Efficacy evaluation of three surgical methods for elderly rotator cuff injury with adhesive capsulitis

doi:10.3877/ cma.j.issn.1674-134X.2025.01.014

Abstract

Abstract:

Objective

To investigate the differences about the efficacy of single-row(SR), modified Mason-Allen (MA) and suture bridge(SB) in the treatment of rotator cuff injury with adhesive capsulitis in the elderly.

Methods

A prospective study was conducted in the 72 patients with rotator cuff injury combined with adhesive capsulitis treated with operation in the Civil Aviation General Hospital from February 2022 to February 2023.The patients were divided into three groups according to the suture methods, 24 patients were enrolled in each group.One-way ANOVA and pairwise q test were used to compare the tendon healing tissue thickness, active shoulder range of motion before and one year after operation, as well as Constant-Murley score,University of California Los Angeles score (UCLA) and visual analogue scale (VAS) before operation and two weeks, six weeks, three months, six months, one year after operation among the three groups.The smoking and diabetes mellitus prevalence, re-tear and stiffness rate were compared by chi square test and Fisher's exact test,and the preoperative tear degree was compared by rank sum test.

Results

There was no significant difference among the groups in active shoulderrange of motion, smoking and diabetes prevalence before and one year after operation, nor in the preoperative tear degree, re-tear or stiffness rates one year after operation (F=0.689,0.380, 0.175, 0.968, 2.074, 0.994, 2.352, 0.549; χ²=0.453, 1.125; H=0.231; all P>0.05).There were no significant differences in Constant-Murley, UCLA or VAS scores among three groups before operation and in two weeks, six weeks, and three months after operation (F=0.174, 0.267, 1.800, 0.574, 2.355, 0.158, 2.61,0.207, 2.826, 1.397, 0.012, 0.1.265, all P>0.05).The UCLA of SB group was significantly higher than those of SR and MA groups at six months and one year after operation (P=0.020, 0.008).The UCLA of MA group was significantly higher than that of SR group at one year after operation (P=0.030).The thickness of tendon healing tissue of SB and MA groups at one year after operation were thicker than that of SR group (F=4.106, P=0.021).

Conclusions

SR, MA and SB are all effective surgical methods to rotator cuff injury combined with adhesive capsulitis in the elderly.There is no significant difference in the early recovery of shoulder function among three groups.SB and MA are better than SR at one year after operation, which are more conducive to the healing of rotator cuff tissue.

Key words: Rotator cuff injury, Bursitis, Suture techniques, Arthroscopy

Dong Ma, Junjie Zeng, Bo Yuan, Ming Tian, Shaolong Zhang. Efficacy evaluation of three surgical methods for elderly rotator cuff injury with adhesive capsulitis[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2025, 19(01): 94-101.

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URL: https://zhgjwkzz.cma-cmc.com.cn/EN/10.3877/ cma.j.issn.1674-134X.2025.01.014

https://zhgjwkzz.cma-cmc.com.cn/EN/Y2025/V19/I01/94

Figures/Tables 8

Figure 1 Three suture methods.A is location of internal anchors; B is single-row suture; C shows that tendon completely covers the footprint after single-row suture; D is modified MA suture; E shows that tendon completely covers the footprint after the modified MA suture; F is suture bridge method; G shows that tendon completely cover the footprint after suture bridge suture

Table 1 Comparison of general clinical data of the patients

项目Items	单排组Single-row group	改良MA组Modified MA group	缝线桥组Suture-bridge group	统计值Statistical values	P值
例数 Case number	24	24	24	-	-
年龄[岁，（ $\overset{ˉ}{x}$ ±s）]	66±4	64±3	65±4	F=1. 792	>0. 05
Age（year）
性别Gender（例）
男Male	9	11	8	χ ²=0. 818	>0. 05
女Female	15	13	16
身体质量指数[kg/m²，（ $\overset{ˉ}{x}$ ±s）]Body mass index	27±3	27±4	27±3	F=0. 205	>0. 05
病程（个月）Course of disease（month）	16±5	15±5	14±4	F=2. 005	>0. 05
吸烟史Smoking（例）
是Yes	11	11	9	χ ²=0. 453	>0. 05
否No	13	13	15
糖尿病史Diabetes（例）
是Yes	4	5	7	χ ²=1. 125^b	>0. 05
否No	20	19	17
术前撕裂程度（例）Tear degree
小型Small	7	9	7
中型Medium	10	9	11	H=0. 231	>0. 05
大型Large	5	3	4
巨大型Huge	2	3	2

Table 1 Comparison of general clinical data of the patients

项目Items	单排组Single-row group	改良MA组Modified MA group	缝线桥组Suture-bridge group	统计值Statistical values	P值
例数 Case number	24	24	24	-	-
年龄[岁，（ $\overset{ˉ}{x}$ ±s）]	66±4	64±3	65±4	F=1. 792	>0. 05
Age（year）
性别Gender（例）
男Male	9	11	8	χ ²=0. 818	>0. 05
女Female	15	13	16
身体质量指数[kg/m²，（ $\overset{ˉ}{x}$ ±s）]Body mass index	27±3	27±4	27±3	F=0. 205	>0. 05
病程（个月）Course of disease（month）	16±5	15±5	14±4	F=2. 005	>0. 05
吸烟史Smoking（例）
是Yes	11	11	9	χ ²=0. 453	>0. 05
否No	13	13	15
糖尿病史Diabetes（例）
是Yes	4	5	7	χ ²=1. 125^b	>0. 05
否No	20	19	17
术前撕裂程度（例）Tear degree
小型Small	7	9	7
中型Medium	10	9	11	H=0. 231	>0. 05
大型Large	5	3	4
巨大型Huge	2	3	2

Table 2 Range of active shoulder motion of the patients before and one year after operation

组别Groups	例数Case numbe	术前
组别Groups	例数Case numbe	前屈Anteflexion	外展Abduction	体侧外旋Externalrotation	体侧内旋Internalrotation
单排组Single-row group	24	106. 3±9. 7	76. 9±5. 1	25. 4±5. 1	70. 0±10. 2
改良MA组Modified MA group	24	107. 3±11. 8	77. 71±2. 5	24. 6±5. 1	65. 0±15. 3
缝线桥组Suture-bridge group	24	103. 9±8. 4	76. 74±4. 4	25. 2±5. 1	67. 6±12. 5
F值		0. 689	0. 380	0. 175	0. 968
P值		>0. 05	>0. 05	>0. 05	>0. 05
组别Groups	例数Case numbe	术后1年
组别Groups	例数Case numbe	前屈Anteflexion	外展Abduction	体侧外旋Externalrotation	体侧内旋Internalrotation
单排组Single-row group	24	151. 9±17. 3	124. 8±4. 0	42. 3±2. 5	85. 0±7. 2
改良MA组Modified MA group	24	144. 6±17. 6	122. 7±5. 9	39. 4±5. 9	85. 0±7. 8
缝线桥组Suture-bridge group	24	154. 3±16. 5	123. 7±5. 3	41. 3±5. 1	87. 0±7. 0
F值		2. 074	0. 994	2. 352	0. 549
P值		>0. 05	>0. 05	>0. 05	>0. 05

Table 3 Comparison of Constant-Murley score at follow-up points among three groups

组别Groups	例数Case numbe	术前Before operation	术后2周Two weeks afteroperation	术后6周Six weeks afteroperation	术后3个月Three months afteroperation	术后6个月Six months afteroperation	术后1年One year afteroperation
单排组Single-row group	24	66. 0±4. 1	8. 7±2. 2	46. 8±11. 1	61. 3±7. 9	84. 6±2. 9	89. 3±4. 0
改良MA组Modified MA group	24	66. 4±2. 6	8. 3±2. 4	46. 0±8. 9	60. 4±6. 7	83. 9±2. 9	91. 1±3. 5
缝线桥组Suture-bridge group	24	65. 8±3. 5	8. 7±2. 2	41. 9±8. 8	59. 0±6. 9	83. 7±2. 9	89. 1±3. 4
F值		0. 174	0. 267	1. 800	0. 574	0. 574	2. 337
P值		>0. 05	>0. 05	>0. 05	>0. 05	>0. 05	>0. 05

Table 4 Comparison of UCLA score at follow-up points among three groups

组别Groups	例数Case numbe	术前Before operation	术后2周Two weeks afteroperation	术后6周Six weeks afteroperation	术后3个月Three months afteroperation	术后6个月Six months afteroperation	术后1年One year afteroperation
单排组Single-row group	24	17. 6±2. 3	8. 5±1. 4	17. 5±2. 3	26. 4±2. 3	26. 6±2. 9	29. 2±1. 5
改良MA组Modified MA group	24	17. 8±2. 6	8. 7±1. 7	16. 7±2. 6	26. 7±2. 2	26. 3±2. 5	30. 1±0. 9
缝线桥组Suture-bridge group	24	16. 3±2. 8	8. 5±1. 3	18. 3±2. 3	26. 3±2. 3	28. 3±1. 8	30. 3±1. 7
F值		2. 355	0. 158	2. 611	0. 207	4. 651	4. 180
P值		>0. 05	>0. 05	>0. 05	>0. 05	0. 013	0. 019

Table 5 Comparison of VAS scores at follow-up points among three groups

组别Groups	例数Case numbe	术前Before operation	术后2周Two weeks afteroperation	术后6周Six weeks afteroperation	术后3个月Three months afteroperation	术后6个月Six months afteroperation	术后1年One year afteroperation
单排组Single-row group	24	6. 4±1. 1	4. 4±1. 4	3. 3±1. 2	1. 9±0. 7	1. 4±0. 8	0. 8±0. 6
改良MA组Modified MA group	24	6. 2±1. 2	5. 0±1. 6	3. 3±1. 1	1. 8±0. 6	1. 7±1. 1	1. 0±0. 5
缝线桥组Suture-bridge group	24	7. 0±1. 5	4. 5±1. 1	3. 3±1. 1	2. 1±0. 7	2. 0±0. 9	1. 1±0. 5
F值		2. 826	1. 397	0. 012	1. 265	2. 037	1. 777
P值		>0. 05	>0. 05	>0. 05	>0. 05	>0. 05	>0. 05

Table 6 Comparison of complication incidences and thickness of healing tendon tissue among three groups

组别Group	例数Case number	肌腱愈合组织厚度［mm,（ $\overset{ˉ}{x}$ ±s）］thickness of tendon healing tissue	再撕裂（例）Re-tear		关节僵硬（例）Stiffness
组别Group	例数Case number		是Yes	否No	是Yes	否No
单排组Single-row group	24	6. 6±0. 6	1	23	5	19
改良MA组Modified MA group	24	7. 0±0. 5	1	23	4	20
缝线桥组Suture-bridge group	24	7. 0±0. 5	0	24	3	21
统计值Statistical values		F=4. 106	-		-
P值		0. 021	1. 000^*		0. 922^*

Table 6 Comparison of complication incidences and thickness of healing tendon tissue among three groups

组别Group	例数Case number	肌腱愈合组织厚度［mm,（ $\overset{ˉ}{x}$ ±s）］thickness of tendon healing tissue	再撕裂（例）Re-tear		关节僵硬（例）Stiffness
组别Group	例数Case number		是Yes	否No	是Yes	否No
单排组Single-row group	24	6. 6±0. 6	1	23	5	19
改良MA组Modified MA group	24	7. 0±0. 5	1	23	4	20
缝线桥组Suture-bridge group	24	7. 0±0. 5	0	24	3	21
统计值Statistical values		F=4. 106	-		-
P值		0. 021	1. 000^*		0. 922^*

Figure 2 MRI of typical cases using single row method, modified MA（Mason-Allen）method and suture brigde method before operation and one year after operation.A is preoperative MRI of right shoulder of single row method case showing partial supraspinatus tendon injury; B is MRI of right shoulder of single row method case showing that tendon continuity recovered one year after operation; C is preoperative MRI of right shoulder of MA method case showing partial supraspinatus tendon injury; D is MRI of right shoulder of MA suture case showing that tendon continuity recovered one year after operation; E is preoperative MRI of left shoulder of single bridge case showing partial supraspinatus tendon injury; F is MRI of left shoulder suture bridge method case showing that tendon continuity recovered one year after operation

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