腱板修復術後の Knot Impingement
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概要
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We occasionally experienced some patients who feel awkward, uncomfortable with their shoulder state despite a full range of motion, enough muscle strength, and good cuff integrity of MRI. They had some characteristic signs of image; acromial erosion, enlargement of acromio-humeral interval of X-ray, no re-tear but effusion of the subacromial space in MRI. We hypothesized these phenomenon and signs were the cause of knots. We thought that mechanical impingement between acromion and knots, and chemical influence of thread maybe the cause. We operated on these patients again and removed knots and free threads. They showed obviously improvement.The purpose was to investigate the cause of knot impingement, the relationship between knots and acromial erosion, tear size, suture technique, the kind of thread, and so on. From Aug. 2002, we operated on rotator cuff tears with suture anchor technique in 569 shoulders. We used X-ray, MRI and 3DCT to understand the morphology of acromion correctly. We re-operated in10 shoulders.Knot impingement and acromial erosion were confirmed in 39%. Some following characteristic points have been confirmed. High risk group is smaller size and bursal side partial tear of rotator cuff, younger patients who need high activity, used high strength suture at lateral row. Low risk group is patients who had limitation of ROM, performed bridging suture technique and re-tear patients.There may be a possibility of cause being high strength suture. It is important that physicians select and consider suture methods, kind of anchors, threads and patients background.
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