Mini-open Rotator Cuff Repair Research Articles

Clinical Outcome In All-Arthroscopic Versus Mini-Open Rotator Cuff Repair In Small- To Medium-Sized Tears: A Randomized Controlled Trial In 100 Patients

Clinical Outcome In All-Arthroscopic Versus Mini-Open Rotator Cuff Repair In Small- To Medium-Sized Tears: A Randomized Controlled Trial In 100 Patients

Arthroscopic versus mini-open rotator cuff repair: a prospective, randomized study with 24-month follow-up

This prospective, randomized study was performed to evaluate the results of mini-open and arthroscopic rotator cuff repair in a comparative case series of patients followed for 24 months. A total of 125 patients were randomized to mini-open (Group I) or arthroscopic (Group II) rotator cuff repair at the time of surgical intervention. The University of California Los Angeles (UCLA) score, the American Shoulder and Elbow Surgeons (ASES) index, and muscle strength were measured to evaluate the clinical results, while magnetic resonance arthrography was used at 24-month follow-up to investigate the postoperative rotator cuff integrity. Fifty-three patients in Group I and 55 patients in Group II were available for evaluation at 24-month follow-up. At 24-month follow-up, the UCLA score, the ASES index, and muscle strength were statistically significantly increased in both groups postoperatively, while no significant difference was detected between the 2 groups. Intact rotator cuffs were investigated in 42 patients in Group I and 35 in Group II, and there was a significant difference in postoperative structural integrity between the two groups (P < 0.05). When analysis was limited to the patients with full-thickness tear, the muscle strength of the shoulder was significantly better in Group II, and the retearing rate was significantly higher in Group II. Based on the results obtained from this study, it can be indicated that arthroscopic and mini-open rotator cuff repair displayed substantially equal outcomes, except for higher retearing rate in the arthroscopic repair group. While for patients with full-thickness tear, arthroscopic rotator cuff repair displayed better shoulder strength and significantly higher retearing rate as compared to mini-open rotator cuff repair at 24-month follow-up.

Mini-Open Rotator Cuff Repair Has High Rates of Success at Fifteen-Year Follow-up

Mini-Open Rotator Cuff Repair Has High Rates of Success at Fifteen-Year Follow-up

Arthroscopic management of recalcitrant stiffness following rotator cuff repair: A retrospective analysis

Background:Rotator cuff repair surgery is one of the most commonly performed procedures in the world but limited literature exists for guidance of optimal management of post-operative arthrofibrosis following cuff repair. The purpose of this study is to report the results of arthroscopic capsular release, lysis of adhesions, manipulation under anesthesia, and aggressive physical therapy in patients with recalcitrant postoperative stiffness after rotator cuff repair.Materials and Methods:Twenty-nine patients who had recalcitrant arthrofibrosis following either an arthroscopic (62%), open (28%), or mini-open (10%) rotator cuff repair were included in study. The average age at the time of index cuff repair surgery was 49.8 years (range 24−70 years). Sixteen patients (55%) were involved in worker's compensation claims. The mean time from the date of index operation to lysis of adhesions was 9.7 months (range 4.2−36.2 months), and the mean time from lysis of adhesion to most recent follow-up 18.2 months (range 4.1−43.7 months). Post-operative evaluation was performed using American Shoulder and Elbow Surgeons Score (ASES), Visual Analog Score (VAS), Single Assessment Numeric Evaluation (SANE), and Simple Shoulder Test (SST) on 18 (62%), while range of motion (ROM), dynamometer strength testing, and Constant-Murley Scoring were performed on 13 (45%). Statistical analysis was performed using a Student's t-test.Results:Prior to arthroscopic lysis of adhesions, mean forward active elevation (FE) was 103.8°, (range 60-145° (SD 26.3) and external rotation at the side (ERS) was 25.3°, (range 5-70° SD 15.1°). Post-operatively, at the most recent follow-up, FE was significantly improved to 158.3°, (range 110−180° SD 22.3°), and ERS improved to 58.9°, (range 15−90° SD 18.6°) in both cases. Involvement in a worker's compensation claim resulted in a lower ASES, VAS, and SANE score, but there was no statistically significant difference in motion.Conclusion:Arthroscopic capsular release, lysis of adhesions, and manipulation under anesthesia is a safe, reliable method of treating persistent stiffness following rotator cuff repair.

Long-Term Longitudinal Follow-up of Mini-Open Rotator Cuff Repair

Rotator cuff tears are a common clinical problem, and few long-term studies concerning the outcomes of rotator cuff repairs have been performed. The purpose of this study was to report the fifteen-year outcomes of arthroscopic subacromial decompression with mini-open rotator cuff repair. The study included seventy-nine patients who had undergone arthroscopic subacromial decompression with mini-open rotator cuff repair from 1993 to 1996. Outcomes were reviewed in 1997, 2002, and 2010. At the final review, forty-nine patients (forty-nine shoulders) were available or were suitable for evaluation. There were eight large tears, forty medium tears, and one small tear. The patients were assessed with the University of California, Los Angeles (UCLA) score at each evaluation. The mean age of the patients at the time of follow-up was 70.1 years, and the mean follow-up period was 15.6 years. At the time of final follow-up, the outcome was good or excellent in thirty-four patients (69%), fair in seven, and poor in eight. Three patients required a reoperation. Between the two and fifteen-year evaluations, twenty-nine patients (59%) had maintained their good or excellent result; the overall raw scores had deteriorated for fifteen patients (31%), and they had improved for twenty-four (49%). Forty-one patients (84%) were satisfied with the final outcome of the shoulder surgery. This study shows that arthroscopic subacromial decompression with mini-open rotator cuff repair can provide a lasting, durable, and satisfactory outcome for a large proportion of patients fifteen years after surgery. Patient satisfaction at the final evaluation did not necessarily correspond with a good or an excellent UCLA score.

Clinical Outcome in All-Arthroscopic Versus Mini-Open Rotator Cuff Repair in Small to Medium-Sized Tears: A Randomized Controlled Trial in 100 Patients With 1-Year Follow-up

The purpose of this study was to compare clinical outcomes in the first postoperative year of patients with full-thickness small to medium-sized tears undergoing all-arthroscopic (AA) versus mini-open (MO) rotator cuff repair. One hundred patients were randomized to either AA or MO rotator cuff repair at the time of surgery on an intention-to-treat basis. Patients were evaluated before and 6, 12, 26, and 52 weeks after surgery using the Disabilities of the Arm, Shoulder, and Hand (DASH) score as a primary outcome score and the Constant-Murley score, visual analog scale (VAS)-pain/impairment score, and measurement of active forward flexion/external rotation as secondary outcome measures. Ultrasound evaluation was used to assess structural integrity of the repair 1 year postoperatively. Forty-seven patients were analyzed in the AA group and 48 in the MO group. Five patients were lost to follow-up. Mean age was57.2 (SD 8.0) years in the AA group and 57.8 (SD 7.9) years in the MO group. Primary and secondary outcome measures significantly improved in both groups postoperatively. Overall mean primary and secondary postoperative outcome scores did not statistically significantly differ between the treatment groups (DASH between-group mean difference: -3.4; 95% confidence interval [CI], -10.2 to 3.4; P= .317). However, at the 6-week follow-up, DASH score, VAS-pain and-impairment, and active forward flexion were significantly more improved in the AA group than in the MO group. Aretear was seen in 8 patients (17%) in the AA group and 6 patients (13%) in the MO group. Five patients in the AA group (11%) and 6 patients (13%) in the MO group developed adhesive capsulitis. Functional outcome, pain, range of motion, and complications do not significantly differ between patients treated with all-arthroscopic repair and those treated with mini-open repair in the first year after surgery. Patients do attain the benefits of treatment somewhat sooner (6 weeks) with the arthroscopic procedure. Level II, randomized controlled trial without postoperative blinding.

Paper 165: Arthroscopic Management of Stiffness Following Rotator Cuff Repair: Techniques and Results

Stiffness is the most common complication following rotator cuff repair independent of repair technique. The purpose of this study is to identify a cohort of patients who developed stiffness following rotator cuff repair and to report the results following arthroscopic capsular release, lysis of adhesions, manipulation under anesthesia, and aggressive physical therapy. Operative logs of the four senior surgeons were reviewed and thirty-one patients who underwent an arthroscopic lysis of adhesions between July 2004 and April 2007 for the treatment of arthrofibrosis following either an arthroscopic (56%), open (28%), or mini-open (16%) rotator cuff repair were identified. Data was obtained retrospectively from chart reviews and each patient was re-evaluated for purposes of this study by a single examiner. The average follow-up was 24.0 months (range, 12 to 41 months, sd 10) at which time range of motion (ROM), outcome scores (American Shoulder and Elbow Surgeons Score, Constant-Murley, Visual Analog Score, and Simple Shoulder Test), and dynamometer strength testing was recorded. Prior to arthroscopic lysis of adhesions, shoulder ROM averaged: 104.5 degrees of forward elevation (FE) and 27.2 degrees of external rotation at the side (ERS). At most recent follow-up, a significant increase in ROM was noted with FE of 150.2 degrees (p<0.001) and ERS of 56.2 degrees (p<0.001). Subjective outcome scores and strength were also improved. There were 3 (10%) failures requiring a repeat operative procedure for recurrent stiffness. There was no difference in outcomes with regard to index surgery repair technique (arthroscopic, open or mini-open repair). There were no complications such as dislocation, infection, or nerve injury. Arthroscopic capsular release and lysis of adhesions is safe, reliable, and our preferred method of treating stiffness following rotator cuff repair. Furthermore, significant improvement in shoulder ROM, strength, subjective outcome scores, and patient satisfaction can be expected with an arthroscopic technique and aggressive rehabilitation treatment protocol.

Anterolateral approach for mini-open rotator cuff repair

This study was undertaken to introduce an anterolateral approach for mini-open rotator cuff repair and evaluate its clinical outcome and effectiveness. We evaluated 128 consecutive cases that were repaired by mini-open repair using an anterolateral approach. There were 80 men and 48 women, with an average age of 56.2 years. Average follow-up was 25.7 months. There were eight partial-thickness, 26 small, 40 medium, 39 large and 15 massive tears. After arthroscopic glenohumeral examination and subacromial decompression, we made a 3- to 4-cm skin incision from anterolateral edge of the acromion and dissected to the raphe between the anterior and middle deltoid. The torn tendon was repaired with single- or double-row technique using suture anchors. To prevent avulsion of the deltoid from the acromion, additional suturing within the bone tunnel was performed. We retrospectively evaluated clinical outcomes using the American Shoulder and Elbow Surgeon (ASES) scoring system. The average visual analogue scale (VAS), activity of daily living (ADL) and ASES scores improved, respectively, from 6.6, 12.0 and 36.7 preoperatively to 1.2, 26.6 and 88.2 postoperatively. There were 71 excellent, 39 good, ten fair and eight poor results. There were no statistically significant difference between final ASES scores and age, symptom duration, tear size or preoperative stiffness, but men had significantly higher final ASES scores than women (P = 0.014). Anterolateral approach for mini-open rotator cuff repair produces satisfactory results. It may also provide better visualisation for rotator cuff tears of all sizes.

Prospective randomised comparison of arthroscopic versus mini-open rotator cuff repair of the supraspinatus tendon

The aim of the study was to evaluate whether arthroscopic (ASC) repair of rotator cuff ruptures causes less postoperative pain and better range of motion (ROM) in the early postoperative period than a mini-open (MO) technique. Inclusion criteria were a rupture of the supraspinatus tendon with retraction with a maximum to the apex of the humeral head and minor fatty degeneration and atrophy of the muscle. Each group (n = 17) had similar demographics and preoperative magnetic resonance imaging (MRI) findings (mean age 60.1 years, SD 8.8, range 43-71). The ASC group underwent double-row repair with resorbable anchors; the MO group received a transosseous repair. The postoperative rehabilitation was standardised and equivalent in both groups. In the first week fewer nonsteroidal anti-inflammatory drug (NSAID) tablets were needed in the ASC group. Pain scores on the visual analogue scale were similar in the first three weeks; however, from week four to eight the MO group had less pain (p < 0.05). After six months, the Constant-Murley score and the ROM improved significantly (p < 0.05) in both groups without differences between the groups. Postoperative MRI revealed in three of 16 patients a discontinuity of the tendon in both groups; in the ASC group there were more patients (n = 9) with a thinning of the tendon compared to the MO group (n = 6). There was less use of NSAIDs in the first postoperative week in the ASC group, indirectly indicating less pain, but higher pain scores in the later course (weeks four to eight) compared to the MO group. ROM, MRI findings and the scores were similar after six months, demonstrating that both techniques are equivalent regarding the outcome in this period.

Over Ten Years of Long Term Clinical Results of Mini-open Rotator Cuff Repair

Over Ten Years of Long Term Clinical Results of Mini-open Rotator Cuff Repair

전외측 도달법을 이용한 소절개 회전근 개 봉합술

Purpose: To introduce mini-open rotator cuff repair using the anterolateral approach and evaluate its clinical outcomes and effectiveness. Materials and Methods: 59 consecutive cases of rotator cuff tearing which were treated with mini-open repair utilizing the anterolateral approach were evaluated. The population comprised 39 men and 20 women, with an average age of 56.6 years. An average follow-up time period was 26 months. Clinical outcomes were analyzed based on VAS, ADL, and ASES scores. Results: The average respective VAS, ADL, and ASES scores improved from 7.04, 12.37, and 35.32 preoperatively to 1.02, 27.20, and 90.08 postoperatively (p=0.000). There were 41 excellent, 11 good, 2 fair, and 5 poor results. There were satisfactory results in 52 cases (88.1%). There were no statistically significant differences between the final ASES scores and age, sex, duration of symptoms, tear size, and preoperative stiffness (p>0.05). Conclusion: Mini-open rotator cuff repair using the anterolateral approach effective in providing better visualization.

Delamination tearing of the rotator cuff: Prospective analysis of the influence of delamination tearing on the outcome of arthroscopically assisted mini open rotator cuff repair

Limited information regarding the effect of delamination tearing on the outcome of rotator cuff repair is available in the literature. Studies have reported equally good results for rotator cuff repair using an open, mini-open, and arthroscopic repair techniques. Negative results have been reported for arthroscopic rotator cuff repair when delamination is present. The purpose of this study was to assess the affect of delamination on the outcome of the arthroscopically assisted mini-open technique. Two-hundred sixty-three consecutive operations were followed prospectively in this study. All underwent arthroscopically assisted mini-open repairs by a single surgeon. Patient demographics, compensation status, and tear characteristics were investigated. Variables were compared using the Western Ontario Rotator Cuff Index (WORC) pre-operatively and at 1 and 2 years postoperative. The incidence of delamination was 71% of rotator cuff tears. Patient demographics did not affect the incidence of delamination. The presence of delamination did not affect the outcome of mini-open rotator cuff repair. We believe this technique is better able to produce reliable outcomes in the presence of delamination tearing.

Total cost and operating room time comparison of rotator cuff repair techniques at low, intermediate, and high volume centers: Mini-open versus all-arthroscopic

The objective of this study was to determine mean cost and operative time differences between mini-open and all-arthroscopic rotator cuff repair techniques at surgical centers of low, intermediate, and high annual rotator cuff repair volume. The 2006 New York State Ambulatory Surgery Database (NY-SASD) was utilized. It represents 100% of all outpatient procedures performed in hospital-affiliated and freestanding surgical centers, containing 10,658,923 patients for 2006 alone. Only patients who had an arthroscopic acromioplasty and either open or arthroscopic rotator cuff repair were included, leaving 5,224 patients for the study. These were divided into 2 groups: the mini-open group (1,334) and the all-arthroscopic group (3,890). Surgical center volume data were divided into 3 groups: low volume (<75 rotator cuff repairs per year), intermediate volume (75-199 rotator cuff repairs per year), and high volume (200+ rotator cuff repairs per year). Patient age and gender were normally distributed within the 2 groups with no significant differences between them (P = .82 and P = .31, respectively). Operative time was significantly shorter in the mini-open group (103 minutes) compared to the all-arthroscopic group (113 minutes), P < .00001. Surgical charges were also significantly less in the mini-open group ($7,841) compared to the all-arthroscopic group ($8,985), P < .00001. Regardless of the repair method, high volume surgical centers were significantly more expensive when compared to low and intermediate volume centers, P < .00001. The mini-open rotator cuff repair technique requires significantly less operative time and is significantly less expensive than the all-arthroscopic repair. Regardless of the repair technique, high volume surgical centers cost significantly more than low and intermediate volume surgical centers.

Arthroscopic Management of Stiffness Following Rotator Cuff Repair: Techniques and Results (SS-03)

Arthroscopic capsular release and lysis of adhesions is safe, reliable, and our preferred method of treating stiffness following rotator cuff repair. Stiffness is the most common complication following rotator cuff repair independent of repair technique. The purpose of this study is to identify a cohort of patients who developed stiffness following rotator cuff repair and to report the results following arthroscopic capsular release, lysis of adhesions, manipulation under anesthesia, and aggressive physical therapy. Operative logs of the four senior surgeons were reviewed and thirty-one patients who underwent an arthroscopic lysis of adhesions between July 2004 and April 2007 for the treatment of arthrofibrosis following either an arthroscopic (56%), open (28%), or mini-open (16%) rotator cuff repair were identified. The average age of patients was 48.7 at the time of injury and 19 (61%) were involved in workman's compensation claims. Data was obtained retrospectively from chart review for 30 patients. Thirteen patients were available for follow-up at which time range of motion (ROM), outcome scores (American Shoulder and Elbow Surgeons Score, Constant-Murley, Visual Analog Score, and Simple Shoulder Test), and dynamometer strength testing was recorded for purposes of this study by a single examiner. Three patients were available for a phone interview only. The average follow-up was 44.9 months. Prior to arthroscopic lysis of adhesions, shoulder ROM averaged: 103.8 degrees of forward elevation (FE) and 27.2 degrees of external rotation at the side (ERS). At most recent follow-up, a significant increase in ROM was noted with FE of 157.1 degrees (p<0.001) and ERS of 58.2 degrees (p<0.001). Subjective outcome scores and strength were also improved. There were 3 (10%) failures requiring a repeat operative procedure for recurrent stiffness. There was no difference in outcomes with regard to index surgery repair technique (arthroscopic, open or mini-open repair). There were no complications such as dislocation, infection, or nerve injury. Arthroscopic capsular release and lysis of adhesions is safe, reliable, and our preferred method of treating stiffness following rotator cuff repair. Furthermore, significant improvement in shoulder ROM, strength, subjective outcome scores, and patient satisfaction can be expected with an arthroscopic technique and aggressive rehabilitation treatment protocol.

Arthroscopic vs mini-open rotator cuff repair. A quality of life impairment study

We compared the clinical and quality of life related outcome of rotator cuff repair performed using either a mini-open or an arthroscopic technique for rotator cuff tears of less than 3 cm. The records of 64 patients who underwent rotator cuff repair between September 2003 and September 2005 were evaluated. Thirty-two patients underwent a mini-open rotator cuff repair, and 32 patients underwent an arthroscopic rotator cuff repair. The mean follow-up period was 31 months in the mini-open group and 30.6 months in the arthroscopic group (P > 0.05). The UCLA rating system, range of motion examination and the self-administered SF-36 used for postoperative evaluation showed a statistically significant improvement from the preoperative to the final score for both groups (P < 0.05). No statistically significant difference in the total UCLA scores was found when comparing the two repair techniques (P > 0.05). This study suggests that there is no difference in terms of subjective and objective outcomes between the two surgical procedures studied if patients have rotator cuff tears of less than 3 cm.

Mini-Open Rotator Cuff Repair Improved Quality of Life at 3 Months

Mini-Open Rotator Cuff Repair Improved Quality of Life at 3 Months

A Randomized Clinical Trial Comparing Open to Arthroscopic Acromioplasty With Mini-Open Rotator Cuff Repair for Full-Thickness Rotator Cuff Tears: Disease-Specific Quality of Life Outcome at an Average 2-Year Follow-Up

A Randomized Clinical Trial Comparing Open to Arthroscopic Acromioplasty With Mini-Open Rotator Cuff Repair for Full-Thickness Rotator Cuff Tears: Disease-Specific Quality of Life Outcome at an Average 2-Year Follow-Up

Prediction of Rotator Cuff Repair Failure by Histological Analysis

Background We aimed to determine if recognised histological features seen in specimens taken during rotator cuff repair could predict which tendon repairs were at risk of re-rupture. Methods Forty rotator cuff tendon edge specimens from 40 patients were analysed histologically following routine mini-open rotator cuff repair. Thirty-two patients returned at a mean follow up of 35 months for an ultrasound examination to determine repair integrity. Results Overall there were 8 small tears, 13 medium tears, 15 large tears and 4 massive tears. Of the 32 patients followed up with ultrasound scan (USS) the overall re-rupture rate was 46%. Small and medium tears had a re-rupture rate of 35% while 60% of the large and massive tears suffered a re-rupture. Comparison of histological features and repair integrity revealed that the rotator cuff repairs which remained intact demonstrated a greater reparative response, in terms of increased fibroblast cellularity, cell proliferation and a thickened synovial membrane, than those repairs that re-ruptured. The larger tears that did remain intact also showed a higher degree of vascularity and a significant inflammatory component than the larger tears that re-ruptured. Conclusion These results indicate the importance of good tissue quality at the time of surgery but that larger tears can heal if the tissue quality is favourable. Post-operative histological analysis of tendon tear edge can aid prognosis and has the potential to guide post-operative immobilization and subsequent physiotherapy.

An analysis of outcome of arthroscopic versus mini-open rotator cuff repair using subjective and objective scoring tools

The purpose is to perform a comparative analysis of mini-open and arthroscopic rotator cuff repairs through the use of subjective and objective scoring tools. We conducted a prospective comparative cohort study that evaluated 123 consecutive patients who underwent rotator cuff repairs (arthroscopic and 31 mini-open repair). Subjective and objective functional assessment was performed preoperatively and postoperatively at 3, 6, 12, 18 and 24 months using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the Oxford Shoulder Score (OSS) and the Constant-Murley score. Statistical analysis was performed on the datasets assessing the Pearson correlation coefficients and any significant differences present at each respective time point. At every time point the arthroscopic group scored better than the mini-open group, regardless of the assessment tool employed. The percentage recovery from the baseline measured at 1 year was similar with either treatment option. A significant difference was found between the arthroscopic and mini-open groups for the Constant-Murley, DASH and OSS scoring systems preoperatively (P < 0.05), reflecting a difference in tear severity. Arthroscopic rotator cuff repair is comparable with the mini-open technique with well correlated postoperative rates recovery. Subjective scoring provides an accurate and potentially easier method of postoperative assessment for long-term follow-up of rotator cuff repairs.

Shoulder dislocation combined with rotator cuff injury and Bankart lesion

Objective To explore the feasibility of arthroscopic repair of anterior dislocation of shoulder combined with rotator cuff injury and Bankart lesion. Methods Sixteen cases of shoulder dis-location combined with rotator cuff injury and Bankart lesion were inspected arthroscopically. They were 14 males and 2 females. Six left and 10 right shoulders were affected. There were 8 traffic injuries, 4 sports injuries, and 4 traction injuries. All patients underwent magnetic resonance arthrography (MR.A). The aver-age duration between injury to operation was 4.5 (1.5 to 11.0) months. Arthroscopic inspection revealed 12 cases of rotator cuff tear at the greater tuberosity of humerus combined with rotator cuff contracture. Nine cases had rotator cuff release and fixation with suture anchor or bone anchor. Three cases had mini-open rotator cuff repair because of severe contracture of the rotator cuff. Four cases had plasma shrinkage and tightening suture of the rotator cuff because of rotator cuff laxity. Three cases of Bankart lesion had arthroscopic fixation with bio-absorbable Bankart anchor, 3 cases had titanium suture anchor, and 7 cases had bone anchor. Results All patients were followed up for an average of 16.5(range, 7 to 34) months. Twelve cases restored normal abduction and upright movement. Two cases had slight limitation of extension, and 2 cases had pain in ac-tivity. Two eases had re-operation due to extraction of titanium suture anchor. UCLA ( University of California at Los Angeles) scores were 21.5±5.5 and 32.4±5.6, respectively. Twelve eases were excellent and 4 were good. Conclusions MRA is beneficial for diagnosis of shoulder dislocation combined with rotator cuff injury and Bankart lesion. Severe eontracture of rotator cuff should be released sufficiently and repaired without tension. Allograft bone anchor might achieve biological fixation and low consumption. Key words: Shoulder dislocation; Arthroseopy; Rotator cuff; Bankart lesion; Bone trans-plantation