Min-Su Joo, Gyeong-Hoon Lim, Jae-Won Kim, Gi-Woong Sim, Jeong-Woo Kim
{"title":"使用跟腱同种异体移植的微型开放钥匙孔技术进行上囊重建术,对术前假性瘫痪的患者有良好的疗效,但对假性瘫痪持续时间较长的患者,疗效和力量都较差。","authors":"Min-Su Joo, Gyeong-Hoon Lim, Jae-Won Kim, Gi-Woong Sim, Jeong-Woo Kim","doi":"10.1016/j.arthro.2024.07.020","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to analyze whether unique SCR with key-hole technique using Achilles allograft can improve pseudoparalysis in patients with irreparable rotator cuff tears and additionally to identify preoperative factors that influence clinical outcomes.</p><p><strong>Methods: </strong>Between January 2018 and October 2021, patient data from SCR with our institution's unique key-hole technique using Achilles were retrospectively collected (minimum 2-years follow up). The patients were categorized into pseudoparalysis group (P group) and no pseudoparalysis group (NP group). Active range of motion (ROM) of shoulder, clinical scores (constant and pain visual analog scale scores) and muscle strength was assessed preoperatively and at 2-years postoperatively. And the correlation between preoperative and postoperative clinical data was analyzed through simple linear regression in the P group.</p><p><strong>Results: </strong>69 patients who underwent SCR with key-hole technique using Achilles, were included in the study. Group P and NP had 24 and 45 cases, respectively. Preoperative ROM (FE, ER), constant score and muscle strength (FE, ER) were significantly lower in P group than NP group. At 2-year follow-up the active ROM (FE, p<0.001, ER, p<0.001), constant score, VAS, muscle strength (FE, p<0.001, ER, p<0.001) were improved in the P group. In P group, pseudoparalysis recovered in 21 out of 24 patients (87.5%) at 2-year after surgery. The minimum clinically important difference of patient reported outcomes (Constant Score / VAS) were 8.15/1.05 for the P group and 9.47/0.92 for the NP group. Among the 3 cases of recovery failed, 2 cases were due to graft failure, and 1 case had delayed recovery. Prolonged preoperative pseudoparalysis and weaker preoperative external rotation strength were associated with worse clinical outcomes.</p><p><strong>Conclusions: </strong>Superior capsular reconstruction with mini open key-hole technique using Achilles allograft demonstrates favorable outcomes for patients with preoperative pseudoparalysis. However, for SCR with the pseudoparalyis patients the careful attention is needed because the longer pseudoparalysis duration and the weaker external rotation strength could have the tendency of worse postoperative outcomes.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4000,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Superior Capsular Reconstruction with the mini open key-hole Technique using Achilles allograft demonstrates favorable outcomes for patients with preoperative pseudoparalysis but worse outcome and strength with longer duration pseudoparalysis.\",\"authors\":\"Min-Su Joo, Gyeong-Hoon Lim, Jae-Won Kim, Gi-Woong Sim, Jeong-Woo Kim\",\"doi\":\"10.1016/j.arthro.2024.07.020\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>The purpose of this study was to analyze whether unique SCR with key-hole technique using Achilles allograft can improve pseudoparalysis in patients with irreparable rotator cuff tears and additionally to identify preoperative factors that influence clinical outcomes.</p><p><strong>Methods: </strong>Between January 2018 and October 2021, patient data from SCR with our institution's unique key-hole technique using Achilles were retrospectively collected (minimum 2-years follow up). The patients were categorized into pseudoparalysis group (P group) and no pseudoparalysis group (NP group). Active range of motion (ROM) of shoulder, clinical scores (constant and pain visual analog scale scores) and muscle strength was assessed preoperatively and at 2-years postoperatively. And the correlation between preoperative and postoperative clinical data was analyzed through simple linear regression in the P group.</p><p><strong>Results: </strong>69 patients who underwent SCR with key-hole technique using Achilles, were included in the study. Group P and NP had 24 and 45 cases, respectively. Preoperative ROM (FE, ER), constant score and muscle strength (FE, ER) were significantly lower in P group than NP group. At 2-year follow-up the active ROM (FE, p<0.001, ER, p<0.001), constant score, VAS, muscle strength (FE, p<0.001, ER, p<0.001) were improved in the P group. In P group, pseudoparalysis recovered in 21 out of 24 patients (87.5%) at 2-year after surgery. The minimum clinically important difference of patient reported outcomes (Constant Score / VAS) were 8.15/1.05 for the P group and 9.47/0.92 for the NP group. Among the 3 cases of recovery failed, 2 cases were due to graft failure, and 1 case had delayed recovery. Prolonged preoperative pseudoparalysis and weaker preoperative external rotation strength were associated with worse clinical outcomes.</p><p><strong>Conclusions: </strong>Superior capsular reconstruction with mini open key-hole technique using Achilles allograft demonstrates favorable outcomes for patients with preoperative pseudoparalysis. However, for SCR with the pseudoparalyis patients the careful attention is needed because the longer pseudoparalysis duration and the weaker external rotation strength could have the tendency of worse postoperative outcomes.</p>\",\"PeriodicalId\":55459,\"journal\":{\"name\":\"Arthroscopy-The Journal of Arthroscopic and Related Surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.4000,\"publicationDate\":\"2024-07-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Arthroscopy-The Journal of Arthroscopic and Related Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.arthro.2024.07.020\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.arthro.2024.07.020","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Superior Capsular Reconstruction with the mini open key-hole Technique using Achilles allograft demonstrates favorable outcomes for patients with preoperative pseudoparalysis but worse outcome and strength with longer duration pseudoparalysis.
Purpose: The purpose of this study was to analyze whether unique SCR with key-hole technique using Achilles allograft can improve pseudoparalysis in patients with irreparable rotator cuff tears and additionally to identify preoperative factors that influence clinical outcomes.
Methods: Between January 2018 and October 2021, patient data from SCR with our institution's unique key-hole technique using Achilles were retrospectively collected (minimum 2-years follow up). The patients were categorized into pseudoparalysis group (P group) and no pseudoparalysis group (NP group). Active range of motion (ROM) of shoulder, clinical scores (constant and pain visual analog scale scores) and muscle strength was assessed preoperatively and at 2-years postoperatively. And the correlation between preoperative and postoperative clinical data was analyzed through simple linear regression in the P group.
Results: 69 patients who underwent SCR with key-hole technique using Achilles, were included in the study. Group P and NP had 24 and 45 cases, respectively. Preoperative ROM (FE, ER), constant score and muscle strength (FE, ER) were significantly lower in P group than NP group. At 2-year follow-up the active ROM (FE, p<0.001, ER, p<0.001), constant score, VAS, muscle strength (FE, p<0.001, ER, p<0.001) were improved in the P group. In P group, pseudoparalysis recovered in 21 out of 24 patients (87.5%) at 2-year after surgery. The minimum clinically important difference of patient reported outcomes (Constant Score / VAS) were 8.15/1.05 for the P group and 9.47/0.92 for the NP group. Among the 3 cases of recovery failed, 2 cases were due to graft failure, and 1 case had delayed recovery. Prolonged preoperative pseudoparalysis and weaker preoperative external rotation strength were associated with worse clinical outcomes.
Conclusions: Superior capsular reconstruction with mini open key-hole technique using Achilles allograft demonstrates favorable outcomes for patients with preoperative pseudoparalysis. However, for SCR with the pseudoparalyis patients the careful attention is needed because the longer pseudoparalysis duration and the weaker external rotation strength could have the tendency of worse postoperative outcomes.
期刊介绍:
Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.