一次修復不能な腱板広範囲断裂に対するテフロンフェルトを用いた鏡視下パッチ法の中長期成績 Arthroscopic Patch Graft Procedure for Irreparable Massive Rotator Cuff Tears Using Teflon Felt: A Two to Six Year Follow-up
To date, reverse shoulder arthroplasty or tendon transfer procedures have been believed to be the preferred treatment options for patients with irreparable massive rotator cuff tears. However, these are relatively invasive and salvage procedure can be very difficult. The purpose of this study is to report the outcomes of arthroscopic patch graft procedure using Teflon felt. Between January 2003 to June 2007, 37 shoulders underwent primary arthroscopic graft procedure using a Teflon felt patch with 3mm thickness. Subjects consist of 31 patients who were able to follow-up for a minimum of 2 years, including 17 males and 14 females with an average age of 64.6 years (range, 33-80). After a tendon mobilization procedure, a Teflon felt patch was introduced to the glenohumeral joint through the standard anterior portal and fixed arthroscopically. Clinical outcomes were evaluated using the JOA and UCLA scores at an average of 40 months (range, 24-72).<BR>The mean postoperative JOA and UCLA score improved significantly to 90.2 and 31.7, respectively. Active forward flexion significantly increased on average from 104 to 158 degrees, with a mean strength increasing from 2.7 to 4.7. In external rotation, strength and ROM demonstrated no significant improvement. On X-rays, 7 out of 21 patients demonstrated bone absorption within 2 years after surgery, however, no progression of absorption was observed more than 2 years after surgery. Further, no patients complained of symptoms related to bone absorption. Arthroscopic graft procedure using Teflon felt patch yielded excellent outcomes in terms of pain relief and flexion strength, and patients' satisfaction was very high. This technique could be an alternative procedure for these difficult patient populations.
肩関節 34(2), 459-462, 2010