Prospective evaluation of the effect of rotator cuff integrity on patient outcomes following arthroscopic rotator cuff repair (SS-75)

Abstract

Arthroscopic rotator cuff repair (RCR) has been reported to have good clinical results but 70% to 90% retear rates by ultrasound. This study prospectively evaluates postoperative cuff integrity, as assessed by MRI, and patient outcomes following arthroscopic RCR. Methods: Fifty-two consecutive patients after arthroscopic RCR by a single surgeon were prospectively enrolled for evaluation preoperatively and at one year follow-up, including a postoperative MRI. Any tendon defect was graded a retear, even if smaller than the original tear. Results: Thirty-two patients had completed the arthroscopic RCR protocol and were evaluated. Overall ASES scores improved from 46 to 77, and Constant scores from 52 to71 (P < .05). Strength in forward elevation and external rotation improved significantly, from 5.9 to 9.8 lb, and 9.4 to 13.3 lb (P < .05). The average preoperative tear size was 3.1 cm; 15 tears were <3 cm and 17 >3 m. 47% of the rotator cuffs were intact by MRI. Of tears <3 cm, 80% were intact at follow-up; of tears >3 cm, 18% were intact at follow-up. 13% of massive tears (≥5 cm) were intact by MRI. There was a trend to better scores with an intact cuff (Constant 80, ASES 90, P = .06) than with a retear (Constant 72, ASES 78). Patients with intact cuffs had significantly greater strength of elevation (P < .005) and strength in external rotation (P < .02). Conclusion: Arthroscopic RCR yields excellent clinical outcomes which are better if the tendon is intact at follow-up. Repairs of small and medium tears of the rotator cuff have a high rate of cuff integrity (80%) while the large and massive tears have a higher retear rate. It should be noted that these results evaluate early arthroscopic methods. As techniques continue to evolve, e.g., current use of a double row of anchors, it is hoped that security of repairs of larger tears will improve.