当院における腱板広範囲断裂例に対する鏡視下腱板部分修復術の臨床成績

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Treatments of massive rotator cuff tears continue to be a challenge. Many surgical treatment approaches have been attempted for this problem. This study reports the clinical outcome of arthroscopic partial repair for massive rotator cuff tear. We retrospectively reviewed 19 cases of partial repair in whom a water-tight repair of rotator cuff tear was not possible. The average age was 69.5 years old, and mean follow-up period was 20.3 months. Clinical results were evaluated with JOA scores of pre and post operation. MRI was performed on 17 cases postoperatively, and was evaluated using Sugayas Classification. Average postoperative forward flexion was 138°, and external rotation was 28°. JOA scores were significantly improved from pre-operational 58.7 to post-operational 80.3. In JOA endpoints, pain score remarkably increased from 9.7 to 22.3. Postoperative MRI revealed 12 typeIV, 5 typeV. New anatomical knowledge shows the footprint of the infraspinatus on the greater tuberosity is wider than that of the supraspinatus. In addition, when rotator cuff tear repair is attempted, the mobility of the posterior leaf is typically better than that of the center or anterior leaf. In fact, we have performed proximal advancement of posterior cuff tendon and tendon-to-bone repair with suture anchors. Although the cuff repair is not anatomic, that decreases the mechanical strain at the margins of the tear, and reconstructs balanced force couples. Arthroscopic partial repair for irreparable rotator cuff tears can provide generally good improvement.

当院における腱板広範囲断裂例に対する鏡視下腱板部分修復術の臨床成績

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