腱板完全断裂に対する重層固定法による関節鏡視下腱板修復術の成績 ∼ Repair Integrity向上のための工夫

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The purpose of this study is to evaluate clinical outcome and repair integrity of our recent series of arthroscopic standard double-row repair, which was initiated in 2004 with some modifications in order to improve repair integrity. Subjects consist of a consecutive series of 116 shoulders in 116 patients, including 63 males and 53 females with an average age of 62 years old (range, 30-78), who underwent primary arthroscopic rotator cuff repair for full-thickness rotator cuff tears between January 2004 and May 2008 and were followed for minimum of 2 years. There were 39 small, 45 medium, 29 large, and 3 massive tears. Arthroscopic standard double-row procedure was performed by a single surgeon (H.S.) using high strength sutures for the medial-row, and incorporated a novel anatomical concept regarding footprint of the supra and infraspinatus in order to maximize anatomical balanced repair. Further, shoulders with irreparable massive rotator cuff tears which demonstrated Goutalliers stage IV were not included as candidates for primary repair. Repair integrity was assessed using MRI which was performed one year after surgery and functional outcome was evaluated using JOA, UCLA, ASES scoring systems at the final follow-up. The mean postoperative JOA, UCLA, and ASES score improved significantly to 96.4, 34, and 96 respectively from preoperative 76.1, 19.4, and 56.5 respectively. Re-tear was observed in 10 shoulders (8.6%) overall. Re-tear rate was 5.9% in small to medium tears and 15.6% in large and massive tears. However, shoulders diagnosed as re-tear postoperatively did not demonstrate any functional inferiority compared to intact shoulders. In conclusion a recent series of our arthroscopic standard double-row repair with some modifications in patient selection and procedure yielded significantly improved repair integrity compared with previous reports.

腱板完全断裂に対する重層固定法による関節鏡視下腱板修復術の成績 ∼ Repair Integrity向上のための工夫

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