背景:存在一种现象,其中肌腱在肩袖修复后似乎增加了长度。然而,目前尚不清楚在何种情况下发生肌腱延长以及延长的程度如何影响手术结果。本研究旨在评估磁共振成像(MRI)术前和术后的肌腱连接(MTJ)和肌腱长度,并评估术后肌腱延长及其对术后结局的影响。
方法:我们回顾了109例关节镜肩袖修复术后修复完整性良好的患者。包括冈上肌腱被简单地横向拉出而没有任何额外程序的患者。他们在手术前和手术后3、6和24个月接受了系列MRI检查。测量了MTJ相对于关节盂窝的线和冈上肌腱长度的位置。术后2年进行临床评估,包括肩部运动的范围,肩部强度指数(受影响/未受影响的强度),恒定的分数,加州大学,洛杉矶(UCLA)得分,和疼痛数字评定量表(NRS)。术前肌腱的特点,肌腱长度随时间的变化,MTJ位置和肌腱长度的横向移位量,分析肌腱延长对术后临床结局的影响。
结果:术前肌腱回缩与MTJ位置(r=-0.75;p<0.0001)和术前肌腱长度(r=-0.46;p<0.0001)显著相关。术后3、6和24个月的肌腱长度明显长于手术前(26.7±5.8mm,27.9±6.6mm,28.5±5.6mm,和21.5±5.1毫米,分别)。从手术前到手术后24个月,MTJ位置横向移动8.4±8.6mm,肌腱长度增加7.0±6.1mm。发现肌腱延长和外展强度指数之间存在显著和弱的负相关(r=-0.22;p=0.03);然而,与疼痛没有显著相关性,肩部运动范围,外旋强度指数,恒定的分数,找到了加州大学洛杉矶分校的分数。多元线性回归分析还显示,肌腱延长仅与外展强度指数相关(标准化系数=-0.20,p=0.03)。
结论:在关节镜肩袖修复后观察到肌腱延长和MTJ位置的侧向移位,它们与术前肌腱回缩有关。尽管肌腱延长量与外展强度指数呈负相关,但它不影响其他术后结局.
BACKGROUND: There is a phenomenon in which the tendon appears to increase the length after rotator cuff repair. However, it is unclear in which cases tendon lengthening occurs and how the degree of lengthening affects the surgical outcome. This study aimed to evaluate preoperative and postoperative musculotendinous junction (MTJ) and tendon length on magnetic resonance imaging and assess the postoperative tendon lengthening and its impact on postoperative outcomes.
METHODS: We reviewed 109 patients with good repair integrity after arthroscopic rotator cuff repair. Patients whose supraspinatus tendons were simply pulled out laterally without any additional procedures were included. They underwent serial magnetic resonance imaging before surgery and at 3, 6, and 24 months after surgery. The location of the MTJ in relation to the line of the glenoid fossa and the supraspinatus tendon length were measured. Clinical evaluation was conducted 2 years after surgery, including the range of shoulder motion, shoulder strength index (affected/unaffected strength), Constant score, University of California, Los Angeles score, and pain numeric rating scale. The characteristics of the preoperative tendon, change in tendon length over time, amount of the lateral shift of MTJ location and tendon length, and impact of tendon lengthening on postoperative clinical outcomes were analyzed.
RESULTS: The preoperative tendon retraction significantly correlated with the MTJ location (r = -0.75; P < .0001) and preoperative tendon length (r = -0.46; P < .0001). The tendon length at 3, 6, and 24 months after surgery was significantly longer than those before surgery (26.7 ± 5.8 mm, 27.9 ± 6.6 mm, 28.5 ± 5.6 mm, and 21.5 ± 5.1 mm, respectively). From before surgery to 24 months after surgery, the MTJ location moved 8.4 ± 8.6 mm laterally and the tendon length increased 7.0 ± 6.1 mm. A significant and weak negative correlation was found between tendon lengthening and the abduction strength index (r = -0.22; P = .03); however, no significant correlation with pain, range of shoulder motion, external rotation strength index, Constant score, and University of California, Los Angeles score was found. Multiple linear regression analysis also showed that tendon lengthening was only associated with the abduction strength index (standardized coefficient = -0.20, P = .03).
CONCLUSIONS: Tendon lengthening and lateral shift of MTJ location were observed after arthroscopic rotator cuff repair, and they correlated with preoperative tendon retraction. Although the amount of tendon lengthening had negative weak correlation with abduction strength index, it did not affect other postoperative outcomes.