We present the results of arthroscopic repair of full-thickness tears of the rotator cuff in 73 patients (39 men and 34 women). The average age of the patients at the time of the operation was 60.7 years (range, 31 to 82 years). All of the patients were followed for at least 2 years (average, 30 months; range, 24 to 40 months). The shoulders were evaluated with the rating scale of the University of California at Los Angeles, the shoulder index of the American Shoulder and Elbow Surgeons, and the functional rating scale of Constant and Murley. In addition, the patients completed the Short-Form 36 Health Survey (SF-36) preoperatively and at the yearly follow-up evaluations. 11 tears were small (less than one centimeter in length), 45 were medium (one to 3 centimeters), 11 were large (more than 3 to 5 centimeters), and 6 were massive (more than 5 centimeters). The average length of the tear was 12 millimeters, and the average width was 27 millimeters. 69 tendons were repaired anatomically, and 4 were repaired an average of 3 millimeters (range, 2 to 8 millimeters) medial to the anatomical insertion of the tendon. An average of 2.3 (range, one to 4) suture anchors were used in the repair. 63 glenohumeral joints were normal, and 10 had an intra-articular lesion. 7 patients had a concomitant resection of the acromioclavicular joint. The average duration of the operation was 56 minutes (range, 35 to 90 minutes). The active and passive ranges of motion improved significantly after the procedure (p = 0.0001). The strength of resisted elevation improved from 7.5 to 14.0 pounds (3.4 to 6.3 kilograms) (p = 0.0001). The average total score according to the rating scale of the University of California at Los Angeles improved from 12.4 to 31.1 points; the average total score according to the shoulder index of the American Shoulder and Elbow Surgeons, from 30.7 to 87.6 points; and the average absolute score according to the rating system of Constant and Murley, from 41.7 to 83.6 points (p = 0.0001 for all comparisons). The average score for the pain component of the rating scale of the University of California at Los Angeles improved from 2.4 to 8.6 points; 57 (78 per cent) of the 73 patients rated the relief of pain as good or excellent on the visual-analog scale. The average score for satisfaction improved from 0.4 to 4.6 points; 66 patients (90 per cent) rated their satisfaction as good or excellent at the time of the most recent examination. None of the shoulders were rated as good or excellent before the operation, whereas 61 (84 per cent) were so rated at the most recent follow-up evaluation after the index procedure. In addition, significant improvements (p = 0.0015) were noted in the scales and summary measures of the SF-36. Arthroscopic repair of full-thickness tears of the rotator cuff produced satisfactory results with regard to traditional orthopaedic criteria as well as with regard to patient-assessed criteria such as satisfaction, pain relief, and general health. The arthroscopic method offers several advantages, including smaller incisions, access to the glenohumeral joint for the inspection and treatment of intra-articular lesions, no need for detachment of the deltoid, and less soft-tissue dissection. However, these advantages must be considered against the technical difficulty of the method, which limits its application to surgeons who are skilled in both open and arthroscopic procedures on the shoulder.
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We present the results of arthroscopic repair of full-thickness tears of the rotator cuff in 73 patients (39 men and 34 women). The average age of the patients at the time of the operation was 60.7 years (range, 31 to 82 years). All of the patients were followed for at least 2 years (average, 30 months; range, 24 to 40 months). The shoulders were evaluated with the rating scale of the University of California at Los Angeles, the shoulder index of the American Shoulder and Elbow Surgeons, and the functional rating scale of Constant and Murley. In addition, the patients completed the Short-Form 36 Health Survey (SF-36) preoperatively and at the yearly follow-up evaluations. 11 tears were small (less than one centimeter in length), 45 were medium (one to 3 centimeters), 11 were large (more than 3 to 5 centimeters), and 6 were massive (more than 5 centimeters). The average length of the tear was 12 millimeters, and the average width was 27 millimeters. 69 tendons were repaired anatomically, and 4 were repaired an average of 3 millimeters (range, 2 to 8 millimeters) medial to the anatomical insertion of the tendon. An average of 2.3 (range, one to 4) suture anchors were used in the repair. 63 glenohumeral joints were normal, and 10 had an intra-articular lesion. 7 patients had a concomitant resection of the acromioclavicular joint. The average duration of the operation was 56 minutes (range, 35 to 90 minutes). The active and passive ranges of motion improved significantly after the procedure (p = 0.0001). The strength of resisted elevation improved from 7.5 to 14.0 pounds (3.4 to 6.3 kilograms) (p = 0.0001). The average total score according to the rating scale of the University of California at Los Angeles improved from 12.4 to 31.1 points; the average total score according to the shoulder index of the American Shoulder and Elbow Surgeons, from 30.7 to 87.6 points; and the average absolute score according to the rating system of Constant and Murley, from 41.7 to 83.6 points (p = 0.0001 for all comparisons). The average score for the pain component of the rating scale of the University of California at Los Angeles improved from 2.4 to 8.6 points; 57 (78 per cent) of the 73 patients rated the relief of pain as good or excellent on the visual-analog scale. The average score for satisfaction improved from 0.4 to 4.6 points; 66 patients (90 per cent) rated their satisfaction as good or excellent at the time of the most recent examination. None of the shoulders were rated as good or excellent before the operation, whereas 61 (84 per cent) were so rated at the most recent follow-up evaluation after the index procedure. In addition, significant improvements (p = 0.0015) were noted in the scales and summary measures of the SF-36. Arthroscopic repair of full-thickness tears of the rotator cuff produced satisfactory results with regard to traditional orthopaedic criteria as well as with regard to patient-assessed criteria such as satisfaction, pain relief, and general health. The arthroscopic method offers several advantages, including smaller incisions, access to the glenohumeral joint for the inspection and treatment of intra-articular lesions, no need for detachment of the deltoid, and less soft-tissue dissection. However, these advantages must be considered against the technical difficulty of the method, which limits its application to surgeons who are skilled in both open and arthroscopic procedures on the shoulder.
Copyright remains with the authors and publisher.