Pearls and pitfalls of arthroscopicrotator-cuff repair

Editorial Commentary: Biology and Biomechanics Must Be Carefully Balanced for a Durable Rotator Cuff Repair

Arthroscopic rotator cuff repair strategies have evolved over 3 decades, but suture anchor design, anchor configuration, and stitches have been largely driven by repair biomechanics. In recent years there has been a shift toward repair strategies that enhance the biology of tendon repair. Double-row and transosseous equivalent suture anchor repair constructs demonstrate excellent time zero mechanical properties, but the resulting increased repair tension and tendon compression may compromise tendon healing. Modern single-row repairs employing medialized triple-loaded suture anchors, simple stitches, and lateral marrow venting avoid some of the problems associated with double-row repairs and demonstrate excellent short-term healing and clinical results. The most robust repair fails if the tendon does not heal. Biology and biomechanics must be carefully balanced.

Early Results of Concurrent Arthroscopic Repair of Rotator Cuff and Type II Superior Labral Anterior Posterior Tears

Background:

Recent reports on concurrent arthroscopic rotator cuff and type II superior labral anterior posterior (SLAP) repair have raised concerns over postoperative stiffness and patient satisfaction. However, it is unclear if the observed stiffness relates to the repair of degenerative SLAP tears in older adults, the surgical technique, the postoperative rehabilitation, or to a combination of these factors.

Purpose:

The purpose of this study was to evaluate the outcome and repair integrity of concurrent arthroscopic rotator cuff and type II SLAP repair.

Study Design:

Case series.

Methods:

Of 11 patients identified, 7 had a full-thickness rotator cuff tear and 4 had a high-grade partial thickness tear that was completed. A cannula placed through the rotator cuff tear improved the trajectory for posterior suture anchor placement during SLAP repair. Postoperative rehabilitation employed continuous passive motion to prevent stiffness.

Results:

At minimum of 1-year follow-up, mean yes responses on the Simple Shoulder Test improved from 5.4 to 10.7 (out of 12; P < .01), and mean American Shoulder and Elbow Surgeons scores improved from 40 to 87 (out of 100; P < .01). Mean forward elevation improved from 148° to 161° (P < .01) and external rotation from 58° to 67° (P < .01). Magnetic resonance imaging, obtained at most recent follow-up in 10 patients, demonstrated a healed SLAP tear in all patients and a persistent rotator cuff defect in 1 patient.

Conclusions:

Arthroscopic rotator cuff repair can be successfully combined with type II SLAP repair in relatively young patients who have sustained traumatic injury to their shoulders. Allowing early passive motion may help prevent postoperative stiffness without compromising rotator cuff healing.

Arthroscopic repair of full-thickness tears of the rotator cuff in patients younger than 40 years

PURPOSE

Recent reports document excellent outcomes with arthroscopic repair of rotator cuff tears (RCT). However, full-thickness RCT are uncommon in patients younger than 40 years, and few reports document results after repair in this population. The purpose of this study is to retrospectively report results of arthroscopic repair of full-thickness RCT in patients younger than 40 years.

METHODS

Twenty-three consecutive patients younger than 40 years with full-thickness RCT underwent arthroscopic repair with suture anchors. Mean age was 37 years (range, 21 to 39). The mean size of RCT was 2.4 cm in the largest dimension (range, 1 to 4 cm). The mean number of anchors used was 2.5 (range, 1 to 4). Concomitant procedures included subacromial decompression (22), distal clavicle resection (13), SLAP repair (2), biceps tenodesis (2), anterior capsulorraphy (1), and capsular releases (1), and were performed at the discretion of the surgeon. Twenty-two patients (95%) recalled a single incipient trauma; two patients sustained a dislocation. Ten patients (43%) claimed Workers' Compensation (WC). Minimum follow-up was 24 months, and mean follow-up was 26 months (range, 24 to 29).

RESULTS

Mean preoperative American Shoulder and Elbow Surgeon's (ASES) self-report score was 42 (range, 22 to 60); the mean postoperative score was 92 (range, 65 to 100; P < .01). Twenty-one patients (90%) returned to their previous level of activity and employment, including 9 (90%) with WC claims. All patients (100%) reported diminished pain, and 22 (95%) reported improvement with activities of daily living. Complications included superficial wound infection (1) and axillary nerve palsy after initial dislocation (1). Given the choice, 22 patients (95%) would have same procedure again.

CONCLUSIONS

Excellent outcomes were observed following arthroscopic rotator cuff repair both with and without concomitant procedures in patients younger than 40 years. Full-thickness RCT in patients younger than 40 years appeared to be traumatic in etiology. Successful repair returns patients to their pre-injury level of function. These results support arthroscopic rotator cuff repair in young, active patients.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.