A Randomized Clinical Trial Comparing Open to Arthroscopic Acromioplasty with Mini-Open Rotator Cuff Repair for Full-Thickness Rotator Cuff Tears

Abstract

Background Rotator cuff tears affect patients’ quality of life. The evolution toward less invasive operative techniques for rotator cuff repair requires appropriate comparisons with the standard open procedure, using validated outcomes in a randomized fashion. Hypothesis There is no difference in disease-specific quality of life outcomes at 2 years between an open surgical repair (open) versus an arthroscopic acromioplasty with mini-open (scope mini-open) repair for patients with full-thickness rotator cuff tears. Study Design Randomized controlled trial; Level of evidence, 1. Methods Patients with unremitting pain, failed nonoperative treatment, and imaging indicating full-thickness rotator cuff tears were included in the study. Massive irreparable cuff tears were excluded. Patients were assessed using the disease-specific Rotator Cuff-Quality of Life index, which produces a maximum score of 100, representing a high quality of life. Secondary shoulder-specific outcomes (American Shoulder and Elbow Society, Shoulder Rating Questionnaire, and Functional Shoulder Elevation Test) were also measured at baseline, 3 and 6 months, and 1 and 2 years. Results The mean Rotator Cuff-Quality of Life scores at an average follow-up of 28 months were not statistically different: open, 86.9 (95% confidence interval: 81.8–92.0); and scope mini-open, 87.2 (95% confidence interval: 80.6–93.8). At 3 months, the patients who underwent scope mini-open showed statistically significantly better outcomes (55.6 vs 71.3; P = .005). The baseline to 3-month difference in Rotator Cuff-Quality of Life scores between the scope mini-open and open groups was also statistically significant. Conclusion Patient outcomes improved from baseline to all postoperative measurement intervals. There was no difference in outcome at 1 and 2 years after surgery between the scope mini-open and open procedures. The quality of life of patients undergoing the arthroscopic acromioplasty with mini-open rotator cuff repair improved statistically significantly and clinically at 3 months compared with the open group.