Clinical and magnetic resonance imaging results of arthroscopic full-layer repair of bursal-side partial-thickness rotator cuff tears

Kyoung Hwan Koh, Min Soo Shon, Tae Kang Lim, Jae Chul Yoo
American Journal of Sports Medicine 2011, 39 (8): 1660-7

BACKGROUND: Partial rotator cuff tears are being diagnosed more often because of high-resolution magnetic resonance imaging (MRI). Articular-side partial tears are much more common than bursal-side tears, and all-inside or PASTA repairs that preserve the bursal tissue have gained popularity. In contrast, there have been few reports about preserving the articular tissue during bursal tear repair.

PURPOSE: To report clinical and radiological results of bursal-side partial-thickness rotator cuff tear (PTRCT) repair with preservation of as much of the intact articular-side tendon as possible.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: From May 2006 to March 2008, 109 patients with PTRCT underwent arthroscopic repair. Among them, 38 consecutive patients who received a full-layer repair on the bursal side for greater than 50% thickness PTRCT were retrospectively evaluated. All repairs were performed with a technique that preserved intact articular fibers. To assess the outcome, pain visual analog scale (PVAS), American Shoulder and Elbow Surgeon (ASES) score, and Constant score were evaluated at final follow-up. Postoperative MRI at least 6 months after surgery was evaluated for repair integrity.

RESULTS: All 38 patients (21 men and 17 women) were available for final follow-up. The mean age at surgery was 50.8 years (range, 30-58 years), and the mean follow-up time was 26.9 months (range, 24-41 months). There were 21 right shoulders and 17 left shoulders, for which the mean time from the onset of symptoms to surgery was 47.0 months (±83.3 months). The PVAS improved from 5.2 (±2.5) to 1.6 (±1.5), and mean ASES and Constant scores improved from 53.1 (±20.4) and 59.9 (±15.3) to 87.2 (±9.4) and 83.2 (±12.0), respectively. Postoperative MRI was available in 33 patients at a mean 8.2 months after surgery. Twenty-nine shoulders (87.9%) had an intact repaired tendon, while 3 patients had shown partial-thickness delaminated retears, and 1 patient demonstrated a full-thickness retear on postoperative MRI.

CONCLUSION: For bursal-side PTRCT, clinical outcomes and tendon healing showed good results at a minimum 2 years after surgery, with minimal damage to intact articular tendon fibers on postoperative MRIs.

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