Cuff Integrity Following Arthroscopic Versus Open Rotator Cuff Repair: A Prospective Study
Authors: J Bishop et al.
References: Presented at AAOS 2004
Arthroscopic rotator cuff repairs demonstrate similar clinical outcomes with open repairs but a higher retear rate with large tears.
Introduction: Arthroscopic rotator cuff repair (RCR) has been reported to have good clinical results but 70% to 90% retear rates by ultrasound. This study prospectively assesses postoperative cuff integrity and outcome following arthroscopic RCR, and compares these results to open RCR by the same surgeon.
Method: Fifty-five consecutive patients after arthroscopic RCR by a single surgeon were prospectively enrolled for evaluation preoperatively and at one year follow-up, including a postoperative MRI. A prior prospective study of open RCR by the same surgeon was used for comparison
Results: There were 32 patients in the open RCR group, and 40 patients have completed the arthroscopic RCR protocol. ASES scores improved from 40 to 85 in the open group and from 46 to 84 in the arthroscopic group, and Constant scores from 53 to 80 in the open group and from 52 to 75 in the arthroscopic group (p<0.0001).
69% of the open and 53% of the arthroscopic group were intact by MRI. Of tears <3cm, 74% in the open and 84% in the arthroscopic group were intact. Of tears >3cm, 62% were intact in the open group and only 24% in the arthroscopic group. This difference was insignificant with p=0.036. There was a trend towards better scores with an intact cuff than with a retear in both groups, however this only reached significance (p<0.03) in the arthroscopic group when evaluating the ASES score, (Constant 79, ASES 89 - when intact and Constant 72, ASES 75 - when retorn). In the arthroscopic group, patients with intact cuffs had significantly greater strength of elevation (p=0.01) and external rotation (p=0.02)
Conclusion: Open and arthroscopic RCR had similar outcomes. Cuff integrity was comparable for small tears, but the retear rate for large tears was twice as high after arthroscopic repair.