Tam Kat Rotator Manşet Yırtıklarında Artroskopik Yardımlı Onarım: 5 Yıllık Takipte Fonksiyonel ve Radyolojik Sonuçlar

Öz

Amaç: Çalışmamızda geniş ve masif olan tam kat rotator manşet yırtığı tanısı ile artroskopik yardımlı mini-açık rotator manşet tamiri yapılan hastaların ameliyattan sonra ortalama 5 yıllık klinik ve radyolojik sonuçları ve manyetik rezonans görüntüleme ile tekrarlayan yırtık gelişme oranları değerlendirildi. Yöntemler: Kliniğimizde geniş ve masif tam kat rotator manşet yırtığı tanısı ile konservatif tedaviye yanıt alınamayarak artroskopik yardımlı mini-açık rotator manşet tamiri uygulanan 38 hasta ameliyat öncesi ve sonrası klinik ve radyolojik olarak değerlendirildi. Bulgular: Hastaların ameliyat sonrası takip süreleri 60.4 aydı. UCLA skorlamasına göre 26 hastada mükemmel, 10 hastada iyi ve 2 hastada ise orta derecede sonuç mevcuttu. Constant skorlamasına göre 24 hastada mükemmel, 12 hastada iyi ve 2 hastada ise orta derecede sonuç mevcuttu. 38 hastanın 34’ü sonuçtan memnun olduğunu belirttiler. Hastaların son takiplerinde çekilen omuz MRG’lerinde rotator manşet devamlılığı değerlendirildi ve 8 hastada tekrarlayan yırtık olduğu görüldü. Sonuç: Hastaların yaşına bağlı olarak tekrarlayan yırtık oranları değişmekle birlikte ileri yaşlı hastalarda orta derece klinik sonuçlar elde edilmektedir. Buna rağmen tam kat, geniş ve masif yırtıkların tedavisinde tekrarlayan yırtık oranlarına rağmen artroskopik yardımlı mini-açık rotator manşet tamiri ile tatminkar klinik sonuçlar elde edilebilmektedir.

Anahtar Kelimeler

• Rotator manşet, omuz artroskopisi, artroskopik-yardımlı, mini-açık

Arthroscopic-Assisted Repair in Full-Thickness Rotator Cuff Ruptures: Functional and Radiologic Results of Five-Year Follow-Up

Öz

Objective: In our study, we evaluated the post-operative 5-year clinical and radiological results and the ratio of re­current ruptures under magnetic resonance imaging of the patients diagnosed as wide and massive, full-thick­ness rotator cuff rupture and arthroscopic-assisted mini-open rotator cuff repair is applied. Methods: We evaluated the pre-operative and post-op­erative clinical and radiological results of 38 patients with wide and massive, full-thickness rotator cuff rupture and arthroscopic-assisted rotator cuff repair is applied after failure of conservative treatment. Results: Mean post-operative follow-up period was 60.4 months. According to UCLA scoring there were excellent results in 26 patients, good results in 10, and moderate results in 2 patients. According to Constant scoring there were excellent results in 24 patients, good results in 12, and moderate results in 2 patients. 34 of the 38 patients indicated that they were satisfied with the results. The continuity of the rotator cuffs are evaluated with magnetic resonance imaging at the last visits of the patients and there was recurrent ruptures at the 8 patients. Conclusion: Although recurrent rotator cuff rupture rates varies depending on the age of the patients, moderate clinical results are obtained in elder patients. Neverthe­less, despite the rupture rates in the treatment of wide and massive, full-thickness ruptures, satisfactory clinical results can be obtained with arthroscopic-assisted mini-open rotator cuff repair.

Anahtar Kelimeler

• rotator cuff, shoulder arthroscopy, arthroscopic-assisted, mini-open

Kaynakça

1. 1. McKee MD, Yoo DJ. The effect of surgery for rotator cuff disease on general health status. Results of a prospective trial. J Bone Joint Surg Am 2000;82:970-979.
2. 2. Cole BJ, McCarty LP 3rd, Kang RW, et al. Arthroscopic rotator cuff repair: prospective functional outcome and repair integrity at minimum 2-year follow-up. J Shoulder Elbow Surg 2007;16:579-585.
3. 3. Galatz LM, Ball CM, Teefey SA, et al. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am 2004;86:219-224.
4. 4. Gartsman GM, Brinker MR, Khan M. Early effectiveness of arthroscopic repair for full-thickness tears of the rotator cuff: an outcome analysis. J Bone Joint Surg Am 1998;80:33-40.
5. 5. Liu SH, Baker CL. Arthroscopically assisted rotator cuff repair: correlation of functional results with integrity of the cuff. Arthroscopy 1994;10:54-60.
6. 6. Paulos LE, Kody MH. Arthroscopically enhanced “miniapproach” to rotator cuff repair. Am J Sports Med 1994;22:19- 25.
7. 7. Wilson F, Hinov V, Adams G. Arthroscopic repair of fullthickness tears of the rotator cuff: 2- to 14-year follow-up. Arthroscopy 2002;18:136-144.
8. 8. Cofield RH. Subscapular muscle transposition for repair of chronic rotator cuff tears. Surg Gynecol Obstet 1982;154:667-672.

9. 9. Neer CS 2nd. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am 1972;54:41-50.
10. 10. Yamaguchi K, Levine WN, Marra G, et al. Transitioning to arthroscopic rotator cuff repair: the pros and cons. Instr Course Lect 2003;52:81-92.
11. 11. Owen RS, Iannotti JP, Kneeland JB, et al. Shoulder after surgery: MR imaging with surgical validation. Radiology 1993;186:443-447.
12. 12. Karapınar S, Uruç V, Özden R, et al. Clinical and radiological outcomes of rotator cuff repair by single-row sutureanchor technique with mini-open approach. Dicle Med J 2014;41:347-351.
13. 13. Levy HJ, Uribe JW, Delaney LG. Arthroscopic assisted rotator cuff repair: preliminary results. Arthroscopy 1990;6:55-60.
14. 14. Liu SH.Arthroscopically-assisted rotator-cuff repair. J Bone Joint Surg Br 1994;76:592-595.
15. 15. Mohtadi NG, Hollinshead RM, Sasyniuk TM, et al. A randomized clinical trial comparing open to arthroscopic acromioplasty with mini-open rotator cuff repair for fullthickness rotator cuff tears: disease-specific quality of life outcome at an average 2-year follow-up. Am J Sports Med 2008;36:1043-1051.
16. 16. Ozbaydar M, Elhassan B, Esenyel C, et al. A comparison of single-versus double-row suture anchor techniques in a simulated repair of the rotator cuff: an experimental study in rabbits. J Bone Joint Surg Br 2008;90:1386-1391.
17. 17. Demirhan M, Esenyel CZ. All arthroscopic treatment of rotator cuff tears. Acta Orthop Traumatol Turc 2003;37 Suppl 1:93-104.
18. 18. Harryman DT 2nd, Mack LA, Wang KY, et al. Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am 1991;73:982-989.
19. 19. Gazielly DF, Gleyze P, Montagnon C. Functional and anatomical results after rotator cuff repair. Clin Orthop Relat Res 1994;304:43-53.
20. 20. Knudsen HB, Gelineck J, Sojbjerg JO, et al. Functional and magnetic resonance imaging evaluation after singletendon rotator cuff reconstruction. J Shoulder Elbow Surg 1999;8:242-246.
21. 21. Gerber C, Schneeberger AG, Beck M, et al. Mechanical strength of repairs of the rotator cuff. J Bone Joint Surg Br 1994;76:371-380.
22. 22. Castagna A, Conti M, Markopoulos N, et al. Arthroscopic repair of rotator cuff tear with a modified Mason-Allen stitch: mid-term clinical and ultrasound outcomes. Knee Surg Sports Traumatol Arthrosc 2008;16:497-503.
23. 23. Jost B, Pfirrmann CW, Gerber C, et al. Clinical outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am 2000;82:304-314.
24. 24. Hanusch BC, Goodchild L, Finn P, et al. Large and massive tears of the rotator cuff: functional outcome and integrity of the repair after a mini-open procedure. J Bone Joint Surg Br 2009;91:201-205.
25. 25. Boileau P, Brassart N, Watkinson DJ, et al. Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am 2005;87:1229- 1240.
26. 26. Burns JP, Snyder SJ. Arthroscopic rotator cuff repair in patients younger than fifty years of age. J Shoulder Elbow Surg 2008;17:90-96.
27. 27. DeFranco MJ, Bershadsky B, Ciccone J, et al. Functional outcome of arthroscopic rotator cuff repairs: a correlation of anatomic and clinical results. J Shoulder Elbow Surg 2007;16:759-765.
28. 28. Shen PH, Lien SB, Shen HC, et al. Long-term functional outcomes after repair of rotator cuff tears correlated with atrophy of the supraspinatus muscles on magnetic resonance images. J Shoulder Elbow Surg 2008;17(1 Suppl):1S-7.