A Prospective Randomized Clinical Study Comparing Two Repair Techniques for Partial-Thickness Articular Sided Rotator Cuff Tears (SS-13)

Abstract

IntroductionAwareness of partial rotator cuff tears continues to increase in concert with imaging modality improvements and arthroscopic technique advancements. Although partial rotator cuff tears cause frequent shoulder pain and dysfunction, the optimal surgical treatment of partial-thickness rotator cuff tears is still debated. The purpose of this study was to prospectively compare clinical outcomes and tendon integrity potential of the arthroscopic transtendon repair technique and arthroscopic repair after conversion to full-thickness tear in patients with a symptomatic partial-thickness articular sided rotator cuff tear.MethodsForty-eight consecutive patients with a symptomatic partial-thickness articular sided rotator cuff tear more than 50% of thickness were randomly assigned to two groups at the time of operation. Twenty-four patients received arthroscopic rotator cuff repair using a transtendon technique (group I) and others received arthroscopic rotator cuff repairs after tear completion (group II). Indications for surgery included symptomatic partial-thickness articular sided rotator cuff tear exceeding 50% of the tendon thickness in non-athletic patients who failed conservative treatment. Partial-thickness articular sided rotator cuff tears were diagnosed using preoperative MRI findings and tear depths were confirmed at the time of surgery. Pain intensity and patient satisfaction were assessed by visual analogue scales and functional outcomes were evaluated using ASES and Constant shoulder scores. Tendon integrity was evaluated by MRI at 6 months after surgery.ResultsNo significant demographic differences were observed between the two groups. Clinical outcomes were significantly improved after repair in both groups at an average of 31 months follow-up. Average ASES scores increased from 50.8 ± 4.3 preoperatively to 89.1 ± 2.1 at final follow-up in group I (p<0.001) and from 49.2 ± 4.2 preoperatively to 86.2 ± 3.2 at final follow-up in group II (p<0.001). Constant shoulder scores also improved from 54.8 ± 2.6 to 84.8 ± 2.7 in group I (p<0.001) and from 59.0 ± 3.1 to 87.1 ± 2.4 in group II (p<0.001). Twenty-two of the 24 patients in each group (92%) were satisfied with their surgeries and clinical outcomes. However, shoulder function and range of shoulder motion recovered faster in group II during the recovery period (ASES, 54.9 ± 3.7 vs 64.6 ± 3.2 (p=0.037)) and Constant scores; 57.9 ± 2.9 vs 70.8 ± 3.3, (p=0.019) at 3 months after surgery). Furthermore, patients in group I suffered from significantly more pain (5.9 ± 0.4) than patients in group II (2.8 ± 0.5, p=0.001) until 3 months after surgery. Postoperative adhesive capsulitis developed in 3 patients in group I and in 2 patients in group II. According to postoperative 6-month MRI assessments, all patients in group I achieved complete integrity, whereas 2 patients in group II developed a retear.ConclusionArthroscopic repair of partial-thickness articular sided rotator cuff tears more than 50% of thickness provided satisfactory functional improvements and pain relief regardless of the repair technique. Although repair after conversion to full-thickness tears demonstrated less postoperative morbidity, tendon integrity is a primary concern following repair. On the other hand, the transtendon repair technique resulted in complete tendon integrity, but slower functional recovery. IntroductionAwareness of partial rotator cuff tears continues to increase in concert with imaging modality improvements and arthroscopic technique advancements. Although partial rotator cuff tears cause frequent shoulder pain and dysfunction, the optimal surgical treatment of partial-thickness rotator cuff tears is still debated. The purpose of this study was to prospectively compare clinical outcomes and tendon integrity potential of the arthroscopic transtendon repair technique and arthroscopic repair after conversion to full-thickness tear in patients with a symptomatic partial-thickness articular sided rotator cuff tear. Awareness of partial rotator cuff tears continues to increase in concert with imaging modality improvements and arthroscopic technique advancements. Although partial rotator cuff tears cause frequent shoulder pain and dysfunction, the optimal surgical treatment of partial-thickness rotator cuff tears is still debated. The purpose of this study was to prospectively compare clinical outcomes and tendon integrity potential of the arthroscopic transtendon repair technique and arthroscopic repair after conversion to full-thickness tear in patients with a symptomatic partial-thickness articular sided rotator cuff tear. MethodsForty-eight consecutive patients with a symptomatic partial-thickness articular sided rotator cuff tear more than 50% of thickness were randomly assigned to two groups at the time of operation. Twenty-four patients received arthroscopic rotator cuff repair using a transtendon technique (group I) and others received arthroscopic rotator cuff repairs after tear completion (group II). Indications for surgery included symptomatic partial-thickness articular sided rotator cuff tear exceeding 50% of the tendon thickness in non-athletic patients who failed conservative treatment. Partial-thickness articular sided rotator cuff tears were diagnosed using preoperative MRI findings and tear depths were confirmed at the time of surgery. Pain intensity and patient satisfaction were assessed by visual analogue scales and functional outcomes were evaluated using ASES and Constant shoulder scores. Tendon integrity was evaluated by MRI at 6 months after surgery. Forty-eight consecutive patients with a symptomatic partial-thickness articular sided rotator cuff tear more than 50% of thickness were randomly assigned to two groups at the time of operation. Twenty-four patients received arthroscopic rotator cuff repair using a transtendon technique (group I) and others received arthroscopic rotator cuff repairs after tear completion (group II). Indications for surgery included symptomatic partial-thickness articular sided rotator cuff tear exceeding 50% of the tendon thickness in non-athletic patients who failed conservative treatment. Partial-thickness articular sided rotator cuff tears were diagnosed using preoperative MRI findings and tear depths were confirmed at the time of surgery. Pain intensity and patient satisfaction were assessed by visual analogue scales and functional outcomes were evaluated using ASES and Constant shoulder scores. Tendon integrity was evaluated by MRI at 6 months after surgery. ResultsNo significant demographic differences were observed between the two groups. Clinical outcomes were significantly improved after repair in both groups at an average of 31 months follow-up. Average ASES scores increased from 50.8 ± 4.3 preoperatively to 89.1 ± 2.1 at final follow-up in group I (p<0.001) and from 49.2 ± 4.2 preoperatively to 86.2 ± 3.2 at final follow-up in group II (p<0.001). Constant shoulder scores also improved from 54.8 ± 2.6 to 84.8 ± 2.7 in group I (p<0.001) and from 59.0 ± 3.1 to 87.1 ± 2.4 in group II (p<0.001). Twenty-two of the 24 patients in each group (92%) were satisfied with their surgeries and clinical outcomes. However, shoulder function and range of shoulder motion recovered faster in group II during the recovery period (ASES, 54.9 ± 3.7 vs 64.6 ± 3.2 (p=0.037)) and Constant scores; 57.9 ± 2.9 vs 70.8 ± 3.3, (p=0.019) at 3 months after surgery). Furthermore, patients in group I suffered from significantly more pain (5.9 ± 0.4) than patients in group II (2.8 ± 0.5, p=0.001) until 3 months after surgery. Postoperative adhesive capsulitis developed in 3 patients in group I and in 2 patients in group II. According to postoperative 6-month MRI assessments, all patients in group I achieved complete integrity, whereas 2 patients in group II developed a retear. No significant demographic differences were observed between the two groups. Clinical outcomes were significantly improved after repair in both groups at an average of 31 months follow-up. Average ASES scores increased from 50.8 ± 4.3 preoperatively to 89.1 ± 2.1 at final follow-up in group I (p<0.001) and from 49.2 ± 4.2 preoperatively to 86.2 ± 3.2 at final follow-up in group II (p<0.001). Constant shoulder scores also improved from 54.8 ± 2.6 to 84.8 ± 2.7 in group I (p<0.001) and from 59.0 ± 3.1 to 87.1 ± 2.4 in group II (p<0.001). Twenty-two of the 24 patients in each group (92%) were satisfied with their surgeries and clinical outcomes. However, shoulder function and range of shoulder motion recovered faster in group II during the recovery period (ASES, 54.9 ± 3.7 vs 64.6 ± 3.2 (p=0.037)) and Constant scores; 57.9 ± 2.9 vs 70.8 ± 3.3, (p=0.019) at 3 months after surgery). Furthermore, patients in group I suffered from significantly more pain (5.9 ± 0.4) than patients in group II (2.8 ± 0.5, p=0.001) until 3 months after surgery. Postoperative adhesive capsulitis developed in 3 patients in group I and in 2 patients in group II. According to postoperative 6-month MRI assessments, all patients in group I achieved complete integrity, whereas 2 patients in group II developed a retear. ConclusionArthroscopic repair of partial-thickness articular sided rotator cuff tears more than 50% of thickness provided satisfactory functional improvements and pain relief regardless of the repair technique. Although repair after conversion to full-thickness tears demonstrated less postoperative morbidity, tendon integrity is a primary concern following repair. On the other hand, the transtendon repair technique resulted in complete tendon integrity, but slower functional recovery. Arthroscopic repair of partial-thickness articular sided rotator cuff tears more than 50% of thickness provided satisfactory functional improvements and pain relief regardless of the repair technique. Although repair after conversion to full-thickness tears demonstrated less postoperative morbidity, tendon integrity is a primary concern following repair. On the other hand, the transtendon repair technique resulted in complete tendon integrity, but slower functional recovery.