Mini-open Repair Research Articles

Evaluation of long-term postoperative outcomes between mini-open and arthroscopic repair for isolated supraspinatus tears: a retrospective analysis

Despite arthroscopic repair of the rotator cuff is an increasingly popular procedure, the mini-open (MO) repair still remains a viable and appreciated technique. The purpose of the study was to analyze the long-term clinical outcomes of patients with isolated supraspinatus tear undergoing MO or arthroscopic surgery (AS) repair. Forty-six patients underwent supraspinatus repair with anchors: 24 with MO technique and 22 with AS procedure. They were evaluated postoperatively at 3, 6, 12months and 2years. The mean surgery time, the mean hospital stay and the average costs were shorter in the MO patients respect to the AS group. Despite an initial better Disabilities of Arm, Shoulder and Hand and Constant Murley Score in the first 6months of follow-up in the AS group, no differences were detected at 24months. This study suggests that isolated supraspinatus tears can be treated with a MO or arthroscopic repair procedure with similar clinical outcome in the long-term postoperative period. The mean surgery time and the average costs are less in the MO group respect to the AS group.

Mini-Open Reconstruction of Rotator Cuff of The Shoulder

Background: shoulder pain is one of the most common musculoskeletal (MSK) disorder affecting a large portion of the population. It is estimated that one in three persons will have at least only one episode of shoulder pain within their lifetime. Rotator cuff tears are very common in the general population. Radiographic studies have shown the prevalence of rotator cuff tears to be 4-13% in the population aged between 40-60 years and 20% in population whom age between 60-70 years and 30-50% in population above 70 years. Rotator cuff tears are a common pathology associated with degenerative changes in the shoulder joint. They cause significant disability, pain, dysfunction and poor health status and their prevalence is currently increasing within an aging population. Aim of the Work: the aim of this work was to study the results of mini open rotator cuff repair of the shoulder joint. Patients and Methods: this study was conducted on ten patients presented to Al-Azhar University Hospital with rotator cuff tear of the shoulder. They are treated with mini-open repair technique. All our patients completed a period of at least one year of follow up. Results: a clinical success rate was found in ten patients treated by mini open technique, 70% had excellent and good results according to Constant and Murly score after one year of follow up. Conclusion: repair of rotator cuff tears by mini-open technique is one of the good viable options providing improvement in pain and function of the shoulder joint. Also it is more economic than arthroscopic repair and it does not need high learning curve as arthroscopic repair.

Comparative Study between Arthroscopic and Mini Open Rotator Cuff Repair

AbstractBackground: Tears of the rotator cuff are among the most frequently encountered causes of pain and dysfunction in the shoulder. The mechanism of injury may be traumatic or degenerative. Operative treatment includes open, mini open, arthroscopic techniques. We hypothesized a comparative study between mini open and arthroscopic rotator cuff repair.Aim of Work: To assess the functional outcome of arthro-scopic rotator cuff repair and mini-open rotator cuff repair with ASES scores.Methods: A prospective analysis of 30 patients with rotator cuff tears were evaluated before and after repair of the cuff tear by the arthroscopic repair technique (Group A) and the mini-open repair technique (Group B). The first case was managed in September 2014 and the last in June, 2016. All the cases were managed in El-Kasr Al-Ainy and Police-Hospital Agouza. The follow-up period was 6 months. The patients were evaluated using the American Shoulder & Elbow Society score (ASES), both pre-operatively and post-operatively.Results: After follow-up at 3 months ASES total score (100 points) >90 was no patients for mini-open group and for arthroscopic group was 3 patients (20%) after 6 months was 12 patients (80%) for mini-open and 13 patients (86.6%).Conclusion: Mini-open and arthroscopic rotator cuff repair both improved the function of patients, who failed non-operative treatment, but there is no statistical or clinically important difference in function between the two surgical approaches according to ASES score at 6 months post-operatively but arthroscopic earlier improvement in pain and functional out come.

A comparison of full arthroscopic and arthroscopic-assisted mini-open repair methods in rotator cuff tears 1–3 cm in size

IntroductionRetrospective evaluation of rotator cuff repair with arthroscopic or arthroscopic-assisted mini-open methods for a diagnosis of non-retracted rotator cuff tear. Materials and methodsA total of 45 patients underwent rotator cuff repair; Group 1 (n = 24) with arthroscopic-assisted mini-open method and Group 2 (n = 21) with full arthroscopic method. ResultsWithin both Group 1 and Group 2, a statistically significant results is p = 0.001. The patients of Group 2 were seen to return to daily life earlier than those of Group 1 (p = 0.001). ConclusionsPatients where full arthroscopic repair was applied, there was evidence of an earlier return to daily life. Level of evidenceIV, retrospective comparative study.

Mini open versus arthroscopic repair of rotator cuff tear: A prospective and retrospective study in rural area

Background: Rotator cuff abnormalities (including degenerative tears and those due to injury) reportedly account for up to 70% of symptoms associated with the shoulder and have significant effects on quality of life and activities of daily living. Material and Method: The objective of this study was to compare the use of resources, costs and health-related quality of life outcomes associated with arthroscopic and mini open surgical management of rotator cuff tears using follow-up of 2 years data from retrospectively and prospectively.The study was conducted at Pravara Rural Hospital, an associate hospital of Rural Medical Collage Loni during the period of 2016 to 2018.Results: There are total 125 patient’s data collected by retrospectively and prospectively. Among them 60 patient underwent mini open repair and 65 patient underwent arthroscopic repair of rotator cuff tear. There were, 41 % female patient and 59 % male patient in mini open repair, 53% female and 57 % male patients in arthroscopic repair.Conclusion: There is no significant difference in the functional outcome in the patient operated with mini open repair and arthroscopic repair.There is a significant difference in patient’s preference for surgery according to cost effectiveness as study conducted in rural area, so cost effectiveness is really matters for the patients coming from a poor background in rural area.

Long-term results of arthroscopic and mini-open repair of small- to medium-size full-thickness rotator cuff tears.

This retrospective cohort study evaluated functional outcome and structural integrity after arthroscopic- or mini-open repair of small- to medium-size rotator cuff tears assessed at long-term follow-up. All patients operated between 2001 and 2004 were invited to participate. Functional outcome was measured by Constant-Murley Score, Disability of Arm, Shoulder and Hand and Oxford Shoulder Score. Quality of life was assessed with EuroQol Health 5 Dimension. Patient satisfaction was assessed in terms of pain and overall result. Structural integrity of the rotator cuff repair was determined using ultrasound. Of the eligible 62 patients, 44 patients were available for follow-up. After a mean of 11.3 years, 76% of the patients had good to excellent functional outcome on the Constant-Murley Score (median 82, range 29-95). The majority of patients reported good results on both Disability of Arm, Shoulder and Hand and Oxford Shoulder Score (median Disability of Arm, Shoulder and Hand 5.0, range 1.0-54; median Oxford Shoulder Score 19, range 13-39). The quality of life was also good (mean EuroQol Health 5 Dimension utility score 0.88, standard deviation 0.12). Eighty per cent was satisfied with the overall result. Ultrasound examination revealed structural integrity in 76% of all cases. This study shows that functional outcome is good and structural integrity is high for the majority of patients 11.3 years after repair of small- to medium-size rotator cuff lesions.

Osteoarthritis progression of the shoulder: A long-term follow-up after mini-open rotator cuff repair.

This study aimed to investigate whether (1) the primary repair of rotator cuff tears can prevent the progression of osteoarthritis (OA) and (2) the quality of postoperative cuff integrity affects the incidence of osteoarthritic changes. A total of 86 patients treated with mini-open repair for rotator cuff tears over a minimum of 10 years of follow-up (mean ± standard deviation 11.1 ± 1.0 years) were retrospectively analyzed. Preoperative and postoperative radiographs of the affected and unaffected sides were compared, and the degree of OA was evaluated using the Samilson and Prieto classification. Magnetic resonance imaging was used to evaluate cuff integrity, classify patients into good and poor cuff integrity groups, and compare the degree of OA between the two groups. OA deteriorated either significantly or to a similar degree on both sides postoperatively. However, OA progressed in significantly more cases on the affected side. A comparison between the aforementioned cuff integrity groups showed that the postoperative OA of the poor cuff integrity group was significantly worse than that of the good cuff integrity group on the affected side. Our study showed that even if rotator cuff tears are repaired, the progression of osteoarthritic changes cannot be halted. The progression of OA was affected by cuff integrity. Rotator cuff dysfunction due to poor cuff integrity was a risk factor for shoulder arthritis.

Assessment of functional outcome of mini-open rotator cuff repair: a hospital based prospective study

<p class="abstract"><strong>Background:</strong> The mini-open repair is considered to be the gold standard for rotator cuff repair. This study was aimed to assess functional outcome of mini-open rotator cuff repair of shoulder joint in adult patients<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> This was a one year hospital based prospective study conducted from January 2016 to December 2016. A total of 20 patients diagnosed to have rotator cuff tear of shoulder joint undergoing rotator cuff repair in the department of Orthopaedics, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, and KLES Dr. Prabhakar Kore Charitable Hospital, Belagavi were studied.<strong></strong></p><p class="abstract"><strong>Results:</strong> Majority of the patients (85%) of the patients was male and male to female ratio was 5.6:1. Most of the patients were aged between 31 to 40 years (30%). The mean age was 41.90±13.98 years. Most of patients had degenerative rotator cuff tear (45%) and (70%) presented with features of swelling. At enrollment all the patients (100%) had poor constant score (>30) and fair/poor UCLA score (<27) suggestive of severe pain functional restriction. There were gradual but steady increase in scores from enrollment to each follow up till six month follow up with respect to mean flexion (6.25±5.35 to 163.50±7.63),abduction (5.50±5.10 to 112.0±5.94),external rotation (3.00±4.7 to 82.50±2.56 ),internal rotation (2.50±4.44 to 67.25±3.43 ) and UCLA score (5.35±1.63 to 29.60±0.82 ) (p<0.001) also there was gradual but steady decrease in mean VAS score from enrolment (7.70±0.47 ) to six months follow up (0.00±0.00) and constant score ( from 85.70±1.98 to 7.85±1.46 respectively) (p<0.001). The constant score and UCLA score at six month follow up revealed excellent functional outcome<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> The mini-open rotator cuff repair of shoulder joint results in excellent functional outcome among adult patients with rotator cuff tear of shoulder joint especially after six month with no complications and complete pain relief<span lang="EN-IN">.</span></p>

A Percutaneous Knotless Technique for Acute Achilles Tendon Ruptures

Achilles tendon ruptures are a common tendon injury, usually occurring in middle-aged men during recreational sporting activities. Both nonoperative and operative management are employed to treat these injuries. Several operative treatments are described in the literature, including percutaneous Achilles repair, mini-open repair, and open repair. Open Achilles repair is associated with higher rates of impaired wound healing and infection, whereas minimally invasive techniques have been reported to have an increased risk of iatrogenic sural nerve injury. More recently, low complication rates, improved cosmetic appearance, reduced operating times, and improved clinical outcomes have been reported for the percutaneous Achilles repair technique. In this Technical Note, we present our preferred technique using the Percutaneous Achilles Repair System (Arthrex, Naples, FL), which has been reported to have minimal wound and nerve complications, and early return to activity.

Arthroscopic versus mini-open repair of rotator cuff tears

Background Rotator cuff tears are very common in the general population. Different modalities of repair are well established. We describe two surgical techniques for repair, arthroscopic versus mini-open techniques. Patients and methods This prospective study included 20 patients with complete rotator cuff tear (small to large size) with grade A or B retraction with no or little fatty infiltration of cuff muscles. Patients were divided into two groups, each group included 10 patients: one group was treated by arthroscopic repair by anchors and the other group was treated by mini-open repair by anchors. Results For group A treated by arthroscopic repair over the period of follow-up, the mean Constant and Murley score was 82.1 ± 4.8 (76–90), and all the patients were satisfied. For group B treated by mini-open repair over the period of follow-up, the mean Constant and Murley score was 79.8 ± 7.2 (66–90), and eight patients out of 10 were satisfied. There was no statistically significant difference between both groups (p value 0.4). MRI showed satisfactory tendon healing 6 months postoperatively. Postoperative stiffness occurred in one patient undergoing mini-open repair mainly owing to poor compliance with the rehabilitation program. Conclusion Arthroscopic technique and mini-open technique are viable options for repair of rotator cuff tears in our study, with no significant variations noticed between them, although better results in arthroscopic group.

Mini-open Repair of Achilles Tendon Rupture With the Patient in the Supine Position.

Surgical repair of the Achilles tendon is a common procedure for acute Achilles tendon ruptures. Variations in surgical technique and patient positioning exist, with the ultimate goal of achieving a durable repair while minimizing complications. Recently the use of a mini-open approach has been demonstrated to provide a durable repair that is comparable to using a larger traditional open approach. In this paper we describe a mini-open approach for surgical repair of the Achilles tendon while the patient is in the supine position.

Return to Play After Mini-Open Repair of Achilles Tendon Ruptures in the NFL Athlete

Category: Sports Introduction/Purpose: Non-insertional Achilles tendon ruptures are a devastating injury in the National Football League (NFL) athlete. Depending on timing, these often are season ending injuries. There are mixed reports in the literature regarding impact of Achilles injuries in elite athletes. Additionally, there have been advancements in techniques including a mini-open repair that has proven successful. The purpose of this study was to critically analyze a large, single surgeon series of non-insertional Achilles ruptures in NFL athletes treated with a mini-open technique. Our primary focus was to determine return to play and evaluate possible contributing factors that affect this. Additionally, we sought to compare pre and post injury performance for those who successfully returned to the NFL. Methods: NFL athletes treated for non-insertional Achilles ruptures since 2012 were included. Demographic and performance data were obtained from the NFL.com player database and included position, age, years in the league, return to sport and relevant performance metrics listed below. Pre injury frequency of play (games played per total games in season) for athletes were recorded. The impact of injury on performance after return to sport was assessed by comparing data from two years prior and two years post injury, normalized to a “per game” basis. For defensive players, specific metrics included tackles, pass deflection, interceptions and sacks. For offensive players, rushing and receiving statistics for running backs and wide receivers/tight ends were recorded, respectively. Average yards per run/catch, attempts per game, number of 20+ yard plays and touchdowns were recorded. Data was analyzed with Welch’s method 2-Sample t test in Minitab. Results: Thirty-five ruptures were identified in predominantly defensive players (25/35). Ruptures occurred, on average, at age 27.7 years with 4.1 years of NFL experience. There was no significant difference in offensive (70%) and defensive (76%) player’s ability to return to the NFL (p=1.0). The frequency of play in the two seasons prior to injury differed significantly for players who did not return (21%) compared to those who did (95%) (p=.0013). Due to limited skill-position offensive players, further sub- analysis was limited. Defensive players who returned demonstrated significant differences in performance pre-injury compared to players who failed to return. In the two years following injury, returning defensive players performed at near baseline compared to pre injury statistics (figure 1). Conclusion: Achilles injuries occurred predominately in defensive players. Typically occurring past the average NFL career length, it represents a mid to late career injury. The comeback rate of 74% is excellent and is higher than previously reported. Those who failed to return were utilized less frequently pre-injury and had poorer performance statistics (defensive), indicating less talented players were impacted to a greater extent. Lastly, given limited or no differences found in productivity for those who returned, we conclude that while an Achilles injury is most often season ending, most skilled players are able to return with little impact on performance.

Treatment of distal 1/3 tibia fractures: plating versus intramedullary nailing – A prospective comparative study

Aims and Objectives: This study was undertaken to introduce anterolateral approach for mini-open degenerative rotator cuff tear in elderly and evaluate its outcome and effectiveness. Material and Methods: This study evaluated 25 cases that were repaired by mini-open repair using anterolateral approach. There were 15 men and 10 women with average age of 57.4 years. Average follow up was 12.6 months. There were 2 partial thickness, 4 small, 8 medium, 8 large, and 3 massive tears. An incision around 5-6 cm from anterolateral edge of acromion and dissected to the raphe between anterior and middle deltoid. Subacromial decompression was done by removing anteroinferior part of acromion. The torn tendon was repaired through single or double row technique using bony tunnels drilled in greater tuberosity. The deltoid was sutured back to remaining acromion. Clinical outcomes were evaluated using the American Shoulder and Elbow surgeon (ASES) scoring system. Results: The average visual analogue scale (VAS) and ASES scores improved respectively from 8.88, 83.32 preoperatively to 1.04 and 17.68 postoperatively. There were no statistically significant difference between final ASES scores and age, symptom duration. Men had higher final ASES scores than women (p= 0.012)

Comparison of clinical outcomes in all-arthroscopic versus mini-open repair of rotator cuff tears

The aim of the study was to compare the clinical outcomes of patients undergoing all-arthroscopic (AA) or mini-open (MO) rotator cuff repair. The present study evaluated 50 patients who had undergone AA repair and 50 patients who had undergone MO repair with a minimum 1-year follow-up. Every patient was asked to complete the Disabilities of the Arm, Shoulder and Hand (DASH) and visual analog scale (VAS) questionnaires. Constant-Murley score (CMS) and active ranges, forward flexion and external rotation, were also evaluated and documented. One year after surgery, ultrasound evaluation was done to determine the integrity of the rotator cuff for each patient. The average age of enrolled patients at the time of surgery was 53.0 years (range, 40-59 years), and average follow-up was 16.6 months (range, 12-24 months). At 2 weeks, the range of forward flexion in the AA group was larger than that in the MO group (136.5 ± 10.2 vs 132.5 ± 7.7, P = 0.03). On postoperative day 1, the VAS in the MO group was significantly higher than that in the AA group (6.5 ± 0.6 vs 6.1 ± 0.6, P < 0.01). At 1 month, the difference in VAS between both groups reappeared (2.9 ± 0.6 vs 2.6 ± 0.6, P = 0.03). At 1 month, the CMS score of patients in the AA group was higher than that in the MO group (52.8 ± 3.6 vs 50.9 ± 5.0, P = 0.03). At 3 and 6 months, the DASH score of patients in the AA group was lower than that in the MO group (43.8 ± 8.2 vs 47.8 ± 4.4, P < 0.01 and 38.6 ± 4.3 vs 42.7 ± 9.9, P < 0.01, respectively). Mean operative time was longer in the AA group compared with that in the MO group (71.9 ± 17.6 vs 64.7 ± 12.7 minutes, P < 0.01). Five patients (10.0%) in the AA group and 4 patients (8.2%) in the MO group had rotator cuff retear, and 6 patients (12.0%) in the AA group and 8 patients (16.3%) in the MO group had adhesive capsulitis by the end of follow-up. There is no significant difference between the 2 groups in the incidence of complications. We also found that joint exercising at least 3 times per week was associated with better short- and long-term joint function recovery. The AA approach was associated with less pain and lower DASH score as well as higher CMS score in the early recovery period. No difference was found between the 2 groups in primary and secondary outcomes in the long term, or incidence of complications such as adhesive capsulitis and rotator cuff retear. In conclusion, we consider that the AA procedure has better recovery at short-term follow-ups, while both techniques are equivalent regarding long-term outcomes.

The clinical and radiological results of arthroscopic versus arthroscopy assisted mini-open repair of rotator cuff tears

In this study we reported retrospectively the comperative clinical and radiological results of the two most common surgical procedures in rotator cuff tear repair of shoulder, the golden standart arthroscopic and alternative arthroscopically assisted mini-open surgery. We included 58 patients who admitted to our clinic for rotator cuff tear and treated surgically between january 2013 and august 2015. The two groups were composed of arthroscopically treated 29 patients and 29 patients who were treated with arthroscopically assisted mini open surgery. The arthroscopy group included 18 females and 11 males, the mini-open group included 10 females and 19 males. The mean age was 56,0 (39,0-73,0) years, in arthroscopic and 55,0 (40,0-70,0) years in mini-open surgery group. 6 patients in the arthroscopy group(20,7%) and 10 patients in the mini-open group(34,5%) were defining trauma before the beginning of their complaints. The postoperative follow up was 28,9 months in arthroscopy group and 22,6 months in the mini-open surgery group. Preoperative physical or medical treatments were documented. Any additional surgical procedures like biceps long head tenotomy, subacromial decompression and bursectomy were also noted. Patients were evaluated with ASES and Constant shoulder scales before and after the surgery. Patients were evaluated radiologically with MRI at the last follow up for healing and tendon quality. The type 2 acromion was the dominant in both groups constituting the 44,8% of the total number of patients. 24 (82,8%)patients in the arthroscopically treated patients and 18(62,1%) patients in the mini-open group were undergone at least one of the additional surgical treatments. The mean length of the surgical scar was 3,4(3-5) cm in mini open group. None of the patients complained of the surgical scar. 16 patients in the arthroscopy group and 17 patients in the mini-open group had supraspinatus tendon pathology(either tear or degeneration) in the MRI control at the last follow up. Postoperative pain was present in 1 patient in each group who were classified as bad result. There was no statistically meaningful difference between two groups in terms of clinical or radiological results. In conclusion the arthroscopy assisted mini-open surgery may be a useful tool in hands of training surgeons to prevent ineffective treatment of rotator cuff tears.

Mini open versus open repair techniques in Achilles tendon rupture: clinical and isokinetic evaluation.

The aim of the study was to compare the mini-open to the classic open repair techniques for Achilles tendon ruptures. We retrospectively evaluated at a minimum of 2 years follow-up 32 subcutaneous Achilles tendon ruptures; 17 underwent mini-open surgery (Group A) and 15 the open technique (Group B). No difference in Achilles Tendon Total Rupture Score and in modified Leppillahti score was observed. With respect to the contralateral side the width of the operated Achilles tendon was 4.07 mm thicker in Group A and 7.67 mm in Group B (p<.05); the calf circumference reduction was respectively 10 mm and 23.75 mm (p<.05). Iso-kinetic peak force measurement of the calf muscle strength showed a loss of 8.21% in Group A versus 17.25% in Group B (p <.05). The mean Patient Satisfaction Score was 96.76 in Group A and 88.67 in Group B (p<.01); respectively 82.3% vs 66.7% of patients were able to return to previous levels of sporting activity. There were two post-operative complications in Group B and one in Group A. Mini-open technique minimizes the risk of complications, leads to an improved tendon healing process and functional recovery with higher patient satisfaction. IV.

Long-Term Results of Mini-Open Repair Technique in the Treatment of Acute Achilles Tendon Rupture: A Prospective Study.

An ideal surgical treatment of acute Achilles tendon rupture includes restoring the original length of the tendon, minimizing possible adhesions with the surrounding tissues, minimizing the risk of repeat rupture, alleviating wound problems, and providing an acceptable cosmetic outcome. In the mini-open repair technique, unlike the percutaneous repair technique, the quality of the tenodesis can be visualized without disturbing the healing potential of the surrounding tissues, thus minimizing wound problems. The purpose of the present study was to assess the long-term results of the mini-open repair technique in patients with acute Achilles tendon rupture. A total of 20 consecutive patients with acute Achilles tendon rupture, admitted to our inpatient clinic from October 2003 to March 2008, were included in the present study. The patients underwent Achilles tenodesis with the mini-open repair technique, and each patient was followed up for 5 years. The study was completed in April 2013. The surgical procedure was performed with the assistance of a device designed in our orthosis laboratories, similarly to that defined by Assal etal. Of the 20 patients, 18 were male and 2 were female. Their mean age was 39.3 (range 21 to 55) years. The Achilles tendon rupture was located on the left side in 15 patients (75%) and on the right side in 5 patients (25%). The mean follow-up duration was 58.5 (range 18 to 60) months and no complications occurred during the follow-up period, including repeat rupture, wound site infection, and sural nerve injury. The mean American Orthopaedic Foot and Ankle Society scale score for the patients was 99.2 (range 94 to 100) points at the final follow-up visit. All our patients were able to return to work and sporting activities. According to the Trillat scores, the outcome was excellent in 19 patients and good in 1 patient at the 18th postoperative month. No complaint, such as pain or loss of function, that might have a negative effect on the patients' business or social life was detected in 18 patients who were assessed at 5years after surgery; 2 patients could not be reached at 5 years. In conclusion, as a technique combining percutaneous and open surgical techniques, mini-open repair of Achilles tendon rupture allows a satisfactory end-to-end approximation of the tendon just in the open surgery and provides the wound healing advantages of percutaneous surgery.

Systematic Review of All-Arthroscopic Versus Mini-Open Repair of Rotator Cuff Tears: A Meta-Analysis

The objective of this study was to compare outcomes in patients with rotator cuff tears undergoing all-arthroscopic versus mini-open rotator cuff repair. A systematic review and meta-analysis of outcomes of all-arthroscopic repair versus mini-open repair in patients with rotator cuff repair was conducted. Studies meeting the inclusion criteria were screened and included from systematic literature search for electronic databases including Medline, Embase, Cochrane CENTRAL, and CINAHL library was conducted from 1969 and 2015. A total of 18 comparative studies including 4 randomized clinical trials (RCTs) were included. Pooled results indicate that there was no difference in the functional outcomes, range of motion, visual analog scale (VAS) score, and short-form 36 (SF-36) subscales. However, Constant-Murley functional score was found to be significantly better in patients with mini-open repair. However, the results of the review should be interpreted with caution due to small size and small number of studies contributing to analysis in some of the outcomes. All-arthroscopic and mini-open repair surgical techniques for the management of rotator cuff repair are associated with similar outcomes and can be used interchangeably based on the patient and rotator tear characteristics.

Medium- to long-term results of a randomized controlled trial to assess the efficacy of arthoscopic-subacromial decompression versus mini-open repair for the treatment of medium-sized rotator cuff tears.

We report on the medium- to long-term results of a randomized controlled trial (RCT) aiming to determine whether rotator cuff repair confers any advantage over arthroscopic sub-acromial decompression (ASAD) alone in the management of medium-sized rotator cuff tears. Ethical approval was sought to follow-up patients previously enrolled in a completed and previously published RCT comparing the outcome of ASAD with mini-open cuff repair for the treatment of rotator cuff tear. Forty-two patients were enrolled in the original study, with a mean of 64 years (range 54 years to 77 years). Fifteen of the original 17 patients randomized to ASAD alone and 18 of the original 25 patients randomized to cuff repair were available for follow-up. Each patient underwent American Shoulder and Elbow Surgeons (ASES), Disabilities of the Arm, Shoulder and Hand (DASH) and Constant scoring, and clinical and ultrasound examination. Mean duration of follow-up was 7 years (range 5 years to 11 years). There was no statistically significant difference in terms of ASES, DASH and Constant scores at follow-up between the two groups. Some 33% of patients in the cuff-repair group had a proven re-rupture on ultrasound. This patient subgroup had significantly worse Constant scores compared to patients where the repair remained intact. None of the patients from either group developed cuff-tear arthropathy requiring arthroplasty surgery. In this medium- to longer-term study, there is no demonstrable significant benefit of cuff repair over decompression alone for the treatment of medium-sized rotator cuff tears, in terms of ASES, DASH and Constant scores for pain, function and strength modules. The presence of cuff tear does not necessitate surgical repair. This conclusion should drive surgical strategies and shared decision-making between patients and surgeons.

Risk Factors for Infection After Rotator Cuff Repair

To identify risk factors for infection after rotator cuff repair. We hypothesized that patient characteristics and surgical technique would affect the rate of infection. The records of 1,824 rotator cuff repairs performed by a single surgeon from 1995 to 2010 were reviewed retrospectively. Fourteen patients had an early deep postoperative wound infection that was treated with surgical irrigation and debridement. One hundred eighty-five control patients who were treated with rotator cuff repair and did not develop an infection were selected randomly for comparison and statistical analysis. Data regarding preoperative and intraoperative risk factors for infection were recorded, and a multiple logistic regression was conducted to investigate predictors of infection. The infection rate was 0.77% (14/1,822). On average 2.1 (range 1 to 4) surgical debridements were performed in addition to treatment with intravenous antibiotics. Patients who had open or miniopen rotator cuff repair had a significantly greater risk of acute postoperative infection (odds ratio [OR]= 8.63, P= .002). Seventy-nine percent of the patients in the infection group had an open or miniopen repair, whereas only 28% of the control group had an open or miniopen repair. Male patients also had a significantly greater risk of acute postoperative infection (OR= 9.52, P= .042). A total of 92% of the infection patients were male compared with 58% of the control group. In addition, as body mass index increased there was a reduction in the odds of infection (OR= 0.81, P= .023). The results of this case control study demonstrate that open or miniopen surgical technique and male sex are significant risk factors for infection after rotator cuff repair. In our study, arthroscopic rotator cuff repair reduced the risk of infection compared with open techniques. Level IV.