関節拘縮を伴った腱板不全断裂に対する鏡視下腱板修復・関節包解離術

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The purpose of this study was to analyze clinical outcomes and postoperative MRI findings with combined arthroscopic rotator cuff repair (ARCR) and capsular release (CR) for partial-thickness rotator cuff tear (PTRCT) with shoulder stiffness. The subjects were 76 patients with PTRCT whose average age was 55.9 years old (range, 30-72). Types of PTRCT were bursal-sided tear (BST) in 49 patients and articular-sided tear (AST) in 27 patients. 24 patients with severe shoulder stiffness with an average age of 54.4 years old, including BST in 15 and AST in 9, underwent ARCR and CR. 52 patients with mild stiffness or without stiffness with an average age of 56.6 years old, including BST in 34 and AST in 18, underwent ARCR without CR. Clinical outcomes were assessed on the basis of the JOA score, and postoperative improvement of the shoulder motion was compared between the 2 groups. The average JOA score in the 24 patients underwent ARCR and CR improved from 57.3 points preoperatively to 93.6 points postoperatively, and that in the 52 patients underwent ARCR without CR improved from 71.7 points preoperatively to 95.2 points postoperatively. There was no significant difference between the 2 groups in the postoperative JOA scores and the shoulder motion at the final follow-up. Regarding postoperative MRI findings, all of the patients in the 2 groups obtained sufficient thickness and no retear of the repaired cuff. This study suggested that combined ARCR and CR for PTRCT is a secure and reliable procedure to predict clinical and structural outcomes satisfactorily. Therefore, this procedure can be considered as a 1st-line therapy as well as nonsurgical treatments for PTRCT with severe symptoms and shoulder stiffness.
2009-07-27

関節拘縮を伴った腱板不全断裂に対する鏡視下腱板修復・関節包解離術

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