Mini-open Rotator Cuff Repair Research Articles

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

Mini-open rotator cuff repair via an anterosuperior approach

We retrospectively reviewed the results of arthroscopically assisted rotator cuff repairs done with an anterosuperior approach in 41 patients (average age, 55 years; range, 38-73). Average follow-up was 39 months (range, 24-57 months). There were 2 massive, 8 large 2-tendon, 9 medium-sized, 19 small, and 6 deep partial thickness rotator cuff tears. After arthroscopic inspection and acromioplasty, the anterior portal was enlarged in Langer's lines. The anterior deltoid raphe was incised to repair the tear. This approach was adequate for tears of all sizes. The average American Shoulder and Elbow Surgeon Score improved from 44.7 preoperatively to 91.7 postoperatively. There were 32 excellent (78%), 6 good (15%), and 3 poor (7%) results. Pain improved on a visual analog scale from 6.2 to 0.9. Arthroscopically assisted mini-open rotator cuff repair through an anterosuperior approach is a versatile deltoid-sparing technique. It does not require advanced arthroscopic skills or equipment and is associated with few complications.

Mini-open versus all-arthroscopic rotator cuff repair: Comparison of the operative costs and the clinical outcomes

Rotator cuff injury is one of the most frequently encountered problems of the shoulder in the daily practice of orthopaedic surgeons. This study compared all-arthroscopic cuff repair (ARCR) and mini-open rotator cuff repair (MORCR) methods in regard to clinical outcomes and costs. Fifty patient charts and operative repairs were analysed (25 ARCR and 25 MORCR). Pre-and postoperative Constant-Murley and UCLA scores along with factors such as tear size, tear type, pre-operative physical therapy, motion and satisfaction levels were compared for the two procedures. Cost-benefit analysis was also performed for comparison between procedures. The duration of follow-up was 31.20 and 21.56 months for MORCR and ARCR groups, respectively. Tear sizes (P=0.68), pre-and postoperative Constant-Murley and UCLA scores (P=0.254) and satisfaction levels were not significantly different between groups. However, the differences between pre-and postoperative Constant-Murley and UCLA scores were statistically significant within both groups (P<0.01). The MORCR group stayed 1 day longer in hospital than the ARCR group, which was statistically significant (P=0.036). The differences regarding mean pain scores, abductions, internal and external rotations in Constant-Murley scores and forward flexion scores in UCLA scores were not significant. The ARCR group cost more, leaving less profit. Results suggest that ARCR yields similar clinical results but at a higher cost compared with MORCR.

All-Arthroscopic Rotator Cuff Repair

All-arthroscopic rotator cuff repair has evolved into a viable surgical option, with outcome results equal to that of mini-open and open rotator cuff repair, with less perioperative morbidity and is driven by patient demand. The technique has required refinement of arthroscopic surgical techniques, and further advances from industry to provide alternative tools and techniques to make the procedure technically easier. This manuscript discusses all aspects of arthroscopic rotator cuff repair, and covers the evolution of the technique and provides a step-by-step technique to be used to accomplish a successful rotator cuff repair.

Systematic Review of Arthroscopic Rotator Cuff Repair and Mini-Open Rotator Cuff Repair

Rotator cuff repair is one of the most common surgical procedures performed in the shoulder, and the benefit of repair is well known1-5. Over the past decade, the treatment of rotator cuff tears has evolved from an open procedure to an arthroscopic-assisted (mini-open) technique to an all-arthroscopic technique. Traditional open rotator cuff repairs produce satisfactory results when used for the treatment of nonmassive tears (<5 cm). However, this procedure has been associated with morbidity such as severe early postoperative pain, deltoid detachment and/or weakness, and arthrofibrosis6-8. Mini-open repairs were developed because they had the potential advantage of less deltoid morbidity, and they have demonstrated results that have been similar to those of open repairs (Figs. 1-A through 1-D)9-14. With recent advances in arthroscopic techniques, many surgeons are now performing complete arthroscopic repairs. The potential advantages of this procedure include less pain, more rapid rehabilitation, the ability to treat intra-articular lesions, smaller skin incisions, less soft-tissue dissection, and an extremely low risk of deltoid detachment (Figs. 2-A through 2-E). In the short and long term, the arthroscopic approach has shown promising results3,7,15-27. Despite these advantages, the use of the complete arthroscopic repair is technically demanding and requires a large-volume practice in order for a surgeon to obtain proficiency in this procedure28. Because of the technical demands of this procedure, many orthopaedic surgeons still consider the mini-open repair to be the gold standard for rotator cuff repair29. We hypothesized that arthroscopic rotator cuff repair produces clinical results comparable with those of mini-open rotator cuff repair, with fewer complications. In order to compare the mini-open and all-arthroscopic techniques, we performed a qualitative systematic review with use of a …

Early Outcome of Arthroscopic Rotator Cuff Repair: A Matched Comparison With Mini-Open Rotator Cuff Repair

The purpose of this study was to compare the early functional outcome of mini-open and arthroscopic rotator cuff repair. This was a retrospective study of 128 patients with chronic small- and medium-sized rotator cuff tears who underwent mini-open rotator cuff repair (MRCR) (n=63) or arthroscopic rotator cuff repair (ARCR) (n = 65). Data were collected prospectively at baseline 1 to 2 weeks before surgery and at 3 and 6 months after surgery. Patients were identified from a prospectively created database based on the dimensions of the size of the tear as determined intraoperatively. Outcome was assessed via physical examination, visual analog scales (VASs), the Simple Shoulder Test, the Disabilities of the Arm, Shoulder and Hand questionnaire, and the Short Form 36 (SF-36) Health Survey. Changes between baseline and follow-up were compared. All demographic variables and preoperative baseline parameters of the 2 groups were equivalent. At 3 and 6 months, both MRCR and ARCR showed statistically significant improvement in all patient-derived outcome parameters (P < or = .0001) except for three SF-36 variables. The improvements in the SF-36 bodily pain score at 3 months postoperatively (P = .041) and the VAS pain score at 6 months postoperatively (P = .03) were better for ARCR. All other improvements in patient-derived parameters were equivalent. In our retrospective study we found that the early functional outcomes of MRCR and ARCR of small- and medium-sized rotator cuff tears are nearly equivalent. In light of the purported advantages of ARCR that motivate its popularity, this is an unexpected finding. However, an equally important result of this study was the finding that ARCR was associated with statistically significant improvement in the 3-month SF-36 bodily pain score and 6-month VAS pain score (P = .041 and .03, respectively). Level III, retrospective therapeutic comparative study.

Clinical Outcome and Tendon Integrity of Arthroscopic Versus Mini-Open Supraspinatus Tendon Repair: A Magnetic Resonance Imaging–Controlled Matched-Pair Analysis

Arthroscopic rotator cuff repair produces equally good clinical results compared with open or mini-open repair. However, there are concerns about whether the same repair integrity can be achieved. The purpose of our study was to compare clinical and structural results of arthroscopic and mini-open rotator cuff repair. Nineteen patients who had arthroscopic rotator cuff repair (mean follow-up, 25.0 months) were matched for age, gender, and duration of symptoms with nineteen patients who had mini-open repair (mean follow-up, 17.6 months). We compared preoperative and follow-up Constant scores, as well as early range of motion after 6 weeks and 3 months. All patients were examined with the same magnetic resonance imaging system at follow-up to evaluate cuff integrity. There was no difference in clinical and structural outcome. The overall Constant score improved from 53.8 to 83.9 in the arthroscopic group and from 53.5 to 83.7 in the mini-open group. Early range of motion did not differ significantly at 6 weeks or 3 months postoperatively. The number of retears was 6 (31.6%) in the arthroscopic group and 7 (36.8%) in the mini-open group. This difference was not statistically significant (P = .7358). Although smaller retears had no influence on the clinical result, more retracted retears correlated with lower abduction strength regardless of the repair method. In isolated supraspinatus tears arthroscopic rotator cuff repair produces excellent clinical results and equivalent tendon integrity compared with mini-open repair. Level III, retrospective therapeutic comparative study.

Arthroscopic versus Mini-open Rotator Cuff Repair: Analysis by Postoperative Pain and Inflammation

Arthroscopic versus Mini-open Rotator Cuff Repair: Analysis by Postoperative Pain and Inflammation

Comparison of Suture Welding and Hand-Tied Knots in Mini-Open Rotator Cuff Repair

This study was undertaken to compare the results of mini-open rotator cuff repair with outcomes attained with hand-tied knots and suture welds. A total of 50 consecutive patients treated by a single surgeon with mini-open cuff repair and suture welding were retrospectively evaluated and compared with 55 consecutive patients treated with mini-open cuff repair and hand-tied knots. The groups were similar in terms of age, sex, hand dominance, and preoperative duration of symptoms. All procedures were performed in a hospital outpatient surgery center with patients in a lateral decubitus position under general anesthetic. Glenohumeral arthroscopy and arthroscopic acromioplasty were performed in all cases. Rotator cuff tears were repaired through enlargement of the lateral portal. All patients were evaluated before and after surgery with the University of California Los Angeles (UCLA) Shoulder Scale. In all, 47 of 50 patients treated with suture weld were available for evaluation, with an average follow-up of 26 months. Preoperative UCLA scores averaged 12.5, and postoperative scores averaged 29.6. Of 55 patients treated with hand-tied knots, 40 were available, with an average follow-up of 28 months. Preoperative UCLA scores averaged 13.2, and postoperative scores averaged 31.5. No statistical difference in postoperative UCLA scores was noted between the 2 groups (P = .297). Level III, retrospective comparative study.

All-Arthroscopic Versus Mini-Open Rotator Cuff Repair: A Retrospective Review With Minimum 2-Year Follow-up

To compare the clinical outcomes of patients undergoing all-arthroscopic versus mini-open rotator cuff repair. In addition, ultrasound was used to assess the integrity of the repair. A total of 38 patients who had undergone all-arthroscopic repair and 33 patients who had undergone mini-open repair with minimum 2-year follow-up were evaluated. All patients completed the American Shoulder and Elbow Surgeons' Scoring Survey (ASES), the Simple Shoulder Test, the L'Insalata Scoring Survey, and visual analog scales for pain. Physical examination, including strength testing and ultrasound evaluation to determine the integrity of the rotator cuff, was performed. No statistical difference in ASES scores was noted between patients who had all-arthroscopic repair versus mini-open repair, and 24% of all-arthroscopic repairs and 27% of mini-open repairs showed recurrent defects on ultrasound at follow-up. This difference was not statistically significant. Patients with an original tear larger than 3 cm were 7 times more likely to have a recurrent defect at follow-up. Patients with persistent defects had statistically significant deficits in strength on forward elevation and external rotation when compared with those with a normal shoulder. However, no difference was observed with regard to pain or outcome scores between patients with intact repairs and those with persistent defects. No difference in clinical outcomes was found between patients with rotator cuffs repaired arthroscopically and those repaired with use of a mini-open technique. Level III, retrospective comparative study.

Descriptive Report of Shoulder Range of Motion and Rotational Strength 6 and 12 Weeks Following Rotator Cuff Repair Using a Mini-Open Deltoid Splitting Technique

Retrospective chart review. To measure short-term postsurgery glenohumeral internal rotation and external rotation strength, shoulder range of motion (ROM), and subjective self-report ratings following mini-open rotator cuff repair of full-thickness rotator cuff tears. Physical therapists provide rehabilitation for patients following mini-open rotator cuff repair. Long-term outcome studies have reported a high percentage of good and excellent results following surgery; however, little has been published regarding the immediate short-term results of this procedure, during which the patient is under the direct care of the physical therapist. Charts from 11 female and 26 male patients, with a mean +/- SD age of 57.3 +/- 9.9 years, were reviewed following rotator cuff repair, using an arthroscopically assisted mini-open deltoid-splitting approach. All patients underwent postsurgery rehabilitation by the same therapist using a standard protocol. Retrospective chart review was used to obtain descriptive profiles of shoulder joint ROM at 6 and 12 weeks postsurgery and isokinetically assessed shoulder strength at 12 weeks postsurgery. For the postsurgical shoulder, ROM deficits ranging between 5 degrees to 7 degrees were measured for shoulder abduction and external rotation and internal rotation at 90 degrees of abduction. The postsurgical extremity had greater flexion ROM (9 degrees ) compared to the contralateral side. Isokinetic external rotation strength deficits of 5% to 7% were present at 12 weeks postsurgery, with 2% to 11% greater internal rotation shoulder strength on the operative extremity, when compared to the other side. Patients completed the self-report section of the modified American Shoulder Elbow Surgeons (ASES) Rating Scale at 12 weeks postsurgery and scored a mean of 38.7/45.0 points. The application of early ROM and progressive strengthening following mini-open rotator cuff repair allows for the successful return of ROM and strength 12 weeks postsurgery. The results of this study provide objective data for both shoulder ROM and strength at time points during which patients are traditionally receiving physical therapy following surgery.

The results of arthroscopic repair in partial rotator cuff tears

We evaluated patients who underwent arthroscopic repair for partial rotator cuff tears less than 50% of tendon thickness with respect to the course of tears and functional results. Nineteen patients (10 women, 9 men; mean age 49 years; range 40 to 70 years) who did not benefit from conservative treatment for partial rotator cuff tears were treated with arthroscopic debridement with or without subacromial decompression. Twelve patients had a history of trauma before the appearance of complaints which had a mean duration of 12 months (range 7 to 24 months) before arthroscopic repair. Partial tears were on the articular side in 12 patients, and on the bursal side in seven patients. The patients were assessed with preoperative and postoperative physical examination, magnetic resonance imaging (MRI), and UCLA scores. The mean preoperative and postoperative UCLA scores were 16.8 (range 10 to 20) and 29.0 (range 9 to 35), respectively (p<0.05). The results were excellent or good in 14 patients (73.7%), fair in two patients (10.5%), and poor in three patients (15.8%). One patient developed shoulder stiffness which improved following rehabilitation. Postoperative MRI showed persistence of partial tears in 13 patients, progression in five patients, and development of total rupture in one patient. Complaints of pain increased in severity in patients in whom partial tears manifested a progressive course. One patient with total rupture underwent mini-open rotator cuff repair in the postoperative sixth month. Although clinical symptoms show improvement in most of the patients following arthroscopic treatment, partial rotator cuff tears do not heal completely in a considerable number of cases, and may progress to full-thickness tears in some.

Arthroscopic Versus Mini-Open Rotator Cuff Repair: A Comparison of Clinical Outcome

To compare the outcome of patients who underwent rotator cuff repair using all arthroscopic or mini-open repair techniques. Retrospective comparative study. We retrospectively reviewed 54 patients who underwent either mini-open or arthroscopic rotator cuff repair. Twenty-six patients underwent mini-open repair and 28 patients had arthroscopic repair. Follow-up averaged 33 months (range, 18 to 48 months) for the mini-open group and 19 months (range, 13 to 26 months) for the arthroscopic group. The patient groups were similar with regard to age, activity level, mechanisms of injury, associated findings at surgery, and tear size measured in square centimeters. The outcome for the 2 groups was evaluated using a modified American Shoulder and Elbow Society (ASES) score. Statistical analysis was performed using Pearson correlations and the Student t test. The tear size averaged 2.7 cm2 for the mini-open group and 2.0 cm2 for the arthroscopic group (P = .754). All patients showed significant improvement in their scores for pain, satisfaction, and function at the time of follow-up. The average preoperative and postoperative scores for the mini-open group were as follows: pain 17 and 27 (30 possible points), satisfaction 3 and 9 (10 possible points), function 32 and 53 (60 possible points), and total 52 and 89 (100 possible points) (P < .05). For patients who underwent arthroscopic repair, average preoperative and postoperative scores were as follows: pain 12 and 26, satisfaction 2 and 9, function 28 and 51, and total, 42 and 86 (P < .05). Improvement in scores within each group was significant, but the difference in total scores between the 2 techniques was not statistically significant. This study confirms that short-term results for arthroscopic and mini-open rotator cuff repair are similar and supports continued use of arthroscopic repair techniques. Level III, retrospective comparative study.

Arthroscopic versus mini-open rotator cuff repair: A comparison of clinical outcomes and patient satisfaction

This study compares the results of arthroscopic and arthroscopically assisted mini-open rotator cuff repair in a series of 84 patients who underwent repair of small, medium, or large tears between March 1997 and September 2001 with at least 2 years of follow-up. There were 42 arthroscopic repairs and 42 mini-open repairs. Of the patients, 81 (96.4%) had good or excellent UCLA (University of California, Los Angeles) scores (40 arthroscopic repairs [95.2%] and 41 mini-open repairs [97.6%]); there were 2 fair results and 1 poor outcome. The ASES (American Shoulder and Elbow Surgeons) scores averaged 91.1 for the arthroscopic group and 90.2 for the mini-open group (P > .05). Six patients required further surgery (three from the arthroscopic group and three from the mini-open group). Of 84 patients, 83 (98.8%) reported being satisfied with the procedure. At greater than 2 years of follow-up, arthroscopic and mini-open rotator cuff repairs produced similar results for small, medium, and large rotator cuff tears with equivalent patient satisfaction rates.

Functional Outcome and Health-Related Quality of Life after Surgical Repair of Full-Thickness Rotator Cuff Tear Using a Mini-Open Technique

Background Rotator cuff tear, a common shoulder injury, can lead to shoulder pain and functional loss. Hypothesis Surgical repair of full-thickness rotator cuff tears using the mini-open surgical technique will improve shoulder function and health-related quality of life. Study Design Cohort study. Level of evidence, 2. Methods Patients with a full-thickness rotator cuff tear who underwent a mini-open repair were evaluated for (1) active shoulder range of motion preoperatively, and 6 months and 12 months postoperatively and (2) health-related quality of life preoperatively, 6 months postoperatively, and annually up to 5 years postoperatively. Satisfaction with the repair and return to work status were ascertained 1 year postoperatively. A subgroup analysis of tear size and patient age was also undertaken. Results Of the subjects, 61 (73%) were men, and the average age was 53.2 (±9.9) years. According to repeated-measures analysis of variance, shoulder range of motion (flexion and external rotation) improved significantly from before surgery to 1 year after surgery (P < .001). The mean American Shoulder and Elbow Surgeons scores improved from 53.3 (±20.6) preoperatively to 90.6 (±11.7) 1 year postoperatively (P < .001). The mean Western Ontario Rotator Cuff scores also improved from 43.2 (±20.2) preoperatively to 87.2 (±14.3) 1 year postoperatively (P < .001). No differences were seen in either the American Shoulder and Elbow Surgeons scores or Western Ontario Rotator Cuff scores between the 1-year examination and the last follow-up assessment undertaken at a median of 5 years postoperatively (P > .05). Ninety-six percent of patients were satisfied or very satisfied with the results of their repair; 78% of patients who were working before surgery returned to work without modification by 1 year postoperatively. For the most part, patient age and size of tear did not influence postoperative range of motion or health-related quality of life. Conclusion Mini-open rotator cuff repair led to improved shoulder function and health-related quality of life up to 5 years postoperatively.

The Technique of Arthroscopic Repair of Partial Thickness Rotator Cuff Tears

ABSTRACT The treatment of partial thickness articular side rotator cuff tears remains controversial with recommendations ranging from debridement with or without acromioplasty to mini-open rotator cuff repair following completion of the tear. We describe a fully arthroscopic technique of undersurface rotator cuff repair which does not require take down of the intact bursal surface of the rotator cuff tendon. This technique results in near complete coverage of the greater tuberosity footprint by the torn rotator cuff tendon while avoiding the morbidity of a deltoid split and tear completion. Because the bursal footprint of the rotator cuff insertion is left intact while the articular margin of the tear is repaired, this results in a repair equivalent to a double row technique now being utilized for full thickness rotator cuff tears. We report the early results of a prospective, nonrandomized series of 24 patients who underwent this repair for Ellman Grade III articular sided rotator cuff tears. This reproducible arthroscopic technique results in greater success then debridement alone while avoiding the increased morbidity associated with mini open repair and take down of intact cuff tissue.

Arthroscopic versus mini-open rotator cuff repair: A cohort comparison study

To critically compare arthroscopic and mini-open rotator cuff repair. Retrospective case control study. Nine patients who had an arthroscopic rotator cuff repair (ARCR) were matched for age, gender, dominance, side of injury, history of trauma, duration of symptoms, and type of rotator cuff injury, with 12 patients who had a mini-open rotator cuff repair (MOR). Comparison included a preoperative and postoperative physical examination as well as a completed Simple Shoulder Test (SST) questionnaire at the latest follow-up at a minimum of 27 months. Both groups had significant reductions in pain scores (P < .01) and there was no significant difference in preoperative or postoperative active flexion or external rotation between both groups (P > .20). Although the ARCR group showed a significant improvement in strength (P < .01) and the MOR group did not, no patient had less than 4/5 strength. The impingement sign remained positive in 1 MOR patient, but all patients had a negative Jobe's test result. Pain and Tasks assessment by SST questionnaire showed that neither group had night pain or discomfort when using their arms overhead. There were no significant differences in the overall SST scores between groups. Because all patients in each group were satisfied with the procedure and there were no objective differences in outcome, we conclude that there is no difference in outcome between ARCR and MOR. Thus, the choice of one approach over the other is best based on surgeon or patient preference. Level III, Retrospective Case Control Study.

관절경 보조 소절개 봉합술을 이용한 회전근 개 파열의 치료 - 5∼8년 추시 결과 -

Purpose: To report our experience of treatment of rotator cuff tear and evaluate the mid-term outcome. Materials and Methods: We have performed 50 cases of mini-open rotator cuff repair from March 1996 to March 1999. Male to female ratio was 34：16, the average age 46.5(23∼57) years old, mean follow-up period was 78(62∼93) months. All-arthroscopic repair and open repair cases were excluded. Mean symptomatic period was 12.5(6∼38) months, operation was indicated in cases of no improvement by 6 months of conservative management. Preoperative simple radiographs and Magnetic resonance arthrography were obtained in all cases. We also observed the inflammation, synovitis, thickness of tear and associated pathology intraoperatively. We evaluated pain, function, and range of motion by UCLA score. Results: Overall UCLA score was mean 29.5 points. Excellent 25, good 18, poor 7 cases. Mean pain score was improved 2.6 to 7.5, 44 cases(88%) were improved and 6 cases(12%) were not improved. Mean functional score was improved 3.4 to 8.5, and activity at follow up, 25 cases(50%) were same, 8 cases(14%) were above, 17 cases(34%) were below compared with preoperative level. Mean active forward flexion was preoperative 112° to postoperative 160°, forward flexion strength was improved 3.8 to 4.7. 43 cases(86%) of patients were satisfied at the result, 7 cases(14%) were not satisfied or aggravated. Results: Mini-open rotator cuff repair was effective method in treating rotator cuff tear.

Rotator cuff repair with ultrasonic suture welding (SS-46)

Rotator cuff repair techniques traditionally employ suture fixation of the tendon to both soft and bony tissues. The suture is tied by hand or arthroscopic knot pusher to provide secure loops to fix tissue to facilitate healing. A new technology allows the creation of secure loops with ultrasonic energy welding. This study was conducted to assess the clinical results of mini-open rotator cuff repair employing ultrasonic suture welding. Fifty consecutive patients treated by one surgeon were retrospectively evaluated with an average follow-up of 26 months. These patients were then compared to 55 patients treated by the same surgeon with a technique employing standard knot-tying with nonabsorbable suture with similar follow-up. The groups were similar in regard to age, sex, hand dominance and preoperative duration of symptoms. All procedures were performed in a hospital ambulatory surgery center in a lateral decubitus position. A glenohumeral arthroscopy and arthroscopic acromioplasty were performed in all cases. All patients were evaluated by an independent examiner using the UCLA scale; 47 of the 50 suture weld patients were available for evaluation. Preoperative UCLA score averaged 21.5 and postoperative 29.8. There were four failures in this group but two of the patients who failed had a significant postoperative traumatic events; a dislocation in one and a car accident in another. Both patients underwent revision cuff repair. At revision. both repairs had pulled through tendon without failure of the weld. 40 of the 55 patients treated with tied sutures were available for evaluation. Preoperative UCLA score averaged 13.2 and postoperative 31.6. There was one failure in this group of patients and none with postoperative trauma. Postoperative scores for the two groups did not differ significantly according to Student t test. An Analysis of Covariance (ANCOVA) of postoperative UCLA scores was also not statistically significant. Suture welding produces secure loops that allow for cuff repair with results similar to traditional knot-tying techniques. Welding technology may facilitate arthroscopic cuff repair by obviating the need to tie arthroscopic knots.

All-arthroscopic versus mini-open rotator cuff repair: A long-term retrospective outcome comparison

Purpose: The goal of the study was to compare the results of all-arthroscopic rotator cuff repair with those of our mini-open rotator cuff repair. Type of Study: Retrospective outcome study. Methods: Sixty-four shoulders (58 patients) were identified; 35 in the all-arthroscopic group and 29 in the mini-open group. Average follow-up for all patients was 44.6 months, with a minimum of 24 months. The all-arthroscopic group included 3 small tears (< 1 cm), 24 medium-size tears (1 to 3 cm), and 9 large tears (3 to 5 cm). The mini-open group included 2 small tears, 9 medium tears, and 18 large tears. All patients in both groups underwent arthroscopic assessment with arthroscopic subacromial decompression. None underwent formal acromioclavicular joint resection. Four of the all-arthroscopic and 11 of the mini-open patients underwent coplaning of the acromioclavicular joint. Anchors were the primary method of arthroscopic fixation, with an average of 1.5 anchors per case. Results: The average final follow-up UCLA score for the arthroscopic group was 32.6 and for the mini-open group was 31.4, and the average final follow-up ASES score for the arthroscopic group was 91.7 and for the mini-open group was 90.0. No patients in the arthroscopic group developed fibrous ankylosis, whereas 4 patients in the mini-open group developed the condition (14%). No anchor-related complications were noted. Shoulders in the all-arthroscopic group showed greater motion at 6 and 12 weeks postoperatively and slightly better motion at final review. However, final motion difference was not statistically significant. Overall, 4 patients (6.3%) demonstrated some tenderness in the acromioclavicular joint on palpation, but none had clinical symptoms requiring treatment. Conclusions: All-arthroscopic cuff repair provides comparable outcomes and complication rates to arthroscopic decompression with mini-open repair. The lower incidence of fibrous ankylosis favors the all-arthroscopic technique. A trend for better early motion was also noted in the all-arthroscopic group. Analysis of variance shows no measurable outcome difference between tear sizes.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 3 (March), 2003: pp 234–238