Seguimiento de la cicatrización postoperatoria del manguito rotador mediante resonancia magnética seriada: timing de rerupturas y evaluación de resultados funcionales
DOI:
https://doi.org/10.63403/re.v32i1.386Palabras clave:
Lesiones del Manguito Rotador, Artroscopia,, Imagen por Resonancia Magnética, Cicatrización de Heridas Quirúrgicas, Resultado del TratamientoResumen
Introducción: la reconstrucción artroscópica del manguito rotador con técnica en doble fila “equivalente transóseo” ha mostrado menores tasas de rerupturas en comparación con la técnica de simple fila en lesiones medianas, grandes y masivas. Para evaluar la cicatrización mediante Resonancia Nuclear Magnética (RMN), la clasificación de Sugaya es la más utilizada, la cual nos permite categorizar y evaluar la integridad de la reparación.
Objetivo: determinar por resonancia magnética seriada a los tres, seis y doce meses el momento de la falla estructural del manguito rotador, luego de la reparación artroscópica en desgarros medianos, grandes y masivos mediante una técnica estandarizada en doble fila “TOE” (las siglas por su nombre en inglés, transosseous equivalent). El objetivo secundario fue evaluar los resultados funcionales obtenidos al año de la intervención y la asociación entre las rerupturas y dichos resultados.
Materiales y métodos: se realizó un estudio de cohorte retrospectivo donde se evaluaron treinta y seis pacientes con lesiones medianas, grandes y masivas del manguito rotador tratados con reconstrucción artroscópica en doble fila. Se evaluó la cicatrización mediante RMN según los parámetros propuestos por Sugaya a los tres, seis y doce meses del postoperatorio y la evaluación funcional de los pacientes con los scores SSV, SST, WORC y ASES al año de seguimiento.
Resultados: de los treinta y seis pacientes incluidos, con una edad media de 60.2 años, el 19.44 % presentaron rerupturas, la mayoría (85.7 %) en los primeros tres meses. No se evidenciaron rerupturas entre los seis y doce meses. La tasa de cicatrización al año fue del 80.56 %. Todos los scores funcionales evaluados (SSV, SST, WORC y ASES) mostraron mejoras significativas al año postoperatorio (p <0.001).
Conclusión: el seguimiento con RMN seriada en el postoperatorio de las reparaciones del manguito rotador con técnica en doble fila de equivalente transóseo (TOE) mostró que el mayor porcentaje de rerupturas se produjo durante los primeros tres meses. La evaluación de los resultados funcionales al comparar aquellos pacientes con cicatrización completa del tendón, o sin esta, no mostró diferencias significativas al año de seguimiento.
Nivel de evidencia: IV – cohorte retrospectiva
Citas
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