鏡視下腱板断裂術後における肩峰下面骨侵食の検討
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High strength sutures are widely used in arthroscopic rotator cuff repairs (ARCR), as the initial fixation strength is a significant concern. There was a report about the erosive change of the acromion after ARCR, due to physical impingements by strong sutures or chemical effects. There is no clinical consensus about the erosion, even though it seems to be one of the causes of secondary pain after ARCR. In this study, we reviewed the incidence of the subacromial erosion after double row ARCR, and analyzed the correlation with the clinical findings. 56 cases of rotator cuff(RC) tear, which underwent double-row ARCR with high strength sutures, were included in this study. We evaluated the subacromial erosion and the retear of RC with MRI, pain at 3 months and the range of motion at 6 weeks, 3 months and 6 months and JOA scores at 1 year after operations.<BR>25 cases (44.6%) showed the subacromial erosion. The subacromial erosion was classified into two different types. 'Dent type' was recognized as a small depression of the acromion. 'Wide type' showed the subacromial erosion in the broad range. The retear rate was higher in the group without the subacromial erosion (51.6%) than in that with the subacromial erosion (16.0%). There was a significant difference in JOA pain score at 3 months after operation, which were 21 and 16.9 on average in patients with erosion (E+) and without erosion (E-), respectively. In ROM, there was a relative difference in the flexion at 6 weeks, which was 135.4° in group E+ and 118.4° in grou p E-. There were no differences in the other durations and the range of external rotation. The patients with less pain and more forward flexion without retear tended to show the erosive changes of the undersurface of the acromion.
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