再手術を行った鏡視下腱板断裂修復術後 knot impingement の 3 例

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We occasionally experienced erosion of the inferior surface of the acromion after arthroscopic rotator cuff repair (ARCR). At present, the underlying mechanism of knot impingement after ARCR is fully unknown.<BR>We report three cases of repeated arthroscopic surgery for acromial erosion that developed after ARCR.<BR>Case1 was a 49-year old fireman. Case2 was a 56-year old woman who was a piano teacher, and Case3 was a 44-year old housewife. All cases had partial or full thickness rotator cuff tear and underwent ARCR using double row fixation. Postoperatively all cases achieved good range of motion recovery. However in all cases dullness and mild pain on elevating the arm continued after surgery. Therefore we performed revision arthroscopic surgery.<BR>On arthroscopic evaluation, sutures of the medial row had failed in all cases, the acromial erosion site was brushed by the loose suture end of lateral row in case 1 and case 2, and a broken suture had adhered to the floor of the acromial erosion in case 3. After removing the sutures, most of their symptoms disappeared.<BR>This study suggested that there is a possibility of the brushing of the end of a thread being a cause of prolonged symptoms, in addition to knot impingement and chemical reaction of the thread particles.