Arthroscopic surgery effective for massive rotator cuff repair

VIENNA — Arthroscopic shoulder surgery has advanced in recent years as orthopaedic surgeons have proven its effectiveness for the treatment of rotator cuff tears and the pain that accompanies such injuries.

But as with many other orthopaedic procedures, the approach and skill at which arthroscopic shoulder surgery is performed makes tremendous difference, especially when treating large cuff tears, Andrea Vitullo, MD, said at the 10th EFORT Congress, here.

In a retrospective study performed at two orthopaedic centers in Rome, researchers studied 457 patients who underwent arthroscopic repair of their rotator cuff tear. All of the surgeries were performed between 2000 and 2007, and 93 patients exhibited complete massive cuff tears, he said.

The surgeons performed arthroscopic cuff repair using either a posterior-superior approach or a posterior-superior-anterior technique.

Investigators analyzed the preoperative and postoperative outcomes using the Constant Score (CS), Simple Shoulder Test (SST) and a single-question patient satisfaction questionnaire.

Patients were 55 to 74 years old on average, and the average time from onset of symptoms to surgery was 16.7 months.

Substantial improvement

Results showed that the CS improved from an average score of 42 prior to arthroscopic surgery to 84 postoperatively. The SST scores improved from an average preoperative score of 4 to 8.5 postoperatively, according to Vitullo.

“There were no big differences between the posterior-superior and posterior-superior-anterior groups,” he said. However, there were poor results in approximately 10% of cases, including 7 posterior-superior cases and 3 posterior-superior-anterior cases.

Investigators did not compare the results with patients who underwent an open procedure, Vitullo told Orthopaedics Today Europe.

He said the patients with rotator cuff tears who are the best candidates for an arthroscopic procedure include those who demonstrate no fatty infiltration on nuclear magnetic resonance images and no superior dislocation of the humeral head.

“We typically use the beach chair position with 3 kg of traction,” he said. “We also use five portals: posterior, posterior-lateral, lateral, anterior-lateral and anterior-superior. In some cases, we may use the Nevasier portal.”

Physical therapy vital

Postoperative physical therapy is also important, he said.

“Our patients start with physical therapy on the 15th day with passive motion and massage, and at the 35th day, they start receiving active motion [physical therapy],” Vitullo said.

Ultimately, “Arthroscopic repair is useful for massive cuff tear because of the possibility to release the retracted cuff and repair anteriorly and posteriorly without touching the deltoid muscle,” Vitullo said. “The arthroscopic repair of massive rotator cuff tears is also effective for decreasing pain and improving shoulder function. Patient satisfaction rates are also very high with arthroscopy.”

Later in the session, moderator Rainer Kluger, MD, of Vienna, argued that he has not yet seen a research paper demonstrating conclusive proof that arthroscopic surgery is better than open surgery for rotator cuff repairs. However, when audience members were asked how they perform cuff repairs, half indicated that they use arthroscopic surgery and half continue to perform the procedure using an open approach.

Reference:
Vitullo A, De Biase CF, Casavecchia M, Imperio F. Arthroscopic repair of massive rotator cuff tear: Results at 4- to 6-year follow-up. Paper F75. Presented at the 10th EFORT Congress. 3-6 June 2009. Vienna.