The Outcome and Structural Integrity of Arthroscopic Rotator Cuff Repair Using the Double-Row Suture Anchor Technique (SS-39)

Abstract

The purpose of this study was to evaluate the stuctural ingtegrity of double-row rotator cuff repairs using preoperative and postoperative CT arthrogram at a minimum of 2 years clinical follow-up. The results of this study suggest that the structural integrity of rotator cuff repairs performed with the double-row suture anchor technique compare favorably with other cuff repair techniques and significantly relieve pain and function. The reported rate of failure after arthroscopic rotator cuff repair has varied widely. The influence of repair technique on the failure rates and functional outcomes after open or arthroscopic cuff repair remain controversial. The purpose of this study was to evaluate the functional and anatomic results after arthroscopic rotator cuff repair using the double-row suture anchor technique with the use of CT or MRI arthrogram in order to determine the postoperative integrity of the repair. A prospective series of 105 consecutive patients undergoing arthroscopic double-row rotator cuff repair of the supraspinatus or combined supraspinatus and infraspinatus were evaluated at a minimum of two years after surgery (range 24-58 months). The evaluation included routine history and physical, preoperative and postoperative strength, pain, range of motion and Constant scores. Tears were classified as small, large and massive according to the number of tendons torn and the degree of coronal plan retraction based on the classification of Patte. In addition, all patients in this series had a preoperative and postoperative CT arthrogram or MRI arthrogram in order to define the extent of the rotator cuff tear and evaluate the structural integrity of the repair postoperatively. The rate of structural failure after double-row suture anchor fixation in this study was 11.4%. The mean preoperative and postoperative Constant scores were 43.2 points (range 8-83, S.D.±15.1 points) and 80.1 points (range 46-100, S.D.±11.1 points), respectively. There were 36 small rotator cuff tears, 64 large tears of isolated supraspinatus or combined supraspinatus and infraspinatus tendons and 22 massive rotator cuff tears. Seventeen patients had fraying of the subscapularis that did not require repair. Intact rotator cuff repairs were associated with significantly increased strength and active range of motion. Pain relief and all parameters of shoulder function significantly improved after rotator cuff reconstruction. There were no surgical complications. Arthroscopic repair of rotator cuff tears using the double-row suture anchor technique results in a much lower rate of failure than previously reported for either open or arthroscopic repair methods. There was no significant relationship identified between clinical outcomes and age, size of tear, mechanism of injury, duration of symptoms or workman’s compensation. The excellent clinical results in terms of function and pain relief appear to correlate with the integrity of the repair.