Background:The clinical implications of structural integrity have been a subject of long debate. The oversimplified binary categorization of structural integrity into either healing or retear, along with faulty preoperative baselines for comparison, may contribute to the controversy.Purpose:To determine how the quality of structural integrity in a repaired cuff tendon affects both clinical and structural outcomes by dividing the patients into groups based on integrity and using the immediate postoperative baseline (time zero).Study design:Cohort study; Level of evidence, 3.Methods:A total of 504 patients with a full-thickness rotator cuff tear who underwent arthroscopic rotator cuff repair and were followed up for at least a year with magnetic resonance imaging (MRI) were included. The quality of structural integrity was graded using the Sugaya classification. To evaluate clinical outcomes, pain, range of motion, strength, functional scores, and overall satisfaction and function were used for within- and between-group analyses at the last follow-up. For the assessment of structural outcomes, the Goutallier classification for fatty infiltration (FI) and the tangent sign, occupation ratio, and normalized cross-sectional area for muscle atrophy (MA) were used. The baselines for these structural measurements were both the preoperative and the time-zero MRI scans.Results:The mean clinical follow-up period was 31.8 ± 27.5 months, and the MRI follow-up period was 10.9 ± 5.3 months. There were 178 (35.3%), 228 (45.2%), 58 (11.5%), 14 (2.8%), and 26 (5.2%) shoulders with Sugaya grades 1, 2, 3, 4, and 5, respectively. Regardless of structural integrity, all clinical outcomes at a mean follow-up of 31.8 months after repair significantly improved compared with those before repair. Only in shoulders with Sugaya grade 1 did the FI of the supraspinatus muscle improve significantly from baseline. FI of the infraspinatus muscle did not change significantly in those with grades 1 and 2 but worsened in those with grades 3 and 5. MA measured using the occupation ratio improved significantly in shoulders with Sugaya grades 1 and 2 but declined in those with grade 5.Conclusion:This study established a correlation between improved structural integrity of the repaired cuff tendon and enhanced structural outcomes in rotator cuff muscles. Furthermore, the findings revealed that both FI and MA could be reversed in patients exhibiting high-quality structural integrity. However, these structural improvements were not mirrored in the clinical outcomes.

中文翻译：

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完整性质量对肩袖修复临床和结构结果的影响：504 例病例的回顾性队列研究


背景：结构完整性的临床意义一直是长期争论的话题。将结构完整性过度简单化为愈合或再撕裂，以及用于比较的错误术前基线，可能会引发争议。目的：通过划分来确定修复的袖带肌腱的结构完整性质量如何影响临床和结构结果根据完整性并使用术后立即基线（零时间）将患者分组。 研究设计：队列研究；证据级别，3。方法：共纳入 504 例全层肩袖撕裂患者，他们接受了关节镜下肩袖修复术，并通过磁共振成像 (MRI) 随访了至少一年。使用菅谷分类对结构完整性的质量进行分级。为了评估临床结果，在最后一次随访时使用疼痛、活动范围、力量、功能评分以及总体满意度和功能进行组内和组间分析。为了评估结构结果，使用了脂肪浸润 (FI) 的 Goutallier 分类以及肌肉萎缩 (MA) 的切线符号、占据比和标准化横截面积。这些结构测量的基线是术前和零时间 MRI 扫描。结果：平均临床随访期为 31.8 ± 27.5 个月，MRI 随访期为 10.9 ± 5.3 个月。 Sugaya 1级、2级、3级、4级、5级分别有178（35.3%）、228（45.2%）、58（11.5%）、14（2.8%）和26（5.2%）肩。无论结构完整性如何，修复后平均随访 31.8 个月的所有临床结果均较修复前显着改善。 仅在 Sugaya 1 级的肩部，冈上肌的 FI 较基线显着改善。冈下肌的 FI 在 1 级和 2 级患者中没有显着变化，但在 3 级和 5 级患者中恶化。使用占用比测量的 MA 在 Sugaya 1 级和 2 级患者中显着改善，但在 5 级患者中下降。结论：这项研究建立了修复袖带肌腱结构完整性的改善与肩袖肌肉结构结果增强之间的相关性。此外，研究结果表明，在表现出高质量结构完整性的患者中，FI 和 MA 都可以逆转。然而，这些结构上的改善并未反映在临床结果中。