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Fewer retears seen with arthroscopic vs open rotator cuff repairs
Outcomes at the 5-year follow-up were generally more favorable for patients who underwent arthroscopic repair of their rotator cuffs.
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Arthroscopic knotted and unknotted repairs for rotator cuff tears provided patients with better cuff strength, less difficulty with overhead activities, fewer complications and less pain than in patients who underwent an open double-row repair, according to results of a comparative study.
Retear rates for arthroscopic knotted and unknotted procedures for rotator cuff repairs were significantly lower at the 5-year follow-up than with open double row techniques, Neal L. Millar, PhD, FRCSEd, (Tr&Ortho), said at the British Orthopaedic Association Annual Congress.
“All techniques resulted in improvement of range of movement, pain and overall shoulder function at 5 years. However, arthroscopic rotator cuff repair did have a lower retear rate at final follow-up,” Millar said.
Three different techniques
Millar and colleagues evaluated three groups of patients. Each group underwent three separate procedures for symptomatic rotator cuff repair. In all, 25 patients underwent a mini-open double-row mattress repair, 25 patients underwent a repair with an arthroscopic single-row simple suture knotted technique and 36 patients underwent a repair with an arthroscopic single-row inverted mattress knotless technique. The procedures were performed by a single surgeon. Postoperatively, all the patients wore a sling, but the one patients in the open group wore was different from that used in both arthroscopic groups.
Outcome measures were recorded preoperatively to 3 months, 3 months to 6 months, and 2 years to 5 years. The primary outcome of the study was ultrasound integrity of the rotator cuff at the 2-year and 5-year follow-up.
“All groups improved in range of motion over all time courses. Our patient-ranked scores in all three groups had better subjective pain scores at 2 [years] and 5 years. Interestingly, though, the open group did not seem to improve in any pain or strength outcomes at 5-year outcomes compared to both arthroscopy groups,” Millar said.
Improvement seen at all stages
Arthroscopic knotless repairs resulted in the least amount of retears at the 5-year follow-up. A total of 26% of patients experienced a retear. Also, 33% of patients who underwent an arthroscopic knotted repair experienced a retear at follow-up. Both of these techniques resulted in significantly fewer retears than in the open group, where retear occurred in 48% of patients. Interestingly, between 2 years and 5 years, there was no significant increase in the retear rate no matter what repair type the patient underwent, according to Millar.
Image: Millar NL
Retear rates correlated with older age, preoperative tear size, and weaker preoperative and postoperative rotator cuff strength, he said.
“Strength was not significantly improved in the open group. However, overall shoulder function, irrespective of which technique you used to repair the rotator cuff, at 5 years results in significantly improvement compared to preoperative levels,” Millar said.
Among the weaknesses of the study, according to Millar, were its small sample size, loss of many patients to follow-up and that it was not randomized. Furthermore, the ultrasound scans were performed by different practitioners. – by Robert Linnehan
- Reference:
- Millar NL, et al. Paper #449. Presented at: British Orthopaedic Association Annual Congress; Sept. 15-18, 2015; Liverpool, United Kingdom.
- For more information:
- Neal L. Millar, PhD, FRCSEd, (Tr&Ortho), can be reached at Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Sir Graeme Davies Building, 120 University Place, Glasgow G12 8TA, United Kingdom; email: neal.millar@glasgow.ac.uk.
Disclosure: Millar reports no relevant financial disclosures.