M. Uğur ÖZBAYDAR, Murat TONBUL, Ali Çağrı TEKİN, Okan YALAMAN

Artroskopik rotator manşet onarımı: Sonuçlar ve belirleyici faktörlerin analizi

Amaç: Rotator manşet tamkat yırtık tanısıyla artroskopik tamir uygulanan hastalardaki sonuçlar ve belirleyici faktörler incelendi. Çalışma planı: Konservatif tedaviye dirençli 40 hastanın (16 erkek, 24 kadın; ort. yaş 56; dağılım 39-72) 41 omzu değerlendirildi. Ameliyat öncesi yakınmaların süresi ortalama 15 ay (dağılım 2-24 ay) idi. Otuz dört sağ, yedi sol omuz ameliyat edildi. Bunların %80’i baskın taraftı. Hareket açıklıkları açıölçerle, kas güçleri elle ölçüldü. Sonuçlar fizik, radyolojik muayene ve UCLA skalası ile değerlendirildi. Ameliyattan sonra ortalama izlem süresi 37 ay (dağılım 12-61 ay) idi. Belirleyici faktörler olarak, yaş, ameliyat öncesi bulguların süresi, hareket açıklığı, kas gücü, yırtık büyüklüğü, retraksiyonu, tendon kalitesi ve yağlı dejenerasyon değişikliklerinin sonuçlar üzerine etkisi incelendi. Sonuçlar: UCLA skalasına göre, 29 omuzda (%70.7) tatminkar, beş omuzda (%12.2) orta, yedi omuzda (%17.1) kötü sonuç alındı. Altı omuzda (%14.6) revizyon ameliyatı yapıldı. Öne elevasyon açıklığı ve kas gücü değerlerindeki değişim anlamlı bulunurken (p0.05). Hasta yaşı, yırtık büyüklüğü, retraksiyon, tendon kalitesi ve yağlı dejenerasyon miktarı ile tatminkar olmayan sonuçlar arasındaki ilişki anlamlı bulundu (p0.05). Çıkarımlar: Sonuçlarımız açık tamir sonuçları kadar başarılı değildir. Artroskopik deneyimimizin artması ve belirleyici faktörlerin hasta seçiminde göz önünde bulundurulmasıyla daha iyi sonuçların elde edilmesi mümkün olabilir.

Anahtar Kelimeler:

Dikiş teknikleri, Yaralanma şiddeti skoru, Rotator manşet, Hareket açıklığı, eklem, Artroskopi, Seyir, Tendon yaralanmaları, Tedavi sonucu

Arthroscopic rotator cuff repair: evaluation of outcomes and analysis of prognostic factors

Objectives: The purpose of this study was to evaluate the results of arthroscopic rotator cuff repair of full-thickness tears and to determine prognostic factors. Methods: Forty-one shoulders of 40 patients (16 males, 24 females; mean age 56 years; range 39 to 72 years) unresponsive to conservative treatment were evaluated. The mean symptom duration was 15 months (range 2 to 24 months). Involvement was on the right in 34 shoulders, on the left in seven shoulders, 80% being on the dominant side. The range of motion was measured with a goniometer, muscle strength was measured manually. Clinical and functional evaluations were based on physical and radiological examinations, and the UCLA scale. The mean follow-up was 37 months (range 12 to 61 months). Prognostic factors included age, symptom duration, range of motion, muscle strength, tear size, retraction and quality of tendon, and fatty degenerative changes. Results: According to the UCLA scale, the results were satisfactory in 29 shoulders (70.7%), moderate in five (12.2%), and poor in seven (17.1%). Six shoulders (14.6%) required revision surgery. Postoperative improvements in forward flexion and muscle strength were significant (p<0.05), whereas change in external rotation was insignificant (p>0.05). Age, tear size, retraction and quality of tendon, and fatty degenerative changes were found to significantly affect unsatisfactory results (p<0.05). Preoperative symptom duration, range of motion, and muscle strength were not effective on the results (p>0.05). Conclusion: Our results are not as successful as those obtained from open procedures. The results may be more satisfactory through improving arthroscopic skills and taking prognostic factors into consideration in patient selection. Key words: Arthroscopy/methods; rotator cuff/injuries/surgery; rupture/surgery; tendon injuries/surgery.

Keywords:

Suture Techniques, Injury Severity Score, Rotator Cuff, Range of Motion, Articular, Arthroscopy, Prognosis, Tendon Injuries, Treatment Outcome,

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1. Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg [Am] 1986;68:1136-44.
2. Hattrup SJ. Rotator cuff repair: relevance of patient age. J Shoulder Elbow Surg 1995;4:95-100.
3. Morrison DS, Bigliani LU. The clinical significance of variations in acromial morphology. Orthop Trans 1987;11:234.
4. Neer CS II. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg [Am] 1972;54:41-50.
5. Neer CS II, Flatow EL, Lech O. Tears of the rotator cuff. Long term results of anterior acromioplasty and repair. Orthop Trans. 1988;12:673-4.
6. Bassett RW, Cofield RH. Acute tears of the rotator cuff. The timing of surgical repair. Clin Orthop Relat Res 1983; (175):18-24.
7. Iannotti JP. Full-thickness rotator cuff tears: factors affecting surgical outcome. J Am Acad Orthop Surg 1994;2:87-95.
8. McLaughlin HL. Rupture of the rotator cuff. J Bone Joint Surg [Am] 1962;44:979-83.
9. Bjorkenheim JM, Paavolainen P, Ahovuo J, Slatis P. Surgical repair of the rotator cuff and surrounding tissues. Factors influencing the results. Clin Orthop Relat Res 1988;(236):148-53.
10. Hawkins RJ, Misamore GW, Hobeika PE. Surgery for fullthickness rotator-cuff tears. J Bone Joint Surg [Am] 1985;67:1349-55.
11. Cofield RH, Hoffmeyer P, Lanzer WL. Surgical repair of chronic rotator cuff tears. Orthop Trans 1990;14:251-2.
12. Harryman DT II, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA III. Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg [Am] 1991;73:982-9.
13. Adamson GJ, Tibone JE. Ten-year assessment of primary rotator cuff repairs. J Shoulder Elbow Surg 1993;2:57-63.
14. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 1994;(304):78-83.
15. Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 1999;8:599-605.
16. Post M, Silver R, Singh M. Rotator cuff tear. Diagnosis and treatment. Clin Orthop Relat Res 1983;(173):78-91.
17. Ianotti JP, Naranja RJ, Gartsman GM. Surgical treatment of the intact cuff and repairable cuff defect: arthroscopic and open techniques. In: Norris TR, editor. Orthopaedic knowledge update: shoulder and elbow. Illinois: American Academy of Orthopaedic Surgeons; 1997. p. 151-5.
18. Gupta R, Leggin BG, Iannotti JP. Results of surgical repair of full-thickness tears of the rotator cuff. Orthop Clin North Am 1997;28:241-8.
19. Demirhan M, Esenyel CZ. All arthroscopic treatment of rotator cuff tears. [Article in Turkish] Acta Orthop Traumatol Turc 2003:37 Suppl 1:93-104.
20. Gartsman GM, Hammerman SM. Full-thickness tears: arthroscopic repair. Orthop Clin North Am 1997;28:83-98.
21. Ozbaydar MU, Tonbul M, Yalaman O. The results of arthroscopic repair of full-thickness tears of the rotator cuff. [Article in Turkish] Acta Orthop Traumatol Turc 2005:39:114-20.
22. Hecker AT, Shea M, Hayhurst JO, Myers ER, Meeks LW, Hayes WC. Pull-out strength of suture anchors for rotator cuff and Bankart lesion repairs. Am J Sports Med 1993;21:874-9.
23. Reed SC, Glossop N, Ogilvie-Harris DJ. Full-thickness rotator cuff tears. A biomechanical comparison of suture versus bone anchor techniques. Am J Sports Med 1996;24:46-8.