Roturas masivas del manguito de los rotadores: resultados clínicos de la reparación artroscópica con técnica doble MAC
DOI:
https://doi.org/10.1016/j.rccot.2017.08.006Palabras clave:
artroscopia de hombro, reparación del manguito de los rotadores, técnica doble MAC, roturas masivasResumen
Introducción: Las roturas masivas del manguito de los rotadores representan una de las lesiones más complejas a las cuales se puede enfrentar el ortopedista especialista en hombro y son un gran reto cuando se desean lograr resultados clínicos satisfactorios. El objetivo del trabajo es describir los resultados clínicos de una nueva técnica quirúrgica para la reparación artroscópica de lesiones grandes y masivas del manguito de los rotadores (MR) utilizada en una clínica ortopédica especializada durante un período de 3 años.
Materiales y métodos: Se realizó un estudio descriptivo de una cohorte de pacientes con lesiones grandes y masivas del MR, diagnosticados mediante artrorresonancia directa y que cumplían criterios para reparación artroscópica, a los cuales se les realizó la reparación mediante una nueva técnica denominada doble MAC. Se analizaron como desenlaces la escala de Constant postoperatoria, la existencia de complicaciones y el grado de satisfacción de los pacientes con el procedimiento.
Resultados: Se evaluó a 21 pacientes (10 hombres y 11 mujeres) con una media de edad de 59,4 años (DE: 8,2) en el momento de la cirugía. Las roturas comprometieron el músculo supraespinoso en todos los casos y en el 42,8% el infraespinoso con un tamaño medio de rotura de 34,5 mm (DE: 11,2). El tiempo entre la cirugía y la evaluación fue, por término medio, de 9 meses. La escala de Constant postoperatoria fue, por término medio, de 77,4 (DE: 9,0). No se presentaron complicaciones en la cirugía o falla de los anclajes. Solo un paciente presentó capsulitis adhesiva temprana, que se trató con movilización articular, con la cual se logró normalizar todos los arcos de movilidad.
Discusión: La técnica doble MAC para la reparación artroscópica de las lesiones grandes y masivas del manguito de los rotadores es una técnica segura y efectiva, con buenos resultados funcionales evaluados a medio plazo y un porcentaje de satisfacción superior al 90%.
Nivel de evidencia clínica: Nivel IV.
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