In the JournalsPerspective

Arthroscopic side-to-side rotator cuff repair without fixation had higher re-tear rate

Although patients with large, U-shaped, full-thickness rotator cuff tears had satisfactory clinical outcomes with arthroscopic side-to-side repair, published results showed a higher re-tear rate with simple side-to-side fixation performed without footprint fixation.

Researchers evaluated functional scores and integrity of the tendon repairs among 59 patients with large, U-shaped, full-thickness rotator cuff tears who underwent arthroscopic side-to-side repair. Researchers performed a physical examination on all patients 1 day before the operation and performed postoperative evaluations at 3, 6 and 9 months and 1 and 2 years.

Results showed improvements in the VAS score from approximately 5.7 preoperatively to 2.4 postoperatively, in forward flexion with a mean range of motion of 152.7° preoperatively to 164.5° postoperatively and in the mean Constant-Murley score from 57.3 preoperatively to 77.8 postoperatively. Researchers observed cuff integrity on postoperative MRI examinations, with a re-tear rate of 54.2%. However, researchers found a significantly lower re-tear rate among patients who underwent anchor fixation to the medial row (45%) vs. patients who underwent simple side-to-side repair (73.7%). Patients with healed rotator cuff tears did not have significantly different University of California, Los Angeles shoulder ratings and Constant-Murley scores compared with patients who had re-tears, according to results. – by Casey Tingle

 

Disclosures: The authors report no relevant financial disclosures.

Although patients with large, U-shaped, full-thickness rotator cuff tears had satisfactory clinical outcomes with arthroscopic side-to-side repair, published results showed a higher re-tear rate with simple side-to-side fixation performed without footprint fixation.

Researchers evaluated functional scores and integrity of the tendon repairs among 59 patients with large, U-shaped, full-thickness rotator cuff tears who underwent arthroscopic side-to-side repair. Researchers performed a physical examination on all patients 1 day before the operation and performed postoperative evaluations at 3, 6 and 9 months and 1 and 2 years.

Results showed improvements in the VAS score from approximately 5.7 preoperatively to 2.4 postoperatively, in forward flexion with a mean range of motion of 152.7° preoperatively to 164.5° postoperatively and in the mean Constant-Murley score from 57.3 preoperatively to 77.8 postoperatively. Researchers observed cuff integrity on postoperative MRI examinations, with a re-tear rate of 54.2%. However, researchers found a significantly lower re-tear rate among patients who underwent anchor fixation to the medial row (45%) vs. patients who underwent simple side-to-side repair (73.7%). Patients with healed rotator cuff tears did not have significantly different University of California, Los Angeles shoulder ratings and Constant-Murley scores compared with patients who had re-tears, according to results. – by Casey Tingle

 

Disclosures: The authors report no relevant financial disclosures.

    Perspective
    Julie Bishop

    Julie Bishop

    This study has shown that arthroscopic side-to-side margin convergence rotator cuff repair of large U-shaped tears leads to less pain, and increased range of motion, strength, University of California Los Angeles and Constant scores. Furthermore, MRI documented healing was significantly better if the repair incorporated anchor fixation to the greater tuberosity (55%) vs. side-to-side alone (26.3%). Similar to many other studies though, the authors showed that there was no significant difference in outcomes regardless of cuff healing. Given the challenging nature of these tears, it is thus another study supporting that thankfully patients do well, even without complete rotator cuff healing. However, as surgeons we should continually strive to utilize the most effective fixation techniques, and this study supports the additional fixation of the side-to side repair to the greater tuberosity

    • Julie Bishop, MD
    • Professor of orthopedics
      Chief division of shoulder surgery
      Ohio State University department of orthopedics
      Columbus, Ohio

    Disclosures: Bishop reports no relevant financial disclosures.