Integrity of Arthroscopic Complete Repair with Less Optimal Footprint Coverage in Large Rotator Cuff Tears (SS-01)

Abstract

In large to massive rotator cuff tears, it is sometimes difficult to completely cover the original footprint of greater tuberosity even with substantial release. The study purpose was see the retear rate and clinical outcome of those patients who had complete repair but less than complete coverage of the original footprint. To evaluate the healing status with postoperative MRI of large to massive tears that was repaired completely but with less optimal footprint coverage and to report its clinical results. From 2004-2006, 89 large to massive rotator cuff tears were arthroscopically repaired. Among them, twenty consecutive large to massive rotator cuff tear patients who had been repaired completely to the greater tuberosity but with incomplete coverage of original footprint were prospectively classified and retrospectively reviewed. All of the rotator cuff tears were arthroscopically repaired with suture anchors. Preoperative and postoperative clinical assessments were performed with UCLA score, Constant score, and Pain and Functional visual analogue score. The healing status of repaired tendon was evaluated by postoperative MRI focused on tendon integrity, muscle fatty degeneration and muscle atrophy. The mean follow up period was 24 month (12-32). At final follow-up the UCLA and Constant score improved from 15 to 25 and 39 to 73, respectively with statistical significance (p =0.001). Also pain had decreased and functional visual analogue score had improved significantly (p=0.001). The overall retear rate was 50% (10 cases). But, the sizes of reruptured tendon were smaller than the original tear size in all ten patients. There was no significant progression or improvement of fatty degeneration and muscle atrophy of rotator cuff muscles from the preoperative state (p>0.05). Incomplete coverage of the original greater tuberosity footprint in arthroscopic repair of large to massive rotator cuff tear with suture anchors showed relatively high retear rates (50%). However, the clinical results improved significantly similar to previous literatures and retear size decreased significantly compare to the original size. Incomplete coverage of the entire footprint might be possible cause of high retear rate.