Abstract
BackgroundArthroscopic rotator cuff repair has become popular in the last few years because it avoids large skin incisions and deltoid detachment and dysfunction. Earlier arthroscopic single-row (SR) repair methods achieved only partial restoration of the original footprint of the tendons of the rotator cuff, while double-row (DR) repair methods presented many biomechanical advantages and higher rates of tendon-to-bone healing. However, DR repair failed to demonstrate better clinical results than SR repair in clinical trials. MR imaging at 3 Tesla, especially with intra-articular contrast medium (MRA), showed a better diagnostic performance than 1.5 Tesla in the musculoskeletal setting. The objective of this study was to retrospectively evaluate the clinical and 3 Tesla MRA results in two groups of patients operated on for a medium-sized full-thickness rotator cuff tear with two different techniques.MethodsThe first group consisted of 20 patients operated on with the SR technique; the second group consisted of 20 patients operated on with the DR technique. All patients were evaluated at a minimum of 3 years after surgery. The primary end point was the re-tear rate at 3 Tesla MRA. The secondary end points were the Constant-Murley Scale (CMS), the Simple Shoulder Test (SST) scores, surgical time and implant expense.ResultsThe mean follow-up was 40 months in the SR group and 38.9 months in the DR group. The mean postoperative CMS was 70 in the SR group and 68 in the DR group. The mean SST score was 9.4 in the SR group and 10.1 in the DR group. The re-tear rate was 60% in the SR group and 25% in the DR group. Leakage of the contrast medium was observed in all patients.ConclusionsTo the best of our knowledge, this is the first report on 3 Tesla MRA in the evaluation of two different techniques of rotator cuff repair. DR repair resulted in a statistically significant lower re-tear rate, with longer surgical time and higher implant expense, despite no difference in clinical outcomes. We think that leakage of the contrast medium is due to an incomplete tendon-to-bone sealing, which is not a re-tear. This phenomenon could have important medicolegal implications.Level of evidence III. Treatment study: Case–control study.
Highlights
Arthroscopic rotator cuff repair has become popular in the last few years because it avoids large skin incisions and deltoid detachment and dysfunction
We evaluated clinically and radiologically two groups of patients operated on in our Department by the senior author for an arthroscopic repair of a medium-sized fullthickness rotator cuff tear [39], with either SR repair or “DR double-pulley” repair according to Arrigoni et al [42]
In the DR group there were 12 males and 8 females, the average age at follow-up was 63 ± 7 years, and the dominant arm was involved in 17 cases
Summary
Arthroscopic rotator cuff repair has become popular in the last few years because it avoids large skin incisions and deltoid detachment and dysfunction. In several studies, double-row (DR) repair methods showed, when compared to SR repair methods, better fixation strength [6,7,8,9,10,11], better restoration of the footprint area [7,12,13,14,15,16,17], less micromovements [18] and greater, but more homogeneous, compression pressure through the tendon [16,17,19] These biomechanical advantages led to the higher rates of tendon-to-bone healing observed with DR repair in several studies [3,10,20,21,22,23]; DR repair failed to demonstrate better clinical results than SR repair in clinical trials [10,20,24,25,26,27]
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