RESUMO
BACKGROUND: Bone marrow edema (BME) in the acromioclavicular joint (ACj) may occur after arthroscopic rotator cuff repair (ARCR), resulting in persistent postoperative ACj pain. We investigated the incidence and clinical characteristics of BME in ACj after ARCR. METHODS: Patients exhibiting ACj-related symptoms prior to ARCR surgery, no BME in the ACj on MRI, and an ability to undergo 2-year postoperative physical and MRI examinations of the ACj were included. Patients who underwent distal clavicle resection or osteophyte resection below the ACj and those unable to achieve primary repair of the rotator cuff were excluded. MRI evaluation was performed preoperatively and at 3, 6, 12, and 24 months postoperatively. Patients who showed BME in ACj on fat-suppressed T2 MRI at 24 months postoperatively were classified into the BME + group, and those with no BME were classified into the BME- group. Patient background, operation time, Japanese Orthopedic Association (JOA) score, re-tear rate, ACj tenderness, and cross-body adduction test were compared between groups. In addition, we examined the time of occurrence of BME. RESULTS: A total of 345 ARCRs were performed during the study period. After the exclusion of 114 shoulders, the remaining 231 shoulders were included in this study. There were 208 cases in the BME- group and 23 cases in the BME + group. The incidence of BME was 9.96 %. Although the JOA scores of both groups showed a significant improvement postoperatively compared to preoperatively, there was no significant difference between the two groups. In terms of re-tear, there was 1 case in the BME + group and 7 in the BME- group. Positive ACj tenderness and cross-body adduction test were significantly higher in the BME + group (P < 0.001). BME occurred in 6 cases at 3 months, 9 cases at 6 months, and 8 cases at 1 year postoperatively. None of the patients developed BME at more than 1 year postoperatively. BME was observed on MRI in all cases at 2 years postoperatively. CONCLUSIONS: The rate of occurrence of BME in the ACj after ARCR was 9.96 %. Patients with BME were significantly more likely to have ACj tenderness and positive cross-body adduction test. BME in the ACj often occurs within 6 months to 1 year after ARCR of small-to-medium rotator cuff tears, suggesting a relationship with postoperative functional improvement of the shoulder joint. The ACj should be considered as a potential site of persistent pain after ARCR for small-to-medium rotator cuff tears.
RESUMO
BACKGROUND: The Fosbury flop tear (FFT) has recently been described as a rotator cuff tear that has flipped upon itself and adhered medially. FFT is known to have a high retear rate after arthroscopic rotator cuff repair. The cause of the high postoperative retear rate after arthroscopic rotator cuff repair is believed to be due to the inability to achieve anatomical reduction because of difficulties in reducing the torn tendon stump. Arthroscopic rotator cuff repairs using the triple-row technique may allow better anatomical reduction of the cuff tear when compared with the suture-bridge technique. We compared the clinical outcomes and cuff integrity of the triple-row and suture-bridge techniques in arthroscopic rotator cuff repair for FFT. METHODS: Patients with small-to-medium sized cuff tears of the supraspinatus tendon alone who were diagnosed with FFT, underwent arthroscopic rotator cuff repair, and had 2 or more years of follow-up were included. A total of 34 shoulders underwent the triple-row technique and 22 shoulders underwent the suture-bridge technique. The following were compared between the two techniques: patient background, operation time, number of anchors used during the operation, Japanese Orthopedic Association (JOA) score, active range of motion, and retear rate. RESULTS: No significant difference in patient background was found between the two techniques. Although active range of motion was significantly improved compared with preoperative scores, no significant difference was observed between techniques. The triple-row technique demonstrated a significantly higher 24-month postoperative JOA score, significantly shorter surgery time, significantly lower retear rate, and significantly larger number of anchors used during the operation. CONCLUSIONS: The triple-row technique was an effective method compared with the suture-bridge technique in cases with FFT.
RESUMO
BACKGROUND: This study aimed to compare the clinical outcomes and cuff integrity of the triple-row technique and suture-bridge technique in arthroscopic rotator cuff repair. METHODS: Among patients with more than two years of follow-up (mean 27.4 ± 7.2 months), 71 shoulders that underwent the triple-row technique (46 male and 25 female; mean age, 62.7 ± 10.1 years; small-to-medium tears, 42 shoulders; large-to-massive tears, 29 shoulders) and 64 shoulders that underwent the suture-bridge technique (43 male and 21 female; mean age, 65.5 ± 8.4 years; small-to-medium tears, 46 shoulders; large-to-massive tears, 18 shoulders) were examined. The patient background, operation time, number of anchors used during the operation, Japanese Orthopedic Association (JOA) score, Active range of motion, and retear rate were evaluated and compared between the two techniques. RESULTS: There was no significant difference in the patient background between the two techniques. The JOA score and Active range of motion were significantly improved compared to preoperative scores; however, there were no difference between the two techniques. The number of anchors used during the operation was 5.4 ± 1.6 for the triple-row technique and 4.1 ± 1.9 for the suture-bridge technique. Although significantly more anchors were used for the triple-row technique, there was no significant difference in the operation time between the two techniques. The retear rate was 7.1% for small-to-medium tears and 3.4% for large-to-massive tears using the triple-row technique, and 10.9% for small-to-medium tears and 33.3% for large-to-massive tears using the suture-bridge technique. The retear rate was significantly lower in large-to-massive tears when using the triple-row technique. CONCLUSION: The triple-row technique was an effective method compared to the suture-bridge technique in cases with large-to-massive tears.
