１． Burkhart SS, Danaceau SM, Pearce CE Jr: Arthroscopic rotator cuff repair: analysis of results by tear size
ことができた。これまで、腱板断裂修復術後の肩外転
and by repair technique―margin convergence versus
及び外旋筋力に関しては、術後１年で健側の約80％か
ら90％に改善したと報告されている
direct tendon-to-bone repair. Arthroscopy 2001; 17: 905-
。今回、算出
20），21）
した術後１年６か月後における各筋力の健側比の75％
タイルは90％を超えていた。これは、過去の報告に比
912
２． Sugaya H, Maeda K, Matsuki K, Moriishi J: Repair
integrity and functional outcome after arthroscopic
べ６か月が経過していることを考慮すると、目標とす
double-row rotator cuff repair. A prospective outcome
べきカットオフ値としては概ね妥当な数値と考えられ、
有用な予測ツールとなり得る可能性が示唆された。も
し、術後６か月の時点でカットオフ値に至っていない
study. J Bone Joint Surg Am 2007; 89: 953-960
３． Nho SJ, Shindle MK, Sherman SL, Freedman KB,
Lyman S, MacGillvray JD: Systematic review of
場合は、十分な筋力を獲得できない可能性があるため、
arthroscopic rotator cuff repair and mini-open rotator
筋力増強訓練や自主訓練の継続を検討する必要がある
と考える。
cuff repair. J Bone Joint Surg Am 2007; 89: 127-136
４． 国分毅，名倉一成，豊川成和，乾淳幸，坂田亮介，藤
岡宏幸：鏡視下腱板修復術の術後成績―術前拘縮の影響
今回の重回帰分析の結果において、下垂位内旋の筋
力には本来主動作筋として機能する肩甲下筋を伴う断
裂は影響していなかった。これは、下垂位内旋運動に
について―．肩関節 2009；33：389-392
５．
Cho NS, Rhee YG: The factors affecting the clinical
outcome and integrity of arthroscopically repaired
は大円筋や補助筋である大胸筋、広背筋の影響により
rotator cuff tears of the shoulder. Clin Orthop Surg
筋力が保たれていた可能性が考えられる。
本研究の限界として、単施設での後方視的調査のた
め症例数が少なく、多変量解析において投入できる独
2009; 1: 96-104
６．
Clement ND, Hallett A, MacDonald D, Howie
立変数の数が制限されたこと、健側の腱板評価を行っ
ていないこと、腱板断裂の大きさの評価に関して評価
－81－
C, McBirnie J: Does diabetes affect outcome after
arthroscopic repair of the rotator cuff?. J Bone Joint
Surg Br 2010; 92: 1112-1117
鏡視下腱板修復術後の筋力回復に関連する要因
７．
Andrew AL, Shapiro JA, Ahn AK, Zuckerman JD,
at a minimum of 2 years. Arch Orthop Trauma Surg
Cuomo F: Rotator cuff repair in patients with typeⅠ
diabetes mellitus. J Shoulder Elbow Surg 2003; 12: 416-
2017; 137: 1399-1408
15．
Haviv B, Rutenberg TF, Yaari L, Khatib M, Rath E,
421
Yassin M: Which patients are less likely to improve
８．
Tauro JC: Stiffness and rotator cuff tears: incidence,
after arthroscopic rotator cuff repair?. Acta Orthop
arthroscopic findings, and treatment results.
Arthroscopy 2006; 22: 581-586
Traumatol Turc 2019; 53: 356-359
16．
Cofield RH, Parvizi J, Hoffmeyer PJ, Lanzer WL,
９．
Levy O, Venkateswaran B, Even T, Ravenscroft M,
Ilstrup DM, Rowland CM: Surgical repair of chronic
Copeland S: Mid-term clinical and sonographic outcome
rotator cuff tears. A prospective long-term study. J
of arthroscopic repair of the rotator cuff. J Bone Joint
Surg Br 2008; 90: 1341-1347
Bone Joint Surg Am 2001; 83: 71-77
17．
大澤貴志，大沢敏久，鈴木秀喜，石川隆，荒牧雅之，
10． Ozbayder MU, Tonbul M, Tekin AC, Yalaman O:
饗場佐知子，他：肩腱板断裂修復後の経時的観察．肩関
Arthroscopic rotator cuff repair evaluation of outcomes
and analysis of prognostic factors. Acta Orthop
節 2005；29：347-350
18． Kanda Y: Investigation of the freely available easy-
Traumatol Turc 2007; 41: 169-174
to-use software‘EZR’for medical statistics. Bone
11． 岩堀裕介，梶田幸宏，佐藤啓二，花村浩克，筒井求，
加藤真：鏡視下腱板修復術の術後成績―術前関節拘縮の
Marrow Transplant 2013; 48: 452-458
19．
Oh JH, Kim SH, Lee HK, Jo KH, Bin SW, Gong HS:
有無による比較―．肩関節 2011；35：449-452
Moderate preoperative shoulder stiffness does not
12． Shin SJ, Chung J, Lee J, Ko YW: Recovery of muscle
alter the clinical outcome of rotator cuff repair with
strength after intact arthroscopic rotator cuff repair
arthroscopic release and manipulation. Arthroscopy
according to preoperative rotator cuff tear size. Am J
2008; 24: 983-991
Sports Med 2016; 44: 972-980
20．
小室透，米田稔，関博，加賀谷圭子，埜口博司：肩腱
13．
Oh JH, Yoon JP, Kim DH, Chung SW, Kim JY,
板断裂修復術後の筋力回復と筋力回復訓練上の留意点．
Lee HJ, et al. : Does strength deficit correlate with
肩関節 1998；22：319-322
shoulder function in patients with rotator cuff tears?
21．
Rokito AS, Zuckerman JD, Gallager MA, Cuomo
Characteristics of massive tears. J shoulder Elbow Surg
F: Strength after surgical repair of the rotator cuff. J
2019; 28: 1861-1868
Shoulder Elbow Surg 1996; 5: 12-17
14． Millett PJ, Espinoza C, Horan MP, Ho CP, Warth RJ,
22．
Millican CR, Lam PH, Murrell GAC: Shoulder
Dornan GJ, Katthagen JC: Predictors of outcomes after
stiffness after rotator cuff repair: the fate of stiff
arthroscopic transosseous equivalent rotator cuff repair
shoulders up to 9 years after rotator cuff repair. J
in 155 cases: a propensity score weighted analysis of
Shoulder Elbow Surg 2020; 29: 1323-1331
knotted and knotless self-reinforcing repair techniques
－82－
Yamagata Med J（ISSN 0288-030X）2021；39
柴橋，村川，佐々木，結城，高窪，髙木
（2）
：76-83
DOI 10.15022/00005046
Multiple regression analysis of the predictive factors of
muscle recovery following arthroscopic rotator cuff repair
Hirotomo Shibahashi＊， Miyuki Murakawa＊， Takeshi Sasaki＊， Issei Yuki＊，＊＊，
Yuya Takakubo＊，＊＊， Michiaki Takagi＊，＊＊
Department of Rehabilitation, Yamagata University Hospital
＊＊
Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine
ABSTRACT
Objective: The purpose of this study was to determine the factors affecting rotator cuff muscle
strength and to predict muscle strength 18 months after the arthroscopic rotator cuff repair (ARCR)
surgery.
Methods: We retrospectively identified 104 patients who underwent ARCR at our hospital between
January 1, 2012, and March 31, 2017. We extracted patient data pertaining to preoperative pain,
range of motion and tear size, and muscle strength at both 6 and 18 months after surgery. We used
multiple linear regression, constructed a receiver operating characteristic curve, and predicted muscle
strength 18 months after surgery. We obtained cutoff values for muscle strength 6 months after
surgery.
Results: Multiple linear regression analysis revealed that the factors affecting muscle strength 6
months after ARCR were the number of contracture sites and tear size. Six months postoperatively,
the cutoff values of muscle strength were 62.5% during 90°abduction, 72.4% during 45°abduction,
70.1% during external rotation, and 92.5% during internal rotation.
Conclusion: After ARCR, postoperative therapy should be considered as muscle recovery may be
delayed if there is preoperative contracture and a large tear. In addition, if the cutoff values have not
been achieved 6 months postoperatively, it may not be possible to obtain sufficient muscle strength. It
is necessary to consider continuing muscle strength training or independent training.
Keywords: rotator cuff tear, arthroscopic surgery, muscle strength, prognosis prediction,
regression analysis
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