一次修復不能な腱板断裂に対する鏡視下再建手術

抄録

We have been trying to make an arthroscopic reconstruction for irreparable large and massive rotator cuff tears (IRCT) since January 2005. We have reported 14 cases of IRCT (all men, whose average age at surgery was 65.6 years old) who underwent arthroscopic reconstruction. An average preoperative duration of symptoms was 66 months (11 to120 months). The average follow-up period was 25.6 months. The long head of biceps tendon (LHBT) defect was observed in six cases, severe fibrillation or partial tear of LHBT was seen in 8 cases. We thought arthroscopic reconstruction was indicated in patients who have remaining cuff defect after intensive release of the contracted cuff tissues. We performed posterior cuff rotation in 5 cases, hamstrings autograft in 6, fascia lata patch autograft in 2 for posterosuperior defects, and pectoralis major transfer in 3 cases for anterior defects. Outcome analysis included standard clinical follow-up, the Japanese Orthopaedic Association shoulder score (JOA-SS), the QuickDASH score, range-of-motion (ROM), muscle strength, and MRI repair integrity. The JOA-SS, QuickDASH and ROM were significantly improved postoperatively in all cases. Muscle strength in shoulder abduction and external or internal rotation improved after surgery, without statistical significance. Anatomic outcome showed improvement of the cuff defect in all cases. Small to moderate-sized defects were seen in 6 cases, whereas no enlargement of the defect was seen after surgery. The staging of cuff muscle fatty infiltration was unchanged 12 months after surgery. Reconstruction for IRCT is still challenging. Arthroscopic reconstruction will be a potent method for them with improvement of donor selection, combination of tendon transfer and graft, some inventiveness or advance of devices, and skills of surgeons.