Sugaya, J Bone Joint Surg Am 2007 - Repair Integrity and Functional Outcome after Arthroscopic Double-Row Rotator Cuff Repair. A Prospective Outcome Study

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Repair Integrity and Functional Outcome after Arthroscopic Double-Row Rotator Cuff Repair. A Prospective Outcome Study

Sugaya, Moriishi, et al.·J Bone Joint Surg Am·2007·845 citations·Prospective cohort

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Background

The retear rate following rotator cuff repair is variable. Recent biomechanical studies have demonstrated that double-row tendon-to-bone fixation excels in initial fixation strength and footprint coverage compared with the single-row or transosseous fixation methods. This study was designed to report the repair integrity and clinical outcome following arthroscopic double-row rotator cuff repair.

Methods

A consecutive series of 106 patients with full-thickness rotator cuff tears underwent arthroscopic double-row rotator cuff repair with use of suture anchors and were followed prospectively.
20 patients lacked complete follow-up data or were lost to follow-up.
The 86 study subjects included 52 men and 34 women, with an average age of 60.5 years.
There were 26 small, 30 medium, 22 large, and 8 massive tears.
Clinical outcomes were evaluated at an average of 31 months.
Repair integrity was estimated with use of magnetic resonance imaging, which was performed, on the average, 14 months postoperatively, and was classified into 5 categories, with type I indicating sufficient thickness with homogeneously low intensity; type II, sufficient thickness with partial high intensity; type III, insufficient thickness without discontinuity; type IV, the presence of a minor discontinuity; and type V, the presence of a major discontinuity.

Results

The average clinical outcome scores all improved significantly at the time of the final follow-up (p < 0.01).
At a mean of 14 months postoperatively, magnetic resonance imaging revealed that 37 shoulders had a type-I repair; 21, a type-II repair; 13, a type-III repair; 8, a type-IV repair; and 7, a type-V repair.
The overall rate of retears (types IV and V) was 17%.
The retear rate was 5% for small-to-medium tears, while it was 40% for large and massive tears.
The shoulders with a type-V repair demonstrated significantly inferior functional outcome in terms of overall scores and strength compared with the other types of repairs (p < 0.01).

Conclusions

Arthroscopic double-row repair can result in improved repair integrity compared with open or miniopen repair methods. However, the retear rate for shoulders with large and massive tears remains higher than that for smaller tears, and shoulders with large repair defects (type V) demonstrate significantly inferior functional outcomes.

Copyright remains with the authors and publisher.

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Repair Integrity and Functional Outcome after Arthroscopic Double-Row Rotator Cuff Repair. A Prospective Outcome Study

Sugaya, Moriishi, et al.·J Bone Joint Surg Am·2007·845 citations·Prospective cohort

|

Background

The retear rate following rotator cuff repair is variable. Recent biomechanical studies have demonstrated that double-row tendon-to-bone fixation excels in initial fixation strength and footprint coverage compared with the single-row or transosseous fixation methods. This study was designed to report the repair integrity and clinical outcome following arthroscopic double-row rotator cuff repair.

Methods

A consecutive series of 106 patients with full-thickness rotator cuff tears underwent arthroscopic double-row rotator cuff repair with use of suture anchors and were followed prospectively.
20 patients lacked complete follow-up data or were lost to follow-up.
The 86 study subjects included 52 men and 34 women, with an average age of 60.5 years.
There were 26 small, 30 medium, 22 large, and 8 massive tears.
Clinical outcomes were evaluated at an average of 31 months.
Repair integrity was estimated with use of magnetic resonance imaging, which was performed, on the average, 14 months postoperatively, and was classified into 5 categories, with type I indicating sufficient thickness with homogeneously low intensity; type II, sufficient thickness with partial high intensity; type III, insufficient thickness without discontinuity; type IV, the presence of a minor discontinuity; and type V, the presence of a major discontinuity.

Results

The average clinical outcome scores all improved significantly at the time of the final follow-up (p < 0.01).
At a mean of 14 months postoperatively, magnetic resonance imaging revealed that 37 shoulders had a type-I repair; 21, a type-II repair; 13, a type-III repair; 8, a type-IV repair; and 7, a type-V repair.
The overall rate of retears (types IV and V) was 17%.
The retear rate was 5% for small-to-medium tears, while it was 40% for large and massive tears.
The shoulders with a type-V repair demonstrated significantly inferior functional outcome in terms of overall scores and strength compared with the other types of repairs (p < 0.01).

Conclusions

Arthroscopic double-row repair can result in improved repair integrity compared with open or miniopen repair methods. However, the retear rate for shoulders with large and massive tears remains higher than that for smaller tears, and shoulders with large repair defects (type V) demonstrate significantly inferior functional outcomes.

Copyright remains with the authors and publisher.

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