Open, mini-open rotator cuff repairs show comparable long-term results

Investigators cite clinical advantages of mini-open surgical technique at 3 months.

University of Calgary researchers reported no significant long-term differences in outcomes between open and mini-open surgical repairs for treating full-thickness rotator cuff repairs. The investigators, however, reported clinical and statistical differences at 3 months postop in favor of the mini-open surgical technique.

“For a patient with a full-thickness rotator cuff repair who has failed nonsurgical treatment, there is an improved quality of life with surgical repair, performed either mini-open or open,” said Nicholas C. Mohtadi, MD, MSc, FRCSC, of the Sports Medicine Center at the University of Calgary. “This [benefit], however, will be achieved at an earlier date with a mini-open approach.”

Mohtadi presented his findings at the American Orthopaedic Society for Sports Medicine (AOSSM) 2006 Annual Meeting in Hershey, Pa. Mohtadi and his co-authors received the O'Donoghue Award for best clinical-based research at the AOSSM meeting.

Patient evaluation

In the multicentered, prospective, randomized study, researchers evaluated 67 patients who presented with unremitting pain and a history of 3 months of failed conservative treatment at 4 centers throughout Canada. After evaluation and confirmation of a full thickness tear, patients were randomized by computer to undergo either an open surgical procedure or a mini-open procedure using arthroscopic components. Researchers confirmed full-thickness tears using imaging, ultrasound and arthrograms. They excluded massive tears.

All patients were evaluated at the 3-, 6-, 12- and 24-month postoperative mileposts. There were no complications, infections, nerve injuries or deep vein thromboses. All but 1 patient improved over time.

Quality-of-life assessment

The primary outcome measure: a disease-specific, validated, rotator cuff, quality-of-life questionnaire, with scores potentially ranging from 0 (lowest) to 100 (highest), Mohtadi said. Secondary measures included a shoulder pain questionnaire, the American Shoulder and Elbow Society subjective assessment and the Functional Shoulder Elevation Test.

Mohtadi said the computerized randomization succeeded in terms of the two groups — 30 patients in the open group and 33 in the mini-open group shared similar baseline data. Both groups improved over time, but at the 3- and 6-month follow-ups, there was a statistically significant difference between them.

“At 3 months, the difference was clinically important as well as statistically significant,” he said. “At the 6-month point, we did not consider the differences to be clinically important. At 1 year and 2 years, there were no major differences between the groups.”

Mohtadi said they assessed the changes as differences between the baselines of each group. At 3 months, the open group increased by 13.9 points and the mini-open by 25.4 points. All of the measured outcomes improved over time.

Editors note: This article is taken from the August 2006 issue of Orthopedics Today, page 8.

For more information:
Mohtadi NC, Hollinshead RM, Sasyniuk TM, et al. A randomized clinical trial comparing open to mini-open rotator cuff repair for full-thickness rotator cuff tears: Disease-specific quality of life outcome at 2-years follow-up. O'Donoghue Award Presentation. Presented at the American Orthopaedic Society for Sports Medicine 2006 Annual Meeting. June 29-July 2, 2006. Hershey, Pa.