At a 10-Year Follow-up, Tendon Repair Is Superior to Physiotherapy in the Treatment of Small and Medium-Sized Rotator Cuff Tears
At a 10-Year Follow-up, Tendon Repair Is Superior to Physiotherapy in the Treatment of Small and Medium-Sized Rotator Cuff Tears
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DOI：
10.2106/jbjs.18.01373
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发表时间：
2019-06-19
影响因子：
5.3
通讯作者：
Smith, Hans-Jorgen
中科院分区：
文献类型：
--
作者：
Moosmayer, Stefan;Lund, Gerty;Smith, Hans-Jorgen
背景：肌腱修复和物理治疗是中小型肩袖撕裂的常用治疗方法。在本研究的1年和5年结果的2篇先前出版物中，我们报告了有利于肌腱修复的显著但较小的组间差异。需要长期的结果，以评估是否在两组的结果保持稳定，随着时间的推移。方法：在这项研究中，103例肩袖撕裂不超过3厘米被随机分配到初级肌腱修复或物理治疗，可选的二次修复。在6个月和1年、2年、5年和10年后进行盲态随访。结果测量包括Constant评分;美国肩肘外科医生评分的自我报告部分;肩部疼痛、运动和力量的测量;以及患者满意度。1年后对手术治疗的肩部进行磁共振成像（MRI），5年和10年后对所有肩部进行超声检查。结果：103例患者中有91例接受了最后一次随访。10年后，初次肌腱修复的结果更好，Constant评分为9.6分（p = 0.002），美国肩肘外科医生评分为15.7分（p < 0.001），10 cm视觉模拟疼痛量表上的1.8 cm（p < 0.001），无痛外展19.6度（p = 0.007），无痛屈曲14.3度（p = 0.01）。14例患者从物理治疗转为二次手术，Constant评分结果比初次肌腱修复组低10.0分（p = 0.03）。10年时，对于中小型肩袖撕裂，初次肌腱修复和物理治疗之间的结果差异增加，初次肌腱修复的效果更好。证据等级：治疗I级。有关证据等级的完整描述，请参见作者说明。
Background: Tendon repair and physiotherapy are frequently used treatment methods for small and medium-sized rotator cuff tears. In 2 previous publications of the 1 and 5-year results of this study, we reported significant but small between-group differences in favor of tendon repair. Long-term results are needed to assess whether the results in both groups remain stable over time.Methods: In this study, 103 patients with a rotator cuff tear not exceeding 3 cm were randomly assigned to primary tendon repair or physiotherapy with optional secondary repair. Blinded follow-up was performed after 6 months and 1, 2, 5, and 10 years. Outcome measures included the Constant score; the self-report section of the American Shoulder and Elbow Surgeons score; the measurement of shoulder pain, motion, and strength; and patient satisfaction. Magnetic resonance imaging (MRI) was performed on surgically treated shoulders after 1 year, and ultrasound was performed on all shoulders after 5 and 10 years. The main analysis was by 1-way analysis of covariance and by intention to treat.Results: Ninety-one of 103 patients attended the last follow-up. After 10 years, the results were better for primary tendon repair, by 9.6 points on the Constant score (p = 0.002), 15.7 points on the American Shoulder and Elbow Surgeons score (p < 0.001), 1.8 cm on a 10-cm visual analog scale for pain (p < 0.001), 19.6 degrees for pain-free abduction (p = 0.007), and 14.3 degrees for pain-free flexion (p = 0.01). Fourteen patients had crossed over from physiotherapy to secondary surgery and had an outcome on the Constant score that was 10.0 points inferior compared with that of the primary tendon repair group (p = 0.03).Conclusions: At 10 years, the differences in outcome between primary tendon repair and physiotherapy for small and medium-sized rotator cuff tears had increased, with better results for primary tendon repair.Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.