Abstract：
BACKGROUND: Healing failure after rotator cuff repair is a challenging problem. Acute, trauma-related tears are considered a separate entity and are often treated surgically. The aim of this study was to identify factors associated with healing failure in previously asymptomatic patients with trauma-related rotator cuff tears treated with early arthroscopic repair.
METHODS: This study included 62 consecutively recruited patients (23% women; median age, 61 years; age range, 42-75 years) with acute symptoms in a previously asymptomatic shoulder and a magnetic resonance imaging-verified full-thickness rotator cuff tear after shoulder trauma. All patients were offered, and underwent, early arthroscopic repair, during which a biopsy specimen was harvested from the supraspinatus tendon and analyzed for signs of degeneration. Of the patients, 57 (92%) completed 1-year follow-up and underwent assessment of repair integrity on magnetic resonance images according to the Sugaya classification. Risk factors for healing failure were investigated using a causal-relation diagram where age, body mass index, tendon degeneration (Bonar score), diabetes mellitus, fatty infiltration (FI), sex, smoking, tear location regarding integrity of the rotator cable, and tear size (number of ruptured tendons and tendon retraction) were included and analyzed.
RESULTS: Healing failure at 1 year was identified in 37% of patients (n = 21). A high degree of FI of the supraspinatus muscle (P = .01), a tear location including disruption of rotator cable integrity (P = .01), and old age (P = .03) were associated with healing failure. Tendon degeneration as determined by histopathology was not associated with healing failure at 1-year follow-up (P = .63).
CONCLUSIONS: Older age, increased FI of the supraspinatus muscle, and a tear including disruption of the rotator cable increased the risk of healing failure after early arthroscopic repair in patients with trauma-related full-thickness rotator cuff tears.
METHODS: This study included 62 consecutively recruited patients (23% women; median age, 61 years; age range, 42-75 years) with acute symptoms in a previously asymptomatic shoulder and a magnetic resonance imaging-verified full-thickness rotator cuff tear after shoulder trauma. All patients were offered, and underwent, early arthroscopic repair, during which a biopsy specimen was harvested from the supraspinatus tendon and analyzed for signs of degeneration. Of the patients, 57 (92%) completed 1-year follow-up and underwent assessment of repair integrity on magnetic resonance images according to the Sugaya classification. Risk factors for healing failure were investigated using a causal-relation diagram where age, body mass index, tendon degeneration (Bonar score), diabetes mellitus, fatty infiltration (FI), sex, smoking, tear location regarding integrity of the rotator cable, and tear size (number of ruptured tendons and tendon retraction) were included and analyzed.
RESULTS: Healing failure at 1 year was identified in 37% of patients (n = 21). A high degree of FI of the supraspinatus muscle (P = .01), a tear location including disruption of rotator cable integrity (P = .01), and old age (P = .03) were associated with healing failure. Tendon degeneration as determined by histopathology was not associated with healing failure at 1-year follow-up (P = .63).
CONCLUSIONS: Older age, increased FI of the supraspinatus muscle, and a tear including disruption of the rotator cable increased the risk of healing failure after early arthroscopic repair in patients with trauma-related full-thickness rotator cuff tears.
摘要：
目的：肩袖修复后愈合失败是一个具有挑战性的问题。急性,与创伤相关的眼泪被认为是一个独立的实体，通常通过手术治疗。这项研究的目的是确定与早期关节镜修复治疗的无症状的创伤相关肩袖撕裂患者的愈合失败相关因素。
方法：这项研究包括62名连续招募的患者（23％的女性，中位年龄61[范围42-75]岁），先前无症状的肩部有急性症状，并且在肩部创伤后经MRI证实的全厚度肩袖撕裂。所有患者都被提供，经历了，早期关节镜修复，在此期间，获取冈上肌腱活检并分析变性迹象。根据Sugaya的说法，57（92％）完成了1年的随访，并在MR图像上评估了修复完整性。使用因果关系图(dagitty.com)调查愈合失败的风险因素，其中年龄，BMI,肌腱退变（Bonar评分），糖尿病,脂肪渗透（FI），性别,吸烟,包括并分析了有关旋转电缆完整性的撕裂位置和撕裂大小（肌腱断裂和肌腱回缩的数量）。
结果：37%的患者（n=21）在1年内发现愈合失败。冈上肌的高度FI（p=0.01），撕裂位置，包括旋转电缆完整性的破坏（p=0.01），发现老年（p=0.03）与愈合失败有关。通过组织病理学确定的肌腱变性与1年随访时的愈合失败无关（p=0.63）。
结论：年龄较大，冈上肌的脂肪浸润增加，在创伤相关的全厚度肩袖撕裂患者中，包括旋转电缆断裂在内的撕裂会增加早期关节镜修复后愈合失败的风险。
方法：这项研究包括62名连续招募的患者（23％的女性，中位年龄61[范围42-75]岁），先前无症状的肩部有急性症状，并且在肩部创伤后经MRI证实的全厚度肩袖撕裂。所有患者都被提供，经历了，早期关节镜修复，在此期间，获取冈上肌腱活检并分析变性迹象。根据Sugaya的说法，57（92％）完成了1年的随访，并在MR图像上评估了修复完整性。使用因果关系图(dagitty.com)调查愈合失败的风险因素，其中年龄，BMI,肌腱退变（Bonar评分），糖尿病,脂肪渗透（FI），性别,吸烟,包括并分析了有关旋转电缆完整性的撕裂位置和撕裂大小（肌腱断裂和肌腱回缩的数量）。
结果：37%的患者（n=21）在1年内发现愈合失败。冈上肌的高度FI（p=0.01），撕裂位置，包括旋转电缆完整性的破坏（p=0.01），发现老年（p=0.03）与愈合失败有关。通过组织病理学确定的肌腱变性与1年随访时的愈合失败无关（p=0.63）。
结论：年龄较大，冈上肌的脂肪浸润增加，在创伤相关的全厚度肩袖撕裂患者中，包括旋转电缆断裂在内的撕裂会增加早期关节镜修复后愈合失败的风险。
