[Arthroscopic rotator cuff surgery : New and established methods]

A Systematic Review of Long-term Clinical and Radiological Outcomes of Arthroscopic and Open/Mini-open Rotator Cuff Repairs

BACKGROUND

Arthroscopic rotator cuff repair (aRCR) has shown similar midterm functional results and retear rates as open/mini-open rotator cuff repair (oRCR). A pooled analysis of long-term results of both techniques is yet missing.

PURPOSE

To evaluate the long-term results of aRCR and oRCR for full-thickness rotator cuff tears.

STUDY DESIGN

Systematic review; Level of evidence, 4.

METHODS

The systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The CENTRAL (Cochrane), MEDLINE (PubMed), and Embase databases were searched for studies that reported on long-term clinical and radiographic outcomes of full-thickness aRCR and oRCR with a minimum follow-up of 9 years.

RESULTS

Eleven studies were included: 5 studies on aRCR and 6 studies on oRCR. Studies were based on 550 shoulders (539 patients) with a mean patient age of 56.3 years (range, 25-77). After a mean follow-up of 14.0 years (range, 9-20), the mean preoperative absolute Constant score (CS) and American Shoulder and Elbow Surgeons (ASES) shoulder score were significantly improved postoperatively (CS, 44 to 78 points; ASES, 52% to 91%; both comparisons, P < .001). The retear rate was 41% (141 of 342 shoulders) without a significant difference between groups (aRCR, 43%; oRCR, 39%) (P = .364). A retear was associated with significantly reduced CS as compared with a healed repair (P = .004). No significant differences were found in postoperative functional scores, complications, and retear rates after failed cuff repairs between the arthroscopic and open/mini-open repair groups.

CONCLUSION

Pooled analysis of arthroscopic and open rotator cuff repairs demonstrated sustained improvement in long-term shoulder scores and pain with a substantial retear rate in both groups, which was associated with inferior shoulder function. There were no significant differences in long-term functional outcomes, retear rates, and complications. Both surgical techniques may be used on the basis of factors such as patient or surgeon preference and cost. Further studies using a more robust randomized controlled trial or larger cohort design are recommended to ascertain whether one surgical repair technique is superior to the other.

REGISTRATION

CRD42020180448 (PROSPERO).

The clinical and radiologic outcome of microfracture on arthroscopic repair for full-thickness rotator cuff tear

BACKGROUND

The persistent incidence of retear despite improvements in techniques led orthopedic surgeons to the application of principles of tissue bioengineering to achieve enhanced repair and functional outcomes. The purpose of this study was to compare clinical and radiologic outcomes of arthroscopic single-row repair augmented with microfracture (SRM) at the greater tuberosity with single-row (SR) and double-row (DR) repair in the treatment of full-thickness rotator cuff tears.

MATERIALS AND METHODS

This is a retrospective comparative study. A total of 123 patients were enrolled for arthroscopic repair of full-thickness rotator cuff tears, with 40 patients treated by SR, 44 by SRM, and 39 by DR. The minimum follow-up was 2 years. The primary outcome was retear rate, which was detected by magnetic resonance imaging, and the secondary outcome was functional outcome.

RESULTS

The mean age of the patients was 59.2 years, 58.1 years, and 60.6 years in the SR, SRM, and DR groups, respectively. The retear rate was 33%, 14%, and 36% in the SR, SRM, and DR groups, respectively (P = .045). The SRM group had significantly improved functional outcomes compared with the SR and DR groups in terms of the postoperative Constant score and visual analog scale score (P = .001 and .002, respectively). Delta Constant scores were nonsignificant for retear and intact tendons (P = .137).

CONCLUSION

SRM has a significantly lower retear rate and better functional outcome than SR and DR repair.

Biological Augmentation With Subacromial Bursa in Arthroscopic Rotator Cuff Repair

Rotator cuff tears can be associated with significant shoulder dysfunction and pain. Despite improved surgical techniques and new materials for rotator cuff reconstruction, there is no significant reduction in the re-rupture rate. Innovative approaches for enhanced tendon healing are required. The potential of biologically optimized tendon integration has probably been insufficiently explored so far. The existing practice of debridement might eliminate repair tissue and a major source of cells and blood vessels necessary for tendon healing. Biological augmentation may be an option to improve the healing process. The subacromial bursa is a highly proliferative tissue with mesenchymal stem cells capable of differentiating into various cell lines and is easily accessible during rotator cuff repair. We describe the technique of bursal augmentation in arthroscopic double-row SutureBridge repair of a posterosuperior rotator cuff tear with the aim of improving tendon-to-bone healing.