臨床整形外科58巻10号

2023年10月発行

特集 腱板断裂の治療戦略 一次修復を促進させる治療

腱板断裂修復術におけるBone Marrow Stimulation—適応と限界

著者： 柴田光史¹ 伊﨑輝昌²

所属機関： ¹福岡大学医学部整形外科 ²福岡大学筑紫病院整形外科

ページ範囲：P.1211 - P.1215

腱板断裂に対する関節鏡視下腱板修復術後の再断裂率を低下させるために骨髄刺激法(bone marrow stimulation)が注目されている．骨髄刺激法は上腕骨の腱板停止部に径の細い骨孔を数カ所開けることで，骨孔から成長因子や骨髄間葉系幹細胞等を流出させる簡便な手技である．腱板修復術に併用することにより腱-骨付着部の癒合率を向上させる可能性があるが，腱板修復方法によっては筋腱移行部に再断裂が生じる可能性があるため注意が必要である．

参考文献

1) Hein J, Reilly JM, Chae J, et al. Retear rates after arthroscopic single-row, double-row, and suture bridge rotator cuff repair at a minimum of 1 year of imaging follow-up:a systematic review. Arthroscopy 2015;31(11):2274-81.

2) Snyder SJ, Burns J. Rotator cuff Healing and the bone marrow “Crimson duvet” from clinical observations to science. Tech Shoulder Elb Surg 2009;10(4):130-7.

3) Yang G, Li S, Jiang C, et al. The role of bone marrow stimulation in rotator cuff repair:a systematic review and meta-analysis. J Exp Orthop 2023;10(1):27. doi:10.1186/s40634-023-00589-w.

4) Zhang L, Zhu Y, Xu T, et al. Bone marrow stimulation in arthroscopic rotator cuff repair is a cost-effective and straightforward technique to reduce retear rates:a systematic review and meta-analysis. Front Surg 2023;10:1047483. doi:10.3389/fsurg.2023.1047483.

5) Jeong HJ, Nam KP, Yeo JH, et al. Retear after arthroscopic rotator cuff repair results in functional outcome deterioration over time. Arthroscopy 2022;38(8):2399-412.

6) Ruiz Ibán MA, Sanchez Alepuz E, Diaz Heredia J, et al. Footprint preparation with nanofractures in a supraspinatus repair cuts in half the retear rate at 1-year follow-up. A randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2021;29(7):2249-56.

7) Chen H, Hoemann CD, Sun J, et al. Depth of subchondral perforation influences the outcome of bone marrow stimulation cartilage repair. J Orthop Res 2011;29(8):1178-84.

8) Eldracher M, Orth P, Cucchiarini M, et al. Small subchondral drill holes improve marrow stimulation of articular cartilage defects. Am J Sports Med 2014;42(11):2741-50.

9) Sun Y, Kwak JM, Kholinne E, et al. Small subchondral drill holes improve marrow stimulation of rotator cuff repair in a rabbit model of chronic rotator cuff tear. Am J Sports Med 2020;48(3):706-14.

10) Kim C, Lee YJ, Kim SJ, et al. Bone marrow stimulation in arthroscopic repair for large to massive rotator cuff tears with incomplete footprint coverage. Am J Sports Med 2020;48(13):3322-7.

11) Jo CH, Yoon KS, Lee JH, et al. The effect of multiple channeling on the structural integrity of repaired rotator cuff. Knee Surg Sports Traumatol Arthrosc 2011;19(12):2098-107.

12) Shibata T, Izaki T, Miyake S, et al. Efficacy of bone marrow stimulation for arthroscopic knotless suture bridge rotator cuff repair:a prospective randomized controlled trial. J Shoulder Elbow Surg 2023;32(5):909-16.

13) Taniguchi N, Suenaga N, Oizumi N, et al. Bone marrow stimulation at the footprint of arthroscopic surface-holding repair advances cuff repair integrity. J Shoulder Elbow Surg 2015;24(6):860-6.

14) Yoon JP, Chung SW, Kim JY, et al. Outcomes of combined bone marrow stimulation and patch augmentation for massive rotator cuff tears. Am J Sports Med 2016;44(4):963-71.

15) Dierckman BD, Frousiakis P, Burns JP, et al. Arthroscopic repair of medium to large rotator cuff tears with a triple-loaded medially based single-row technique augmented with marrow vents. Arthroscopy 2021;37(1):28-37.

16) Yamakado K. A prospective randomized trial comparing suture bridge and medially based single-row rotator cuff repair in medium-sized supraspinatus tears. Arthroscopy 2019;35(10):2803-13.

17) Jo CH, Shin JS, Park IW, et al. Multiple channeling improves the structural integrity of rotator cuff repair. Am J Sports Med 2013;41(11):2650-7.

18) Milano G, Saccomanno MF, Careri S, et al. Efficacy of marrow-stimulating technique in arthroscopic rotator cuff repair:a prospective randomized study. Arthroscopy 2013;29(5):802-10.

19) Osti L, Del Buono A, Maffulli N. Microfractures at the rotator cuff footprint:a randomised controlled study. Int Orthop 2013;37(11):2165-71.

20) Pulatkan A, Anwar W, Tokdemir S, et al. The clinical and radiologic outcome of microfracture on arthroscopic repair for full-thickness rotator cuff tear. J Shoulder Elbow Surg 2020;29(2):252-7.

21) Lapner P, Pollock JW, Laneuville O, et al. Preoperative bone marrow stimulation does not improve functional outcomes in arthroscopic cuff repair:a prospective randomized controlled trial. Bone Joint J 2021;103-B(1):123-30.

22) Toro F, Pinochet F, Ruiz F, et al. Functional and radiologic results of the crimson duvet procedure in rotator cuff treatment:a randomized controlled clinical trial. J Shoulder Elbow Surg 2022;31(6):1200-7.