Bishop J, Klepps S, Lo IK , Bird J, Gladstone JN, Flatow EL.
J. Shoulder Elbow Surg. 2006; 15(3): 290-8.
Rotator cuff surgery has produced good clinical results with studies revealing a good function with an intact rotator cuff post operatively. The authors prospectively reviewed the integrity of the rotator cuff following arthroscopic and open repair techniques and compared the clinical outcomes.
Cuff tears were diagnosed using MRI and patients were clinically assessed using the SF36, Constant, ASES and VAS (visual analogue pain) scores. Strength was measured using a dynamometer. The cuff integrity was reviewed at least one year postoperatively using MRI and correlated to clinical outcomes.
In the study there were 32 patients with an open repair and 40 patients with an arthroscopic repair. The mean age was 64 years for both groups, with a total of 41 men and 37 women.
There was an overall improvement in the ASES, VAS and Constant scores (p<0.0001) compared to the preoperative assessment. There was no significant functional difference between the two operative groups except greater strength in external rotation following open repair (p<0.05).
Postoperative cuff integrity revealed a 31% re-tear rate in the open compared to 47% in the arthroscopic repair group (p>0.05). Overall, there was a statistically significant functional improvement in strength if the cuff remained intact (p<0.016) but made no difference to the improvement of pain (p=0.12).
Patients with massive tears had a higher re-tear rate if treated arthroscopically, although this was not significant. Smaller tears <3cm showed a statistically significant improvement in all functional outcomes except improvement in pain, compared to tears >3cm if both were treated arthroscopically.
In conclusion functional scores suggest cuff integrity is significantly associated with improved functional outcome. Both repair modalities result in significant clinical improvement although there was no overall significant difference between the two techniques.
