Abstract：
BACKGROUND: The natural history of rotator cuff tears often involves progressive pain development, tear enlargement, and advancing muscle fatty degeneration. Both surgery and conservative management have proven to be effective treatments. Our study purpose was to compare the short to mid-term effects of rotator cuff repair on shoulder function, progression of tear size, and muscle degeneration compared to controls with asymptomatic tears that developed pain and were managed nonoperatively.
METHODS: This comparative study consists of two separate longitudinal study arms. The control group consisted of asymptomatic degenerative cuff tears followed until pain development and then managed nonoperatively with continued surveillance. The surgical group consisted of subjects with degenerative tears that failed nonoperative treatment and underwent surgical intervention with a minimum of 2 years follow-up. Outcomes included VAS pain, ASES, AROM, strength, and ultrasonography.
RESULTS: There were 83 controls and 65 surgical shoulders. The surgical group was younger at enrollment (58.9±5.3 yr vs. 61.2±7.8 yr, p=0.04). The median follow-up for control subjects after pain development was 5.1 years (IQR 3.6) and the median postoperative follow-up for the surgical group was 3.0 years (IQR 0.2). Baseline tear widths (median 14 mm, IQR 9 vs. 13 mm, IQR 8; p=0.45) and tear lengths (median 14 mm, IQR 13 vs. median 11 mm, IQR 8; p=0.06) were similar between the surgical group and controls. There were no differences in the baseline prevalence of fatty degeneration of the supraspinatus or infraspinatus muscles between groups (p=0.43 and p=0.58, respectively). At final follow-up, the surgical group demonstrated significantly lower VAS pain (0 [IQR 2] vs. 3.5 [IQR 4], p=0.0002), higher composite ASES (95 [IQR 13] vs. 65.8 [IQR 32], p=0.0002) and ADL scores (29 [IQR 4] vs. 22 [IQR 8], p=0.0002), greater abduction strength (69.6 N [SD 29] vs. 35.9 N [SD 29], p=0.0002), greater active forward elevation (155˚ [SD 8] vs. 142˚ [SD 28], p=0.002), greater active external rotation in abduction (mean 98.5˚, SD 12 vs. mean 78.2˚, SD 20; p=0.0002) compared to controls. Additionally, the prevalence of fatty muscle degeneration was lower in the surgical group for the supraspinatus and infraspinatus (25% vs. 41%, p=0.05; 17% vs. 34%, p=0.03; respectively).
CONCLUSIONS: This prospective longitudinal study comparing a surgical cohort undergoing rotator cuff repair with a control group treated nonoperatively supports the notion that surgical intervention has the potential to alter the early natural history of degenerative rotator cuff disease. Patients in the surgical group demonstrated clinically relevant differences in pain and functional outcomes. Surgical intervention was protective against progressive muscle degeneration compared to nonoperative treatment.
METHODS: This comparative study consists of two separate longitudinal study arms. The control group consisted of asymptomatic degenerative cuff tears followed until pain development and then managed nonoperatively with continued surveillance. The surgical group consisted of subjects with degenerative tears that failed nonoperative treatment and underwent surgical intervention with a minimum of 2 years follow-up. Outcomes included VAS pain, ASES, AROM, strength, and ultrasonography.
RESULTS: There were 83 controls and 65 surgical shoulders. The surgical group was younger at enrollment (58.9±5.3 yr vs. 61.2±7.8 yr, p=0.04). The median follow-up for control subjects after pain development was 5.1 years (IQR 3.6) and the median postoperative follow-up for the surgical group was 3.0 years (IQR 0.2). Baseline tear widths (median 14 mm, IQR 9 vs. 13 mm, IQR 8; p=0.45) and tear lengths (median 14 mm, IQR 13 vs. median 11 mm, IQR 8; p=0.06) were similar between the surgical group and controls. There were no differences in the baseline prevalence of fatty degeneration of the supraspinatus or infraspinatus muscles between groups (p=0.43 and p=0.58, respectively). At final follow-up, the surgical group demonstrated significantly lower VAS pain (0 [IQR 2] vs. 3.5 [IQR 4], p=0.0002), higher composite ASES (95 [IQR 13] vs. 65.8 [IQR 32], p=0.0002) and ADL scores (29 [IQR 4] vs. 22 [IQR 8], p=0.0002), greater abduction strength (69.6 N [SD 29] vs. 35.9 N [SD 29], p=0.0002), greater active forward elevation (155˚ [SD 8] vs. 142˚ [SD 28], p=0.002), greater active external rotation in abduction (mean 98.5˚, SD 12 vs. mean 78.2˚, SD 20; p=0.0002) compared to controls. Additionally, the prevalence of fatty muscle degeneration was lower in the surgical group for the supraspinatus and infraspinatus (25% vs. 41%, p=0.05; 17% vs. 34%, p=0.03; respectively).
CONCLUSIONS: This prospective longitudinal study comparing a surgical cohort undergoing rotator cuff repair with a control group treated nonoperatively supports the notion that surgical intervention has the potential to alter the early natural history of degenerative rotator cuff disease. Patients in the surgical group demonstrated clinically relevant differences in pain and functional outcomes. Surgical intervention was protective against progressive muscle degeneration compared to nonoperative treatment.
摘要：
背景：肩袖撕裂的自然史通常涉及进行性疼痛发展，泪液增大,推进肌肉脂肪变性。手术和保守治疗已被证明是有效的治疗方法。我们的研究目的是比较肩袖修复对肩关节功能的短期至中期影响。泪液大小的进展，与无症状泪液出现疼痛并非手术治疗的对照组相比，肌肉变性。
方法：本比较研究由两个独立的纵向研究组组成。对照组包括无症状的退行性袖口撕裂，直到疼痛发展，然后在非手术的情况下进行持续监测。手术组由变性眼泪的受试者组成，这些受试者非手术治疗失败，并接受了至少2年的手术干预。结果包括VAS疼痛，ASES,阿罗姆,力量,和超声检查。
结果：有83个对照和65个手术肩。手术组在入学时年龄较小（58.9±5.3年与61.2±7.8年，p=0.04)。对照组疼痛发展后的中位随访时间为5.1年（IQR3.6），手术组的中位术后随访时间为3.0年（IQR0.2）。基线撕裂宽度(中位数14mm,IQR9vs.13毫米,IQR8；p=0.45）和撕裂长度（中位数14毫米，IQR13vs.中位数11毫米，IQR8；p=0.06）在手术组和对照组之间相似。两组之间冈上肌或冈下肌脂肪变性的基线患病率没有差异（分别为p=0.43和p=0.58）。在最后的后续行动中，手术组VAS疼痛显著降低(0[IQR2]vs.3.5[IQR4]，p=0.0002),更高的复合ASES(95[IQR13]vs.65.8[IQR32]，p=0.0002）和ADL得分（29[IQR4]vs.22[IQR8]，p=0.0002),更大的外展强度(69.6N[SD29]vs.35.9N[SD29]，p=0.0002),更积极的前高程(155º[SD8]vs.142℃[SD28]，p=0.002),外展活动更大(平均98.5°，SD12vs.平均78.2℃，SD20；p=0.0002）与对照组相比。此外,冈上肌和冈下肌手术组脂肪肌肉变性的患病率较低(25%vs.41%,p=0.05；17%vs.34%,p=0.03；分别）。
结论：这项前瞻性纵向研究将接受肩袖修复的手术队列与非手术治疗的对照组进行比较，支持以下观点：手术干预有可能改变退行性肩袖疾病的早期自然史。手术组患者在疼痛和功能结局方面表现出临床相关差异。与非手术治疗相比，手术干预可防止进行性肌肉变性。
方法：本比较研究由两个独立的纵向研究组组成。对照组包括无症状的退行性袖口撕裂，直到疼痛发展，然后在非手术的情况下进行持续监测。手术组由变性眼泪的受试者组成，这些受试者非手术治疗失败，并接受了至少2年的手术干预。结果包括VAS疼痛，ASES,阿罗姆,力量,和超声检查。
结果：有83个对照和65个手术肩。手术组在入学时年龄较小（58.9±5.3年与61.2±7.8年，p=0.04)。对照组疼痛发展后的中位随访时间为5.1年（IQR3.6），手术组的中位术后随访时间为3.0年（IQR0.2）。基线撕裂宽度(中位数14mm,IQR9vs.13毫米,IQR8；p=0.45）和撕裂长度（中位数14毫米，IQR13vs.中位数11毫米，IQR8；p=0.06）在手术组和对照组之间相似。两组之间冈上肌或冈下肌脂肪变性的基线患病率没有差异（分别为p=0.43和p=0.58）。在最后的后续行动中，手术组VAS疼痛显著降低(0[IQR2]vs.3.5[IQR4]，p=0.0002),更高的复合ASES(95[IQR13]vs.65.8[IQR32]，p=0.0002）和ADL得分（29[IQR4]vs.22[IQR8]，p=0.0002),更大的外展强度(69.6N[SD29]vs.35.9N[SD29]，p=0.0002),更积极的前高程(155º[SD8]vs.142℃[SD28]，p=0.002),外展活动更大(平均98.5°，SD12vs.平均78.2℃，SD20；p=0.0002）与对照组相比。此外,冈上肌和冈下肌手术组脂肪肌肉变性的患病率较低(25%vs.41%,p=0.05；17%vs.34%,p=0.03；分别）。
结论：这项前瞻性纵向研究将接受肩袖修复的手术队列与非手术治疗的对照组进行比较，支持以下观点：手术干预有可能改变退行性肩袖疾病的早期自然史。手术组患者在疼痛和功能结局方面表现出临床相关差异。与非手术治疗相比，手术干预可防止进行性肌肉变性。
