A comparison of 2 repair techniques for partial-thickness articular-sided rotator cuff tears

Sang-Jin Shin
Arthroscopy 2012, 28 (1): 25-33

PURPOSE: This prospective randomized study compared the clinical outcomes of patients who underwent partial-thickness articular-sided rotator cuff repairs by 2 surgical techniques.

METHODS: Forty-eight patients with a symptomatic partial-thickness articular-sided rotator cuff tear exceeding 50% of the tendon thickness were randomly assigned to 2 groups at the time of operation. Of the patients, 24 received arthroscopic rotator cuff repair with a transtendon technique (group I) and 24 received arthroscopic rotator cuff repairs after tear completion (group II). Pain intensity and patient satisfaction were assessed by visual analog scales, and functional outcomes were evaluated by use of American Shoulder and Elbow Surgeons and Constant shoulder scores. Tendon integrity was evaluated by magnetic resonance imaging at 6 months after surgery.

RESULTS: Clinical outcomes were significantly improved after repair in both groups at a mean of 31 months' follow-up. In each group 22 patients (92%) were satisfied with surgery. However, shoulder function and range of shoulder motion recovered faster in group II during the recovery period (American Shoulder and Elbow Surgeons score, 54.9 ± 3.7 in group I v 64.6 ± 3.2 in group II; P = .037) (Constant score, 57.9 ± 2.9 in group I v 70.8 ± 3.3 in group II; P = .019). Furthermore, patients in group I had significantly more pain (5.9 ± 0.4) than patients in group II (2.8 ± 0.5) (P = .001) until 3 months after surgery. Postoperative adhesive capsulitis developed in 3 patients in group I and in 2 patients in group II. According to postoperative 6-month magnetic resonance imaging assessments, all patients in group I achieved complete integrity whereas a retear developed in 2 patients in group II.

CONCLUSIONS: Arthroscopic repair of partial-thickness articular-sided rotator cuff tears exceeding 50% of the tendon thickness provided satisfactory functional improvements and pain relief regardless of the repair technique. Although repair after conversion to a full-thickness tear showed less postoperative morbidity, tendon integrity is of primary concern after repair. On the other hand, the transtendon repair technique resulted in complete tendon integrity but slower functional recovery.

LEVEL OF EVIDENCE: Level II, prospective comparative study.

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