腱板大 • 広範囲断裂に対する鏡視下腱板修復術の治療成績

概要

論文の詳細を見る
Background: The reported rate of failure after arthroscopic rotator cuff repair (ARCR) is variable. We evaluate functional outcome and repair integrity of large and massive rotator cuff tears (RCT) that underwent primary ARCR. Methods: We retrospectively followed 146 shoulders on which we performed primary ARCR between June 2006 and March 2011. Average follow up period was 31 months (6-65). We performed ARCR using double row technique, bridging sutures technique and single row technique. We immobilized the shoulder for 8 weeks after operation with a sling immobilizer with an abduction pillow. The abduction angle was 60 degrees for 6 weeks and 30 degrees for another 2 weeks. Exercise of active range of motion was prohibited for 6 weeks. The repair integrity was assessed by Sugaya's MRI classification and clinical results were assessed by JOA score. Results: Re-tear rate was 14.4% (21 shoulders). The change of average total JOA score was from 59.2 ± 10.8 points preoperatively to 91.7 ± 6.4 points postoperatively (Sugaya's type I ∼ III, p<0.01), from 55.6 ± 12.6 points to 89.2 ± 4.5 points (Sugaya's type IV, p<0.01), from 55.3 ± 16.7 points to 57.7 ± 2.5 points (Sugaya's type V, p= 0.82). Discussion: In this study, the clinical results of ARCR for large and massive RCT were mostly satisfactory. Adequate tendon mobilization procedures, strong sutures and careful rehabilitation resulted in superior tendon healing compared with previous study.