Comparison of the Functional Outcomes of Arthroscopic Debridement and Repair of Bursal-side Partial-thickness Rotator Cuff Tears

Yıl 2023, , 357 - 363, 31.08.2023

Fatih İlker Can

https://doi.org/10.35440/hutfd.1317386

Öz

Background: To compare the clinical and functional scores of arthroscopic debridement and repair (conversion to full thickness) surgeries in patients with bursal-side partial-thickness rotator cuff tears (BPTRCT).
Materials and Methods: A single-center retrospective study was conducted to compare the arthroscopic debride-ment and arthroscopic repair for BPTRCT performed between March 2017 and September 2021. Arthroscopic debridement patients were grouped as Group 1 and the repair group as Group 2. A total of 98 patients with an average age of 57.5 years (range 29-83 years), including 41 male and 57 female patients, met the inclusion criteria. VAS (Visual Analogue Scale) and UCLA (University of California Los Angeles) shoulder scores applied in the preopera-tive period and in the 12th month of the postoperative clinical follow-ups were evaluated. In addition to the pre-operative and postoperative comparison of both scores, their improvement of these scores was also compared.
Results: The mean age of the repair group and the debridement group was 64.4 ±11.02 and 52.6 ±11.24, respective-ly. No significant difference between the two groups was observed in terms of demographic characteristics (p˃0.05). The mean operation time was 91.46 ±16.44 min in the repair group and 49.82 ±13.46 min in the debridement group. The VAS score dramatically improved, from preoperative 5.10±1.23 to postoperative 3.68±1.33 points in the deb-ridement group and from preoperative 5.17±1.35 to postoperative 3.58±1.16 points in the repair group. The two groups had no statistically significant difference in postoperative VAS scores (p=0.991). Preoperative and postopera-tive VAS score improvement was also compared between the groups, however, there was also no statistically signifi-cant difference in terms of VAS score changes (p=0.132). The UCLA scores also dramatically improved, from pre-operative 17.14±4.19 to postoperative 24.57±5.04 points in the debridement group and from preoperative 17.46±5.05 to postoperative 25.48±5.61 points in the repair group. No statistically significant difference was ob-served between the two groups in terms of postoperative UCLA scores (p=0.361). In the postoperative first-year follow-up, no re-tears were observed either in the debridement or in the repair group.
Conclusions: Both arthroscopic debridement and arthroscopic repair surgeries provide clinically comparable suc-cessful results and high satisfaction for patients with bursal-side rotator cuff tears. No statistically significant differ-ence was observed between these two methods. Easier early postoperative rehabilitation seems to be the main advantage of the debridement method.

Anahtar Kelimeler

Bursal-side, partial-thickness rotator cuff tear, arthroscopy, repair

Bursal Yüz Kısmi Kalınlıkta Rotator Manşet Yırtıklarının Artroskopik Debridman ve Tamirinin Fonksiyonel Karşılaştırılması

Öz

Amaç: Bursal yüz kısmi kalınlıkta rotator manşet yırtığı (BPTRCT) olan hastalarda artroskopik debridman ve tamir (tam kata dönüştürerek) ameliyatlarının klinik ve fonksiyonel sonuçlarını karşılaştırmak.
Materyal ve Metod: Mart 2017-Eylül 2021 tarihleri arasında opere edilen BPTRCT'de artroskopik debridman ve artroskopik tamiri karşılaştırmak için tek merkezli retrospektif bir çalışma yapıldı. Artroskopik debridman hastaları Grup 1, tamir grubu Grup 2 olarak adlandırıldı. Toplam 98 hasta (41 erkek ve 57 kadın) çalışmaya dahil edildi. Hastala-rın ortalama yaşı 57,5 (29-83 yıl) idi. Ameliyat öncesi ve postoperatif 12. ay VAS (Visual Analog Scale) ve UCLA (Uni-versity of California Los Angeles) omuz skorları değerlendirildi. Her iki skorun preoperatif ve postoperatif karşılaştır-masına ek olarak, bu skorlardaki değişimler de karşılaştırıldı.
Bulgular: Tamir grubunun ve debridman grubunun yaş ortalaması sırasıyla 64,4 ±11,02 ve 52,6 ±11,24 idi. Demografik özellikler açısından iki grup arasında anlamlı bir fark gözlenmedi (p˃0.05). Ortalama operasyon süresi tamir grubunda 91,46 ±16,44 dk, debridman grubunda 49,82 ±13,46 dk idi. VAS skoru, debridman grubunda preoperatif 5.10±1.23'ten postoperatif 3.68±1.33 puana ve tamir grubunda preoperatif 5.17±1.35'ten postoperatif 3.58±1.16 puana ilerleme kaydetti. Postoperatif 12. ay VAS skorlarında iki grup arasında istatistiksel olarak anlamlı fark yoktu (p=0,991). Gruplar arasında preoperatif ve postoperatif VAS skorlarındaki iyileşme de karşılaştırıldı ancak VAS skorla-rındaki değişimler açısından istatistiksel olarak anlamlı bir fark bulunamadı (p=0,132). UCLA skorları da debridman grubunda ameliyat öncesi 17.14±4.19'dan ameliyat sonrası 24.57±5.04 puana ve tamir grubunda ameliyat öncesi 17.46±5.05'ten ameliyat sonrası 25.48±5.61 puana dramatik bir şekilde iyileşti. Ameliyat sonrası UCLA skorları açısın-dan iki grup arasında istatistiksel olarak anlamlı bir fark gözlenmedi (p=0,361). Postoperatif birinci yıl takibinde deb-ridman ve onarım grubunda tekrar yırtık görülmedi.
Sonuç: Bursal yüz rotator manşet yırtıklarının cerrahi tedavisinde hem artroskopik debridman hem de artroskopik onarım klinik olarak karşılaştırılabilir başarılı sonuçlar vermekte olup hastalar açısından oldukça tatmin edici sonuçlar elde edilebilmektedir. Çalışmamızda bu iki yöntem arasında klinik skorlamalar açısından istatistiksel olarak anlamlı bir fark gözlenmedi. Ameliyat sonrası dönemde daha kolay ve erken rehabilitasyon, debridman yönteminin ana avantajı olarak görünmektedir.

Anahtar Kelimeler

Bursal-yüz, kısmi-kalınlıkta rotator manşet yırtıkları, artroskopi, tamir

Kaynakça

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