Arthroscopic Debridement for Refractory Lateral Epicondylitis Results for Substantial Improvement in Tendinosis Scores and Good Clinical Outcomes: Qualitative and Quantitative Magnetic Resonance Imaging Analysis
Arthroscopic Debridement for Refractory Lateral Epicondylitis Results for Substantial Improvement in Tendinosis Scores and Good Clinical Outcomes: Qualitative and Quantitative Magnetic Resonance Imaging Analysis
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DOI：
10.1016/j.arthro.2022.07.019
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发表时间：
2022-12-01
影响因子：
4.7
通讯作者：
Shimada, Kozo
中科院分区：
文献类型：
--
作者：
Miyamura, Satoshi;Temporin, Ko;Shimada, Kozo
目的：对关节镜下清创治疗外上髁炎后伸肌肌腱的磁共振成像（MRI）信号变化进行定性和定量分析，并通过比较恢复和未恢复病例，评价MRI结果与时间临床结果之间的相关性。研究方法：根据日本骨科协会-日本肘协会评分，将34例接受关节镜清创术治疗的难治性外上髁炎患者分为恢复组（n = 24）和未恢复组（n = 10）。本研究纳入了接受术前和术后MRI的患者，排除了既往有肘关节手术史的患者。将术前和术后MRI结果定性分为4级，通过测量肌腱病变面积百分比进行量化，并进行组间比较。结果：术前，两组之间的评分和百分比没有显示出显著差异（P = 0.050和0.519）。恢复组中1级、2级、3级和4级的患者数量分别为1例（4%）、3例（13%）、10例（42%）和10例（42%）;未恢复组中分别为1例（10%）、2例（20%）、7例（70%）和0例（0%）。恢复组和未恢复组的平均百分比分别为42.3%（73.9 mm（2）/168.4 mm（2））和36.5%（50.5 mm（2）/131.0 mm（2））。然而，术后，恢复组的这些指标显著低于未恢复组（P = 0.007和0.014）。恢复组和未恢复组的数量和百分比分别为15（63%）、8（33%）、1（4%）、0（0%）和17.0% 28.6mm（2）/169.8mm（2）和2（20%）、3（30%）、5（50%）和0（0%）和30.5%（39.0mm（2）/131.8mm（2））。结论：定性和定量MRI可用于评价关节镜下肌腱清理术后肌腱愈合的进展。在恢复和未恢复组中，肌腱病变面积的改善分别为60%和16%，表明术后MRI结果反映了临床结局。
Purpose: To qualify and quantify the changes in magnetic resonance imaging (MRI) signals in the extensor tendons after arthroscopic debridement for lateral epicondylitis and evaluate the association between MRI findings and temporal clinical results by comparisons between recovered and unrecovered cases. Methods: Thirty-four patients with refractory lateral epicondylitis treated with arthroscopic debridement were divided into recovered (n = 24) and unrecovered (n = 10) groups according to the Japanese Orthopaedic Association-Japan Elbow Society score. This study included any patients who underwent both the pre- and postoperative MRI and excluded patients with a previous history of any elbow surgery. Pre- and postoperative MRI findings were qualitatively categorized into 4 grades, quantified by measuring the percentage of tendinopathy area, and compared between the groups. Results: Preoperatively, grading scores and percentages did not show significant differences between groups (P = .050 and.519). The respective numbers of patients with grades 1, 2, 3, and 4 were 1 (4%), 3 (13%), 10 (42%), and 10 (42%) in the recovered group; and 1 (10%), 2 (20%), 7 (70%), and 0 (0%) in the unrecovered group. The average percentages in the recovered and unrecovered groups were 42.3% (73.9 mm(2)/168.4 mm(2)); and 36.5% (50.5 mm(2)/131.0 mm(2)). However, postoperatively, they were significantly lower in the recovered group than in the unrecovered group (P = .007 and .014). The numbers and percentages in the recovered and unrecovered groups were 15 (63%), 8 (33%), 1 (4%), and 0 (0%) and 17.0% (28.6mm(2)/169.8mm(2)) and 2 (20%), 3 (30%), 5 (50%), and 0 (0%) and 30.5% (39.0 mm(2)/131.8 mm(2)). Conclusions: Qualitative and quantitative MRI is useful for evaluating the progress of tendon healing after arthroscopic debridement. In the recovered and unrecovered groups, improvement of tendinopathy area were 60% versus 16%, indicating that postoperative MRI findings reflect clinical outcomes.