Mini-open Repair Research Articles

Outcome of mini open anterolateral rotator cuff repair by suture anchor

Background: Rotator cuff tears are a prevalent cause of shoulder pain and dysfunction, necessitating effective surgical interventions to restore function and alleviate symptoms. The mini open anterolateral rotator cuff repair technique using suture anchors has emerged as a promising approach, combining the advantages of arthroscopic and open surgery. This study aimed to evaluate the outcomes of mini open anterolateral rotator cuff repair with suture anchors, focusing on pain relief, range of motion, functional outcomes, complications, and radiographic assessments. Methods: A retrospective analysis was conducted on 30 patients who underwent mini open anterolateral rotator cuff repair. Patient demographics, surgical details, postoperative outcomes, complications, and radiographic findings were evaluated. Results: The average pain score significantly decreased from 7.8 (SD=1.2) preoperatively to 2.3 (SD=0.8) postoperatively (p<0.001). Range of motion improved with an average increase from 60 to 150 degrees of abduction and from 50 to 140 degrees of flexion (p<0.001). Functional outcomes, assessed by the American Shoulder and Elbow Surgeons (ASES) score, increased from 45 to 85 points (p<0.001). Complications, including joint stiffness, pain, and re-tears, were effectively managed. Radiographic assessments demonstrated satisfactory healing and alignment in the majority of patients. Conclusions: Mini open anterolateral rotator cuff repair with suture anchors is an effective and safe surgical approach for managing rotator cuff injuries, leading to improved clinical outcomes and favorable radiographic findings. Further research is warranted to validate these findings and optimize treatment strategies.

Rotator Cuff Repair by All-Arthroscopic Versus Mini-Open Technique: A Comparison of Clinical and Functional Outcome.

Rotator cuff tears can lead to debilitating shoulder function and impairment. Rotator cuff repair aims to eliminate pain and improve function with increased shoulder strength and range of motion. This study evaluated the differences between all-arthroscopic (AA) and mini-open (MO) repair procedures for rotator cuff tendon tears regarding clinical and functional outcomes. This was a prospective study conducted at a tertiary care government Hospital in Kolkata, India, between March 2015 and September 2016 which evaluated 25 patients who had undergone all-arthroscopic surgery and 25 patients who underwent mini-open repair (total of 50 patients) for rotator cuff tear with a minimum one-year follow-up. The UCLA score was used to assess the functional outcome of these patients. The mean age of all patients included in this study was 45.32 years. 86% of patients were male. The two groups had similar demographic characteristics, pre-operative baseline parameters, and intra-op findings. The average UCLA score showed significant improvement from 13.92 pre-operatively to 29.76 at the final follow-up. The patients in the all-arthroscopic surgery group experienced a notable decrease in pain within the first three months compared to the mini-open group. However, at the time of the final follow-up, no significant difference was noted between both groups when comparing the University of California at Los Angeles (UCLA) score, Visual Analogue Scale (VAS) score for pain, and active or passive glenohumeral motion. The outcomes of all-arthroscopic and mini-open rotator cuff repair surgery are equivocal in terms of both clinical and functional results, with no significant difference in post-operative pain, shoulder joint strength range of motion, or patient satisfaction over the long term.

Incidence and risk factors for shoulder stiffness after open and arthroscopic rotator cuff repair.

The aim of this study was to estimate the incidence of stiffness during the first 6 months after rotator cuff repair and to evaluate postoperative stiffness with respect to its risk factors and its influence on the outcome at 6 months postoperatively. In a prospective cohort of 117 patients (69 women, 48 men; average age 59) from our institutional rotator cuff registry, who underwent either arthroscopic (n = 77) or open (n = 40) rotator cuff repair, we measured shoulder range of motion (ROM) at 3 and 6 months post-surgery. We evaluated the incidence of stiffness and analyzed functional outcomes, comparing various preoperative and intraoperative factors in patients with stiffness to those without at the 6-month mark. Shoulder stiffness was observed in 31% of patients (36/117) at 3 months postoperatively, decreasing to 20% (23/117) at 6 months. No significant link was found between stiffness at 6 months and demographic factors, preoperative stiffness, tear characteristics, or the type of repair. Notably, patients undergoing arthroscopic repair exhibited a 4.3-fold higher risk (OR 4.3; 95% CI 1.2-15.6, p = 0.02) of developing stiffness at 6 months compared to those with mini-open repair. Despite these differences in stiffness rates, no significant variation was seen in the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, or Visual Analog Scale (VAS) scores at 6 months between the groups. The incidence of postoperative shoulder stiffness following rotator cuff repair was substantial at 31% at 3 months, reducing to 20% by 6 months. Mini-open repair was associated with a lower 6-month stiffness incidence than arthroscopic repair, likely due to variations in rehabilitation protocols. However, the presence of stiffness at 6 months post-surgery did not significantly affect functional outcomes or pain levels.

A Comparative Analysis of Functional Recovery in Surgical Rotator Cuff Tear Repair: Mini-Open Versus All-Arthroscopic Techniques.

Rotator cuff tears frequently lead to shoulder pain and impaired function, often necessitating surgical intervention to achieve the best results. The choice between mini-open and all-arthroscopic techniques remains a subject of debate, with each approach offering unique advantages and challenges. This study seeks to evaluate and compare the functional outcomes of surgical repair utilizing these two techniques, offering valuable insights into their relative effectiveness. This retrospective observational study was conducted at Shree Krishna Hospital, Karamsad, involving patients treated surgically for rotator cuff tears over the past five years. Clinical records were reviewed to identify patients who underwent either mini-open or all-arthroscopic repair. Follow-up assessments were conducted using the Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) score and the Visual Analog Scale (VAS) for pain. A statistical analysis was performed to compare outcomes between the two groups. A total of 33 patients were included, with 16 undergoing mini-open repair and 17 undergoing all-arthroscopic repair. The mean follow-up duration was 31.06 months for mini-open repair and 20.4 months for all-arthroscopic repair. No statistically significant variances were observed in the postoperative Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) scores or Visual Analog Scale (VAS) scores between the two groups. Both techniques demonstrated satisfactory functional recovery and pain relief at long-term follow-up. Our study provides evidence of comparable outcomes between mini-open and all-arthroscopic techniques for rotator cuff repair. Despite limitations such as a small sample size and the subjective nature of Quick DASH scores, both approaches offer promising results in terms of functional improvement and pain reduction. Further research is needed to assess short-term outcomes, cost-effectiveness, and patient satisfaction, but our findings support the continued use of both techniques in clinical practice.

All-arthroscopic versus mini-open double row rotator cuff repair – A prospective randomised control study based on functional and radiological outcomes

PurposeIn an era where arthroscopic rotator cuff repair is dominant in the United States (77.9 % preference) compared to open surgery (53.33 %), a shift towards minimally invasive All-Arthroscopic (AA) techniques over classical Mini-Open (MO) repair is emerging. This study explores current trends in shoulder procedures in India and compares functional outcomes and radiological repair integrity between AA and MO techniques, which are understudied in the Indian context. MethodologyIn this prospective study, 60 patients (30 in the AA group and 30 in the MO group) with rotator cuff tears underwent assessment. Pre/post-operative clinical evaluations and 12-month follow-ups using UCLA and Oxford Shoulder Score, along with preoperative MRI and postoperative USG, were conducted. ResultsAt one-year follow-up, the AA group showed better functional outcomes (53.3 % excellent/good vs. 30.0 % in MO). No significant radiological differences (Sugaya grading) were found. Tear size was comparable with no association with functional/radiological outcomes. ConclusionThe AA group demonstrated favourable functional outcomes, matched to MO group findings, which is in accordance with global studies. Despite higher costs, the increasing popularity of AA in India is justified by enhanced results and reduced postoperative discomfort.

Comparative Analysis of Mini Open versus Arthroscopic Repair of Supraspinatus Tears

Background and Aim: Among all the rotator cuff tendon injuries, supraspinatus tear is very common and it is mostcommon in older individuals. Before the arthroscopy came into high demand, the open repair of supraspinatustear was the preferred method of surgery. Recently, the miniopen technique of repair has also gained popularitybecause of certain factors like better repair strength, requires less expertise and facilitates early active mobilization.Present stud was performed to compare functional and clinical outcomes of arthroscopic and mini-open repair.Material and Methods: The present analysis is the randomized control study done on the patients diagnosedwith rotator cuff tears and was planned with supraspinatus repair with the use of arthroscopic and mini opentechnique. As per the inclusion and exclusion criteria total of 128 patients were included in the study. The includedpatients were equally divided into two groups: 64 patients who underwent mini-open repair and 64 patientswho underwent arthroscopic repair. Follow up was done after 12 months postoperatively and the results wereevaluated using University of California Los Angeles (UCLA) shoulder score.Results: For arthroscopic repair group, UCLA shoulder score were: 26 patients got excellent result, 30 patients gotgood result and only 8 patients got fair result. In the other group UCLA shoulder score were: 22 patients in whomexcellent results were obtained good results were obtained in 32 patients and in 10 patients we got fair results.Conclusion: The arthroscopic procedure decreased postoperative pain, faster regains normal ROM and quickerreturn to function and in turn early return to work compared to mini-open procedure. The arthroscopic procedurebetter in addressing intra-articular and other associated problems than mini-open technique.

Mini open anterolateral rotator cuff tear repair with the help of suture anchor

Background: It is generally accepted that mini open rotator cuff tear repair with the help of suture anchor gives satisfactory results in the long term, although most studies have so far shown a fairly high rate of good structural and functional outcome. The purpose of this study is to asses functional outcome of mini-open anterolateral rotator cuff tear repair with the help of suture anchor. Method: The 30 consecutive rotator cuff tear patients were selected from outpatient department at medical college. All patients were diagnosed with full thickness rotator cuff tear and subsequently treated with mini-open anterolateral approach technique. Each patient was clinically assessed with DASH questionnaire and constant Murley score for their satisfaction. Results: After a minimum of 12 month follow up period, the average clinical outcome scores all improved significantly at the time of final follow up. Conclusions: Patient with mini-open anterolateral rotator cuff tear repair with the help of anchor suture showed improvement in their functional outcome and range of motion.

Hybrid Percutaneous Management of Acute Midsubstance Achilles Tendon Ruptures

Background: Operative management techniques of Achilles tendon ruptures can be categorized into open repair, mini-open repair, or percutaneous repair. Indications: Surgical repair of acute ruptures of the Achilles tendon is indicated in athletic populations, with percutaneous repair being an effective technique with more favorable outcomes. Technique: With the patient prone, the Achilles rupture is identified and the Percutaneous Achilles Repair System (PARS) jig is inserted under the proximal paratenon. A series of Keith needles and flat braided SutureTape sutures are passed transversely across the proximal stump of the tendon. The sutures are then shuttled through the distal stump using a SutureLasso through medial and lateral percutaneous incisions on the distal medial and distal lateral borders of Achilles, respectively. Sutures are passed, tensioned, and secured to the posterior tuberosity of the calcaneus with two SwiveLock anchors. Results: Percutaneous repair, compared with open repair, results in lower wound complication rates, improved cosmetic appearance and fewer adhesions. Following surgery, patients follow a 5-stage rehabilitation protocol with return to sport when patients demonstrate dynamic neuromuscular control during multiplane activities without pain or swelling. Outcome studies have compared percutaneous repairs to open repairs, with percutaneous repairs demonstrating a quicker return to work or baseline activities (2.8 months versus 5.6 months) and a shorter return to play for athletes (average 18 weeks). Also, a greater number of PARS patients were able to return to baseline activities within 5 months (98%), compared with open repair patients (82%; P = .0001). In a prospective randomized controlled trial of 33 patients, Lim et al reported no postoperative wound infections in the percutaneous group and a 21% infection rate in the open repair group ( P = .01). Finally, in a recent systematic review of only percutaneous repairs, reported rates of sural nerve injury and rerupture were only 3.3% and 2.1%, respectively. Discussion/Conclusion: Compared to open repair, percutaneous Achilles repair allows for decreased risk of soft-tissue complications with comparable functional outcomes and earlier return to activity. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Functional Outcome of Management of Isolated Supraspinatus Tendon Tear by Mini-open repair TechniqueA Prospective Interventional Study

Introduction: Rotator Cuff Injuries (RCIs) are common shoulder injuries, and the supraspinatus muscle, which is part of the rotator cuff, plays a crucial role in shoulder abduction. The mini-open repair technique offers several advantages, including being less invasive, leading to reduced postoperative morbidity, and shorter operative times. Aim: The aim of this prospective interventional study was to assess the functional consequences of open microscopic repair and the functional implications of supraspinatus tendon repair following the procedure and during the postoperative healing period. Materials and Methods: The study was conducted at the Department of Orthopaedics at Great Eastern Medical School and Hospital in Srikakulam, Andhra Pradesh, India. The study duration was one year, from July 2020 to July 2022. A total of 120 patients aged between 20 and 60 years were included, and all surgeries were performed by the same surgeon. Patients were followed up for one year and evaluated with ConstantMurley Score (CMS) system. Patient data were analysed based on gender, age, degree of tears, clinical test results, and postoperative scores. Levene’s test was used to determine variance homogeneity, and the Student’s t-test (two-tailed, dependent) was used to determine the statistical significance of study parameters on a continuous scale within each group. Results: The study included 120 patients (84 males and 36 females), and the majority of them had traumatic tears. When data was analysed based on patient age, the majority were between 46 and 50 years (33 patients, 27%), followed by the age group of 41-45 years. At the end of one year, the outcomes were excellent in 68 patients, good in 24 patients, satisfactory in 16 patients, and poor in 12 patients. Conclusion: Based on the results of the mini-open technique, the authors concluded that mini-open rotator cuff repair resulted in superior repair integrity and shoulder function.

Comparison of Locking-Loop Suture Bridge Repair and Single-Row Suture Anchor Repair in Small to Medium Rotator Cuff Tears: A Prospective Cohort Study With Clinical and Ultrasound Evaluations.

Single-row (SR) and double-row repair techniques have been described to treat rotator cuff tears. We present a novel surgical strategy of arthroscopic-assisted mini-open repair in which a locking-loop suture bridge (LLSB) is used. To compare the functional outcomes and repair integrity of LLSB technique to the SR technique for arthroscopic-assisted mini-open repair of small to medium rotator cuff tears. Cohort study; Level of evidence, 3. Included were 39 patients who underwent LLSB repair (LLSB group) and 44 patients who underwent SR suture anchor repair (SR group) from 2015 to 2018. We evaluated all patients preoperatively and at 3, 6, 12, and 24 months postoperatively using the visual analog scale (VAS) for pain, Oxford Shoulder Score (OSS), and American Shoulder and Elbow Surgeons (ASES) score. Also, shoulder sonography was performed at 12 months postoperatively to evaluate repair integrity using the Sugaya classification system. The independent-sample t test was used to analyze functional outcomes (VAS, OSS, and ASES scores), and the Fisher exact test was used to analyze postoperative sonography results. Patients in both the LLSB and SR groups saw a significant improvement on all 3 outcome measures from preoperatively to 24 months postoperatively (P < .001 for all). However, when comparing scores between groups, only the scores at 3 months postoperatively differed significantly (VAS: P = .002; OSS: P < .001; ASES: P = .005). Shoulder sonography at 12 months postoperatively revealed no significant difference in repair integrity between the LLSB and SR groups (retear rate: 10.26% and 6.82%, respectively; P = .892). Better outcome scores were seen at 3-month follow-up in the LLSB group, with no difference in retear rates compared with the SR group at 12 months postoperatively. The LLSB technique was found to be a reliable technique for rotator cuff repair of small- to medium-sized tears.

Mini-Open Achilles Tendon Repair: Improving Outcomes While Decreasing Complications.

An acute rupture of the Achilles tendon is a traumatic injury that can cause considerable morbidity and reduced function. Nonoperative intervention may put patients at higher risk of rerupture, whereas surgical intervention carries risk of infection, wound complications, and iatrogenic nerve injury. The mini-open Achilles tendon repair technique has been popularized in helping decrease complications. The goal of this study was to examine and compare the functional outcomes and rate of complications in patients treated with a mini-open repair technique versus a traditional open repair for acute Achilles tendon ruptures. A retrospective review was performed of all patients with a complete Achilles tendon rupture that were treated by a single foot and ankle fellowship-trained surgeon. Functional outcome scores were assessed using the American Orthopaedic Foot and Ankle scoring system (AOFAS) and the Achilles Tendon Rupture Score (ATRS). Eighty-one patients with a complete Achilles tendon rupture underwent mini-open repair and 22 patients underwent traditional open repair surgery between 2013 and 2020. The mean follow-up was 38.40 months (range, 12-71). Mean preoperative AOFAS and ATRS improved in the mini-open group from 45.60 and 47.18 respectively, to 90.29 and 87.97 after surgery (p < .05). Mean preoperative AOFAS and ATRS scores for the traditional open repair (n = 22) cohort were 44.02 and 42.27, respectively. Postoperatively, the AOFAS and ATRS scores improved to 85.27 and 86.64 (P value < .05), respectively. There was no statistically significant difference in postoperative ATRS scores. However, the mini-open repair group showed a statistically higher postoperative AOFAS score (90.30) than the traditional open-repair group (85.27) (P value < .05). The overall complication rate for our study was 2.9% (2 mini-open repair and 1 traditional open repair). The complication rate in the mini-open repair group and traditional open repair cohort were 2.4% and 4.5%, respectively (P value > .05). One patient in the mini-open repair cohort (1.2%) reruptured his Achilles tendon 4 months postoperatively. A second patient in the mini-open repair group (1.2%) developed a superficial skin infection and suture irritation. One patient (4.5%) in the traditional open repair group developed a superficial skin infection. There were no sural nerve injuries in our series. The mini-open approach to repair a ruptured Achilles tendon is a viable treatment option to decrease the incidence rate of postoperative complications and rerupture rates while also producing a superior cosmetic result.Level of Evidence: 3 (retrospective cohort study N ≥ 30).

Achilles Tendon Rupture Repairs: Clinical Outcomes of a Novel Technique

Category:Trauma; Ankle; SportsIntroduction/Purpose:Acute Achilles tendon rupture repair has undergone several changes in the past decade, aiming to minimize complications while maximizing clinical outcomes. Less invasive approaches have been associated with comparable results and decreased infection risk compared with traditional open techniques. Patient positioning during surgery also influences outcomes; prone positioning is associated with increased operative times as well as risk of neuropraxia and ophthalmologic injuries as compared to supine positioning. The Medial Mini-Open Supine (MMOS) Achilles Repair technique combines the benefits of supine positioning and mini-open techniques. This study compares 1-year clinical outcomes, operative times, and complication rates of patients undergoing repair with this novel technique to those treated with an open or mini-open approach with prone positioning.Methods:Patients undergoing operative acute Achilles rupture repair at our institution after February 2015 were included in this study. Patients were grouped by technique used: 1) open repair with prone positioning, 2) mini-open repair with prone positioning, or 3) the medial mini-open repair with supine positioning. Patients were followed for a minimum of 1 year postoperatively. Primary outcome measures include Patient-Reported Outcomes Measurement Information System (PROMIS) scores (Physical Function, Pain Interference and Depression), Foot and Ankle Ability Measure (FAAM) assessments (ADLs and Sport) and Visual Analog Scale (VAS) pain scores. Secondary outcome measures include intraoperative times and complication rates. Statistical analysis to assess for significant differences between the groups was conducted using the Kruskal-Wallis test, Nemenyi test, ANOVA with posthoc Tukey test and chi-square test as was appropriate.Results:A total of 56 patients (Group 1: n=18, Group 2: n=14, Group 3: n=24) were included in this study. Average 1-year PROMIS Physical Function scores were 59.57 (+-12.9), 64.29 (+-13.96) and 63.03 (+-11.69) for Groups 1, 2 and 3 respectively.Average Pain Interference scores were 46.05 (+-17.65), 42.12 (+-8.75) and 42.48 (+-7.11). Depression score averages were 40.79 (+-7.61), 36.87 (+-9.35) and 39.81 (+-9.48) for Groups 1, 2 and 3, respectively. Differences between groups were not significant (p >0.05). Group 3 had statistically significant differences in total OR time compared to both Groups 1 and 2. The median difference was 33 min between Groups 1 and 3, and 35 min between Groups 2 and 3 (p<0.01) The majority of time savings arose from pre- incision setup and post-closure times. Differences in complication rates (5.5% (n=1), 14.3% (n=2), and 12.5% (n=3), for Groups 1, 2 and 3 respectively) were not statistically significant (p=0.73).Conclusion:The Medial Mini-Open Supine Achilles Repair technique shows promise as a viable option for acute Achilles tendon rupture repair; ease of patient positioning preoperatively translates to decreased set up, operative, and sedation time, directly benefiting patients. Patient-reported outcomes at 1-year follow-up demonstrate comparable results with both open and mini-open prone techniques, without an increase in complication rates.

Comparison of mini-open repair system and percutaneous repair for acute Achilles tendon rupture

BackgroundTo reduce incision complications, minimally invasive operative approaches for treatment with acute Achilles tendon rupture have been developed, such as Mini-open repair and percutaneous repair. Which technique is the better surgical option? In the present study, we compared the two surgical procedures— modified Mini-open repair versus percutaneous repair—in the treatment of acute Achilles tendon rupture.MethodsFrom January 2016 to November 2018, 68 matched patients with acute Achilles tendon rupture were divided into treatment group (Mini-open with modified Ma-Griffith technique) and control group (the Ma–Griffith technique). The patients were then treated with different surgical techniques and followed up for no less than 24 months, and the functional outcome scores and complications were retrospectively evaluated.ResultsThe mean follow-up time in Mini-open repair group was 29.0±2.9 months, and that in control group was 27.9±2.9 months (P=0.147). The Mini-open repair group showed reliably higher American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and Achilles tendon Total Rupture Score (ATRS) than the control group in functional assessment (95.0±3.8 vs. 92.3±5.3, P=0.000; 93.8±3.8 vs. 90.9±4.5,P=0.000). There was no cases of sural nerve injury in Mini-open repair group, whereas the percutaneous repair group had 5 cases of the same (P=0.027). No significant differences were found in the calf circumference (32.3±3.9 vs. 31.8±3.6) (P=0.564), range of motion of the ankle (51.3±4.8 vs. 50.5±4.2, P=0.362), or wound complications (34/0 vs. 34/0) (P=1.000) between the two groups at the end of the follow-up time. However, the percutaneous repair group had a shorter average operating time (23.1±5.2 min) than that of the Mini-open repair group (27.7±4.3 min) (P=0.000).ConclusionsAcute Achilles tendon ruptures may be treated successfully with a new Mini-open repair system or percutaneous repair technique. However, the Mini-open repair system may represent a superior surgical option, since it offers advantages in terms of direct visual control of the repair, AOFAS Ankle-Hindfoot Score, Achilles tendon Total Rupture Score and risk of sural nerve palsy.Study designCase-control studies, Level of evidence, 3.

Mini-open Repair for Acute Achilles Tendon Rupture: Ring Forceps vs the Achillon Device

Background: Repair of acute Achilles tendon rupture using the Achillon device is a representative mini-open repair technique; however, the limitations of this technique include the need for special instruments and decreased repair strength. A modified mini-open repair using ring forceps might overcome these limitations. Purpose: To compare the Achillon device with ring forceps in mini-open repairs of acute Achilles tendon rupture. Study Design: Cohort study; Level of evidence, 3. Methods: Fifty patients (41 men and 9 women) with acute Achilles tendon rupture on 1 foot were consecutively treated using mini-open repair techniques. The first 20 patients were treated using the Achillon device (Achillon group), and the subsequent 30 were treated using a ring forceps (forceps group). Clinical, functional, and isokinetic results and postoperative complications were compared between the groups at the last follow-up. Clinical evaluations were performed using the AOFAS (American Orthopaedic Foot and Ankle Society) score, Achilles Tendon Total Rupture Score, length of incision, and operation time. Functional evaluations included active range of motion of the ankle joint, maximum calf circumference, hopping test, and single-limb heel rise (SLHR). Isokinetic evaluations were performed using the isokinetic test for ankle plantar flexion. Results: The AOFAS score (P = .669), Achilles Tendon Total Rupture Score (P = .753), and length of incision (P = .305) were not significantly different between the groups (mean ± SD, 90.1 ± 8.7, 88.3 ± 9.9, and 2.7 ± 0.3 cm in the Achillon group vs 92.2 ± 9.4, 89.9 ± 10.9, and 2.5 ± 0.4 cm in the forceps group, respectively). Operation times in the Achillon group were significantly shorter than those in the forceps group (41.4 ± 9.6 vs 62.8 ± 14.1 minutes, P < .001). The maximum height of the SLHR (P = .042) and the number of SLHRs (P = .043) in the forceps group (79.7% ± 7.4% and 72.9% ± 10.2%) were significantly greater than those in the Achillon group (75.3% ± 7.1% and 66.7% ± 11.0%). No significant differences were detected between the groups in mean peak torques for plantar flexion at angular speeds of 30 deg/s (P = .185) and 120 deg/s (P = .271). There was no significant difference in the occurrence of postoperative complications between the groups (P = .093). Conclusion: The ring forceps technique is comparable to the Achillon technique with respect to clinical, functional, and isokinetic results and postoperative complications. Given that no special instrument is required, the ring forceps technique could be a better option for acute Achilles tendon rupture repair.

Short-term outcomes following mini-open repair of chronic gluteus medius tendon tears using a double-row technique.

ABSTRACTGluteal tendon tears represent a common but underreported cause of lateral hip pain and dysfunction. In case of conservative management failure, a surgical procedure must be performed to relieve patient symptoms. Current operative treatments, either open or endoscopic, have been however associated with different drawbacks which led to the introduction of the mini-open technique. The aim of this study was to evaluate and report the short-term outcomes of patients operated through the aforementioned surgical technique for gluteus medius (GM) chronic tears. We retrospectively analysed the records of 14 consecutive patients operated at the La Tour hospital by mini-open repair using a double-row technique for full-thickness GM chronic tears. Intra- and post-operative complications were recorded. The pre- and post-operative pain on visual analogue scale (pVAS), modified Harris Hip score (mHHS), abduction strength and gait dysfunction were assessed for all patients. Pre- and post-operative values were compared to evaluate whether improvements were statistically significant and clinically relevant. The study cohort comprised 13 women (93%) and 1 man (3%) aged 62.4 ± 18.0 at index surgery. No intra- or post-operative complications were noted. Compared to pre-operative values, patients reported a significant improvement in mHHS (59.1 ± 7.1 vs 92.7 ± 4.6) and pVAS (7.4 ± 1.0 vs 1.3 ± 1.3) at last follow-up. Patients exhibited a perfect improvement in muscle strength (3.6 ± 0.5 vs 5.0 ± 0.0), and the proportion of patients with a positive Trendelenburg sign decreased from 71% to 0%. Mini-open repair of chronic GM tendon tears using a double-row technique demonstrated excellent clinical and functional outcomes at short follow-up. Level of Evidence: IV.

Combined endoscopic and mini-open repair of chronic complete proximal hamstring tendon avulsion: a novel approach and short-term outcomes.

To evaluate the outcome of a novel, combined endoscopic and mini-open repair (CEMR) of a chronic complete retracted proximal hamstring tendon avulsion (PHA). A retrospective case series of a single-surgeon database for all patients, with a minimum of 1-year follow-up, who underwent CEMR between July 2015 and September 2019 was performed. Patients were evaluated for their functional outcome using the Perth Hamstring Assessment Tool (PHAT). At the latest follow-up, patients were evaluated for their muscle strength, subjective satisfaction and post-operative complications. Twelve patients who underwent endoscopic surgery for chronic PHA were identified, of which seven patients underwent CEMR. After exclusion of one patient from the study due to an open claim for health insurance, six patients (five males) with a mean age of 48 years (range 20–61 years) were evaluated. The mean time from injury to surgery was 12 months (range 2–43 months). At a mean follow-up of 28 months (range 12–55 months), the average PHAT score was 73 (range 70–80). The mean subjective activity level percentage improved from 34 (range 20–50) pre-surgery to 81 (range 75–90) post-surgery. The mean strength of the quadriceps, hamstring at 30°, and hamstring at 90° of the operated leg compared to the uninjured leg did not differ significantly. One patient underwent adhesiolysis 1 year after the index procedure for treatment of subcutaneous adhesions. CEMR is a viable and safe option for the treatment of chronic complete proximal hamstring tears, with good to excellent short-term functional outcome. Level of evidence: IV.

Comparison of outcome between mini-open and arthroscopic rotator cuff repair

Introduction: The aim of this study is to compare the outcomes of all-arthroscopic repair and mini-open repair for rotator cuff tendon tear on post-operative pain, shoulder joint range of motion and physical function. Materials and Methods: The study is a prospective comparative study of rotator cuff repair. The patients include in the study are enroll into all-arthroscopic surgery or mini-open surgery groups. The patients are assess by UCLA and ASES scores pre and postoperatively for upto 1-year follow-up. Results: A total of 44 patients are include in the study. We find no statistical significance comparing the UCLA and ASES scores of both groups. The patients in the all-arthroscopic surgery group experience significantly less pain initially. Conclusion: According to the results of this study, the outcomes of mini-open surgery and arthroscopic repair are equivocal, with no difference in post-operative pain, shoulder joint range of motion and patient satisfaction. Keywords: Rotator cuff repair, Rotator cuff tears, Arthroscopic repair.

Septuagenarians aged 75 years and older do benefit from arthroscopic rotator cuff repair: a propensity matched-pair analysis.

BackgroundNumerous studies show that patients who failed conservative management, benefit from open, mini open and arthroscopic rotator cuff repair (ARCR). However, there is a paucity of literature addressing ARCR and outcomes in patients older than the age of 75 years. The purpose of our study was to compare the outcomes of ARCR in patients older than 75 years and younger than 75 years of age.MethodsBetween January 2010 and December 2016, 397 patients underwent unilateral ARCR; of which, 23 patients were 75 years of age and older. Outcome measures recorded include the Constant Shoulder Score (CSS), University of California, Los Angeles Shoulder Score (UCLASS), Oxford Shoulder Score (OSS), and visual analog scale (VAS) for pain assessment.ResultsThere were no statistically significant differences in VAS, CSS, and UCLASS between the two groups at all time points of follow-up (all P > .05). At 2 years after surgery, the OSS was 2 ± 5 points better in the <75 group (P = .012). However, the improvement in OSS was comparable between both groups. The improvement in VAS, CSS, and UCLASS at 2 years after surgery compared with baseline was also similar between the two groups (all P < .05).ConclusionsThe improvement in VAS, CSS, and UCLASS was similar in both groups of patients. We conclude that septuagenarians with symptomatic cuff tears, who have failed conservative management, experience significant improvement in pain, and function after surgery and should not be excluded from the benefits of ARCR.

Comparative Study between Arthroscopic and Mini Open Repair of Rotator Cuff Tear

Rotator cuff tears are common amongst the elderly and athletes. Aim of the work : To assess the functional outcome of arthroscopic rotator cuff repair and mini-open rotator cuff repair. Correlation of any improvement of functional scores with all possible variables to predict factors affecting outcome. A systematic review was conducted in adult patients with rotator cuff tears other than massive or irreparable tears to compare clinical outcomes of patients undergoing all-arthroscopic versus mini-open rotator cuff repair. The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. 15 studies evaluating arthroscopy and mini-open repair for rotator-cuff repair were included in the review . The included evidence was based on comparative studies assessing clinical outcomes or providing sub-group data on outcomes of interest in patients with rotator-cuff tear. ASES was used in 7 studies and showed to be increased post operation in both procedures the mean preoperative score was 36.1 , 34.2 in mini open and arthroscopic groups respectively which increased to 90.7, 88.89 post operative respectively .Pain was detected by VAS score in 9 studies and mean preoperative score was 6, 6.5 in mini open and arthroscopic groups respectively which decreased to 3, 2.6 post operative respectively. Arthroscopy repair and mini-open repair are associated with similar clinical outcomes. The choice of the operating technique depends upon the tear size and surgeon’s preference.

Mini-Open Achilles Repair With a Flat Braided Suture in a Low-Profile Configuration

Achilles repair has evolved over the past 30 years, from large open procedures with high complication rates to shorter, less-invasive procedures with better outcomes. Percutaneous repair has comparable failure rates with open repairs, fewer complications, and faster recovery. However, percutaneous Achilles repairs risk sural nerve injury. A mini-open repair fuses the gap between percutaneous and open procedures, and this approach has the potential to mitigate nerve injury while maintaining the increased efficiency in procedure time and patient recovery. The purpose of this Technical Note and accompanying video is to outline the repair of the Achilles tendon using a mini open repair using a low-profile flat braided suture.