Abstract
BackgroundTo prospectively evaluate patients who underwent a "mini-open" repair versus a completely arthroscopic technique for small to large size rotator cuff tears.MethodsFifty-two patients underwent "mini-open" or all arthroscopic repair of a full thickness tear of the rotator cuff. Patients who complained of shoulder pain and/or weakness and who had failed a minimum of 6 weeks of physical therapy and had at least one sub-acromial injection were surgical candidates. Pre and post-operative clinical evaluations included the following: 1) demographics; 2) Simple Shoulder Test (SST); 3) University of California, Los Angeles (UCLA) rating scale; 4) visual analog pain assessment (VAS); and 5) pre-op SF12 assessment. Descriptive analysis was performed for patient demographics and for all variables. Pre and post outcome scores, range of motion and pain scale were compared using paired t-tests. Analysis of variance (ANOVA) was used to evaluate any effect between dependent and independent variables. Significance was set at p is less than or equal to 0.05.ResultsThere were 31 females and 21 males. The average follow-up was 50.6 months (27 – 84 months). The average age was similar between the two groups [arthroscopic x = 55 years/mini-open x = 58 years, p = 0.7]. Twenty-seven patients underwent arthroscopic repair and 25 underwent repair with a mini-open incision. The average rotator cuff tear size was 3.1 cm (range: 1–5 centimeters). There was no significant difference in tear size between the two groups (arthroscopic group = 2.9 cm/mini-open group = 3.2 cm, p = 0.3). Overall, there was a significant improvement from pre-operative status in shoulder pain, shoulder function as measured on the Simple Shoulder test and UCLA Shoulder Form. Visual analog pain improved, on average, 4.4 points and the most recent Short Shoulder Form and UCLA scores were 8 and 26 respectively. Both active and passive glenohumeral joint range of motion improved significantly from pre-operatively.ConclusionBased upon the number available, we found no statistical difference in outcome between the two groups, indicating that either procedure is efficacious in the treatment of small and medium size rotator cuff tears.Level of EvidenceType III
Highlights
To prospectively evaluate patients who underwent a "mini-open" repair versus a completely arthroscopic technique for small to large size rotator cuff tears
Reported satisfactory outcomes for open repair have ranged from 70% to 95% [9-22]
Hata et al found that a mini-open repair caused less post-operative anterior deltoid atrophy, enabled earlier shoulder flexion, and resulted in improved UCLA Shoulder Scores when compared to a conventional open technique [39]
Summary
To prospectively evaluate patients who underwent a "mini-open" repair versus a completely arthroscopic technique for small to large size rotator cuff tears. The effectiveness of open rotator cuff repair is well established, significant pain and morbidity can be associated with the procedure. A significant limitation to rehabilitation after open repair is pain associated with reattachment of the deltoid to the acromion. Reports have described the evolution of rotator cuff repair to help minimize deltoid trauma and expedite post-operative rehabilitation. Hata et al found that a mini-open repair caused less post-operative anterior deltoid atrophy, enabled earlier shoulder flexion, and resulted in improved UCLA Shoulder Scores when compared to a conventional open technique [39]. Kim et al retrospectively evaluated 76 patients who underwent arthroscopic versus miniopen salvage rotator cuff repair at an average of 39 months postoperatively. The authors noted no statistical difference in shoulder scores, pain and activity between the two techniques [40]
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