腱板大断裂 • 広範囲断裂修復術後における再断裂予測因子の検討

抄録

The purpose of this study was to analyze prognostic factors relating to recurrent tear of repaired large and massive tears of the rotator cuff. 66 patients with large or massive rotator cuff tears, whose average age was 64.7 years, were the subjects of this study. 29 patients underwent open repair, and 37 patients underwent arthroscopic double-row repair using suture anchors. The average follow-up period was 23.8 months, and postoperative MRI was performed at 13.9 months on average. Postoperative MRI revealed sufficient thickness of the repaired cuff in 42 patients, thinning in 8 and recurrent tear in 16. Factors compared between the 50 patients with no tear and the 16 patients with recurrent tear were as follows; characteristics of the patients, preoperative history of trauma, subscapularis tear, LHB rupture, delamination and size of the tears. All data were evaluated statistically, and the significance level was set at less than 0.05. The patients with recurrent tear were significantly older than those with no tear. The 14 patients without preoperative history of trauma had markedly higher rate of recurrent tear than the 52 patients with history of trauma. The recurrent tear rates of the patients with subscapularis tear, LHB rupture or diabetes were significantly higher than those without them. This study suggests that older age, history of trauma, subscapularis tear, LHB rupture and diabetes may be incriminated as the risk factors of recurrent tear of the repaired cuff. Protective rehabilitation such as long-time immobilization and delay of the start of active motion should be applied to patients with the risk factors to decrease recurrent tear of the repaired cuff. Moreover, secure and tight repair methods or augmentation of the torn cuff should be devised to obtain better structural outcomes.