin, Sang-Jin (Department of Orthopaedic Surgery, Ewha Womans University School of Medicine)
  • 신상진 (이화여자대학교 의학전문대학원 정형외과학교실)
  • Received : 2010.05.12
  • Accepted : 2010.06.16
  • Published : 2010.06.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Anatomical repair of massive rotator cuff tear has been technically challenging because of medial retraction, muscle atrophy and fatty degeneration. Among several treatment options for massive rotator cuff tear, we reviewed rotator cuff repairs and investigated modalities for improvement of clinical outcomes, decreasing the re-tear rate, and increasing healing. Materials and Methods: Patient-related factors and rotator cuff-related factors were the two major groups of factors we considered when choosing a treatment plan. Results: Mobilization of a massive rotator cuff tear was increased by soft tissue release and by the interval slide technique. After meticulous soft tissue release, anatomical repair could be achieved. If the injury was not amenable to anatomical repair, alternative treatment options such as partial repair, the margin convergence technique and augmentation with a tenotomized biceps tendon were considered. Many reports of massive rotator cuff repair demonstrated satisfactory clinical outcomes, decreased pain, recovery of shoulder functions, and increases in muscle strength. However, the re-tear rate had been reported to be relatively high in long-term follow-up. Conclusion: Despite a high re-tear rate after massive rotator cuff repair, a better understanding of the pathogenesis, progression and clinical symptoms of massive rotator cuff tear and improved surgical materials and techniques will lead to satisfactory clinical outcomes.

목적: 광범위 회전근 개 파열은 파열단의 내측 퇴축, 근위축 및 지방 변성과 함께 주변 조직과의 유착 등으로 해부학적 봉합이 불가능한 경우가 많다. 본 종설에서는 광범위 회전근 개 파열의 여러 가지 치료 방법 중 봉합술에 대하여 문헌 고찰과 함께 임상 결과 향상과 재파열율을 감소시키고 치유력을 높일 수 있는 방법을 알아보고자 한다. 대상 및 방법: 광범위 회전근 개 파열 봉합술의 선택은 환자의 나이, 동반 질환, 통증, 운동 범위 감소, 근력 약화 등의 임상 증상 및 재활 의지 등 환자와 관련된 요인과, 회전근 개 파열 기간, 크기, 퇴축 및 지방 변성 정도 등은 회전근 개와 관련된 요인을 고려하여 선택해야 한다. 결과: 조직의 가동성이 떨어져 해부학적 봉합이 어려운 광범위 회전근 개 파열은 주변 조직 유리술과 간격 활주 방법으로 가동성을 증가시켜 봉합할 수 있다. 주변 조직 유리술을 시행하고 회전근 개의 가동성을 증가시켜도 해부학적 봉합이 불가능한 광범위 회전근 개 파열은 부분 봉합, 변연 수렴 술식 및 상완 이두건 절제 및 고정술 등의 대체 술식을 고려할 수 있다. 광범위 회전근개 파열 환자에서 견봉하 감압술 및 회전근 개 봉합술에 관한 여러 보고는 통증 감소, 견관절 기능 및 근력 회복 등 만족할만한 임상 결과를 보고하고 있으나 장기 추시 결과 높은 재파열율이 관찰되고 있다. 결론: 광범위 회전근 개 파열의 치료는 아직까지 높은 재파열 발생율로 해결해야 할 과제가 많으나 광범위 파열의 병인, 진행 과정 및 임상 양상에 대한 이해와 재파열 예후 인자 분석 등을 통해 향상된 치료 성적을 얻을 수 있을 것으로 사료된다.

Keywords

References

  1. Bigliani LU, Cordasco FA, McIlveen SJ, Musso ES: Operative repair of massive rotator cuff tears: Longterm results. J Shoulder Elbow Surg, 1: 120-130, 1992. https://doi.org/10.1016/1058-2746(92)90089-L
  2. Burkhart SS, Danaceau SM, Pearce CE: Arthroscopic rotator cuff repair: Analysis of results by tear size and by repair technique-margin convergence versus direct tendon-to-bone repair. Arthroscopy, 17: 905-912, 2001. https://doi.org/10.1053/jars.2001.26821
  3. 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
  4. Charousset C, Grimberg J, Duranthon LD, Bellaiche L, Petrover D: Can a double-row anchorage technique improve tendon healing in arthroscopic rotator cuff repair? A prospective, nonrandomized, comparative study of double-row and single-row anchorage techniques with computed tomographic arthrography tendon healing assessment. Am J Sports Med, 35: 1247-1253, 2007. https://doi.org/10.1177/0363546507301661
  5. Cofield RH, Pavizi J, Hoffmeyer PJ, Lanzer WL, Ilstrup DM, Rowland CM: Surgical repair of chronic rotator cuff tears: A prospective long-term study. J Bone Joint Surg Am, 83: 71-77, 2001.
  6. 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: 1428-1428, 2005.
  7. Debeyre J, Patte D, Elmelik E: Repair of ruptures of the rotator cuff of the shoulder. With a note on advacement of the supraspinatus muscle. J Bone Joint Surg Br, 47: 36-42, 1965.
  8. Fenlin JM, Chase JM, Rushton SA, Frieman B: Tuberoplasty: Creation of an acromiohumerral 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
  9. Flatow EL: Coracoacromial ligament preservation in rotator cuff surgery. J Shoulder Elbow Surg, 3: 573, 1994.
  10. Gartman GM: Massive, irreparable tears of the rotator cuff. J Bone Joint Surg Am, 79: 715-721, 1997.
  11. 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.
  12. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC: Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res, 304: 78-83, 1994.
  13. Hamada K, Fukada H, Mikasa M, Kobayashi Y: Roentgenographic findings in massive rotator cuff tears: A long-term observation. Clin Orthop Relat Res, 254: 92-96, 1990.
  14. Harryman DT, Mack LA, Wang KY, Jackins SE, Tichardson ML, Matsen FA: Repairs of the rotator cuff: Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am, 73: 982-990, 1991.
  15. Iannotti JP: Full-thickness rotator cuff tears: factors affecting surgical outcome. J Am Acad Orthop Surg, 2: 87-95, 1994.
  16. Jones CK, Savoie FH: Arthroscopic repair of large and massive rotator cuff tears. Arthroscopy, 19: 564-571, 2003. https://doi.org/10.1016/S0749-8063(03)00169-5
  17. Jost B, Pfirrmann CWA, Gerber C: 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
  18. Kim DH, Elattrache NS, Tibone JE, et al.: Biomechanical comparison of a single-row versus doublerow suture anchor technique for rotator cuff repair. Am J Sports Med, 34: 407-414, 2006. https://doi.org/10.1177/0363546505281238
  19. Lo IK, Burkhart SS: Arthroscopic repair of massive, contracted, immobile rotator cuff tears using sing and double interval slides: Technique and preliminary results. Arthroscopy, 20: 22-33, 2004. https://doi.org/10.1016/j.arthro.2003.11.013
  20. Mattias A, Zumstein, Bernhard J, Juer H, Christian G: The clinical and structural long term result of open repair of massive rotator cuff. J Bone Joint Surg Am, 90: 2423-2431, 2008. https://doi.org/10.2106/JBJS.G.00677
  21. Mazzocca AD, Millett PJ, Guanche CA, Santangelo SA, Arciero RA: Arthroscopic single-row versus double- row suture anchor rotator cuff repair. Am J Sports Med, 33: 1861-1868, 2005. https://doi.org/10.1177/0363546505279575
  22. Melillo AS, Savoie FH, 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
  23. 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, 184: 1456-1463, 2005. https://doi.org/10.2214/ajr.184.5.01841456
  24. Park JY, Lhee SH, Choi JH, Park HK, Yu JW, Seo JB: Comparison of the clinical outcomes of singlewith double-row repair in rotator cuff tears. Am J Sports Med, 36: 1310-1316, 2008. https://doi.org/10.1177/0363546508315039
  25. Rhee YG, Cho NS, Lim CT, Yi JW, Vishvanathan T: Bridging the gap in immobile massive rotator cuff tears: augmentation using the tenotomized biceps. Am J Sports Med, 36: 1511-1518, 2008. https://doi.org/10.1177/0363546508316020
  26. 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
  27. Sugaya H, Maeda K, Matsuki K, Moriishi J: Functional and structural outcome after arthroscopic fullthickness rotator cuff repair: single-row versus dualrow fixation. Arthroscopy, 21: 1307-1316, 2005. https://doi.org/10.1016/j.arthro.2005.08.011
  28. Sugihara T. Nakagawa T, Tshchiya M, Ishizuki M: Prediction of primary reparability of massive tears of the rotator cuff on preoperative magnetic resonance imaging. J Shoulder Elbow Surg, 12: 222-225, 2003. https://doi.org/10.1016/S1058-2746(02)86888-4
  29. Thomazeau H, Boukobza E, Morcet N, Chaperon J, Langlais F: Prediction of rotator cuff repair. Results by magnetic resonance imaging. Clin Orthop Real Res, 344: 275-283, 1997.
  30. Warner JJ: Management of massive irreparable rotator cuff tears: The role of tendon transfer. Instr Course Lect, 50: 63-71, 2001.
  31. Yoo JC, Ahn JH, Yang JH, Koh KH, Cho SH, Yoon YC: Correlation of arthroscopic reparability 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
  32. Zanotti RM, Carpenter JE, Blasier RB, Greenfield MVH, Aler RS, Bromberg MB: The low incidence of suprascapular nerve injury after primary repair of massive rotator cuff tears. J Shoulder Elbow Surg, 6: 258-264, 1997. https://doi.org/10.1016/S1058-2746(97)90014-8

Cited by

  1. Treatment of Massive Rotator Cuff Tears: Focusing on Arthroscopic Approach vol.48, pp.1, 2013, https://doi.org/10.4055/jkoa.2013.48.1.61