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Comparison of Clinical and Structural Outcomes of Open and Arthroscopic Repair for Massive Rotator Cuff Tear

  • Cho, Nam Su (Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Cha, Sang Won (Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Shim, Hee Seok (Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Juh, Hyung Suk (Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University) ;
  • Rhee, Yong Girl (Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University)
  • Received : 2015.05.04
  • Accepted : 2015.08.16
  • Published : 2016.06.30

Abstract

Background: Management of massive rotator cuff tears can be challenging because of the less satisfactory results and a higher retear rate regardless of the use of open or arthroscopic repair technique. Methods: We retrospectively analyzed 102 cases of massive rotator cuff tear treated with either open or arthroscopic repair. Open repair was performed in 38 patients; and arthroscopic repair, in 64 patients. The mean age at the time of surgery was 59.7 years in the open group and 57.6 years in the arthroscopic group. Results: The Constant score increased from the preoperative mean of 55.9 to 73.2 at the last follow-up in the open repair group and from 53.8 to 67.6 in the arthroscopic repair group (p<0.001 and <0.001, respectively). The University of California at Los Angeles (UCLA) score increased from a preoperative mean of 17.7 to 30.8 at the last follow-up in the open group and from 17.5 to 28.7 in the arthroscopic group (p<0.001 and <0.001, respectively). No statistically significant difference in the Constant and UCLA scores was observed between the two groups at the last follow-up (p=0.128 and 0.087, respectively). Retear was found in 14 patients (36.8%) in the open group and 39 patients (60.9%) in the arthroscopic group (p=0.024). Conclusions: Open and arthroscopic repairs of massive rotator cuff tears may provide satisfactory clinical results with no significant difference. However, a significantly lower retear rate was observed for the open repair group compared with the arthroscopic repair group.

Keywords

References

  1. Gartsman GM, Khan M, Hammerman SM. Arthroscopic repair of full-thickness tears of the rotator cuff. J Bone Joint Surg Am. 1998;80(6):832-40. https://doi.org/10.2106/00004623-199806000-00007
  2. Tauro JC. Arthroscopic rotator cuff repair: analysis of technique and results at 2- and 3-year follow-up. Arthroscopy. 1998;14(1): 45-51. https://doi.org/10.1016/S0749-8063(98)70119-7
  3. Burkhart SS, Danaceau SM, Pearce CE Jr. Arthroscopic rotator cuff repair: analysis of results by tear size and by repair technique-margin convergence versus direct tendon-to-bone repair. Arthroscopy. 2001;17(9):905-12. https://doi.org/10.1053/jars.2001.26821
  4. Bishop J, Klepps S, Lo IK, Bird J, Gladstone JN, Flatow EL. Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study. J Shoulder Elbow Surg. 2006;15(3):290-9. https://doi.org/10.1016/j.jse.2005.09.017
  5. Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am. 2004;86(2):219-24. https://doi.org/10.2106/00004623-200402000-00002
  6. Harryman DT 2nd, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA 3rd. Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am. 1991;73(7):982-9. https://doi.org/10.2106/00004623-199173070-00004
  7. Nho SJ, Adler RS, Tomlinson DP, et al. Arthroscopic rotator cuff repair: prospective evaluation with sequential ultrasonography. Am J Sports Med. 2009;37(10):1938-45. https://doi.org/10.1177/0363546509335764
  8. Denard PJ, Jiwani AZ, Ladermann A, Burkhart SS. Long-term outcome of arthroscopic massive rotator cuff repair: the importance of double-row fixation. Arthroscopy. 2012;28(7):909-15. https://doi.org/10.1016/j.arthro.2011.12.007
  9. Verma NN, Dunn W, Adler RS, et al. All-arthroscopic versus mini-open rotator cuff repair: a retrospective review with minimum 2-year follow-up. Arthroscopy. 2006;22(6):587-94. https://doi.org/10.1016/j.arthro.2006.01.019
  10. Yoo JC, Ahn JH, Koh KH, Lim KS. Rotator cuff integrity after arthroscopic repair for large tears with less-than-optimal footprint coverage. Arthroscopy. 2009;25(10):1093-100. https://doi.org/10.1016/j.arthro.2009.07.010
  11. DeOrio JK, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am. 1984;66(4):563-7. https://doi.org/10.2106/00004623-198466040-00011
  12. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;(214): 160-4.
  13. Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. Endresult study of factors influencing reconstruction. J Bone Joint Surg Am. 1986;68(8):1136-44. https://doi.org/10.2106/00004623-198668080-00002
  14. Lo IK, Burkhart SS. Arthroscopic repair of massive, contracted, immobile rotator cuff tears using single and double interval slides: technique and preliminary results. Arthroscopy. 2004;20(1):22-33. https://doi.org/10.1016/j.arthro.2003.11.013
  15. Rhee YG, Vishvanathan T, Thailoo BKBR, Rojpornpradit T, Lim CT. The" 3 Sister Portals" for arthroscopic repair of massive rotator cuff tears. Tech Shoulder Elb Surg. 2007;8(2):53-7. https://doi.org/10.1097/bte.0b013e3180335cc9
  16. Gusmer PB, Potter HG, Donovan WD, O'Brien SJ. MR imaging of the shoulder after rotator cuff repair. AJR Am J Roentgenol. 1997;168(2):559-63. https://doi.org/10.2214/ajr.168.2.9016248
  17. Gazielly DF, Gleyze P, Montagnon C. Functional and anatomical results after rotator cuff repair. Clin Orthop Relat Res. 1994;(304):43-53.
  18. Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am. 2000;82(4):505-15. https://doi.org/10.2106/00004623-200004000-00006
  19. Goutallier D, Postel JM, Gleyze P, Leguilloux P, Van Driessche S. Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg. 2003;12(6):550-4. https://doi.org/10.1016/S1058-2746(03)00211-8
  20. Bedi A, Dines J, Warren RF, Dines DM. Massive tears of the rotator cuff. J Bone Joint Surg Am. 2010;92(9):1894-908. https://doi.org/10.2106/JBJS.I.01531
  21. Bigliani LU, Cordasco FA, McLlveen SJ, Musso ES. Operative repair of massive rotator cuff tears: Long-term results. J Shoulder Elbow Surg. 1992;1(3):120-30. https://doi.org/10.1016/1058-2746(92)90089-L
  22. Trappey GJ 4th, Gartsman GM. A systematic review of the clinical outcomes of single row versus double row rotator cuff repairs. J Shoulder Elbow Surg. 2011;20(2 Suppl):S14-9. https://doi.org/10.1016/j.jse.2010.12.001
  23. Burkhead WZ Jr, Skedros JG, O'Rourke PJ, Pierce WA, Pitts TC. A novel double-row rotator cuff repair exceeds strengths of conventional repairs. Clin Orthop Relat Res. 2007;461:106-13.
  24. Kim DH, Elattrache NS, Tibone JE, et al. Biomechanical comparison of a single-row versus double-row suture anchor technique for rotator cuff repair. Am J Sports Med. 2006;34(3):407-14. https://doi.org/10.1177/0363546505281238
  25. Park MC, Cadet ER, Levine WN, Bigliani LU, Ahmad CS. Tendon-to-bone pressure distributions at a repaired rotator cuff footprint using transosseous suture and suture anchor fixation techniques. Am J Sports Med. 2005;33(8):1154-9. https://doi.org/10.1177/0363546504273053
  26. Sano H, Yamashita T, Wakabayashi I, Itoi E. Stress distribution in the supraspinatus tendon after tendon repair: suture anchors versus transosseous suture fixation. Am J Sports Med. 2007;35(4):542-6. https://doi.org/10.1177/0363546506296310
  27. Mellado JM, Calmet J, Olona M, et al. Surgically repaired massive rotator cuff tears: MRI of tendon integrity, muscle fatty degeneration, and muscle atrophy correlated with intraoperative and clinical findings. AJR Am J Roentgenol. 2005;184(5):1456-63. https://doi.org/10.2214/ajr.184.5.01841456
  28. Liu SH, Baker CL. Arthroscopically assisted rotator cuff repair: correlation of functional results with integrity of the cuff. Arthroscopy. 1994;10(1):54-60. https://doi.org/10.1016/S0749-8063(05)80293-2
  29. Zumstein MA, Jost B, Hempel J, Hodler J, Gerber C. The clinical and structural long-term results of open repair of massive tears of the rotator cuff. J Bone Joint Surg Am. 2008;90(11): 2423-31. https://doi.org/10.2106/JBJS.G.00677
  30. Maman E, Harris C, White L, Tomlinson G, Shashank M, Boynton E. Outcome of nonoperative treatment of symptomatic rotator cuff tears monitored by magnetic resonance imaging. J Bone Joint Surg Am. 2009;91(8):1898-906. https://doi.org/10.2106/JBJS.G.01335