THE CLINICAL AND STRUCTURAL RESULTS OF OPEN REPAIR OF AN ISOLATED ONE-TENDON TEAR OF THE ROTATOR CUFF

Abstract

The practice of rotator cuff repair rapidly moves towards arthroscopic techniques especially for single tendon tears. Although the clinical results are relatively well established, the structural results of open rotator cuff repair and their correlation with the clinical outcome are poorly known. In order to provide a baseline for future studies using other repair techniques, this study was carried out to assess the structural changes in the repaired musculotendinous unit and to correlate these findings with the clinical outcome after rupture and repair of an isolated full thickness single tendon tear of the rotator cuff.

To prospectively assess the quality of an open rotator cuff tendon repair technique, to determine how structural changes of rotator cuff muscles are affected by tendon repair, and to correlate the structural results of MRI studies with the clinical outcome.

Direct open repair of a complete, isolated single tendon tear of the rotator cuff resulted in significant improvement in function and objective evidence of tendon healing on MRI. Successful direct repair was not associated with recovery of preoperative muscular atrophy or fatty infiltration when comparing Goutallier stage fatty infiltration between pre and postoperative patients.

The age and gender-adjusted Constant score increased significantly from an average of 63.9% preoperatively to 94.5% postoperatively (p< 0.0001). Pain improved significantly from 6.8 points to 13.2 points on a visual analogue scale. (p< 0.0001). Activities of daily living increased from 11.2 points preoperatively to 17.9 points postoperatively (p< 0.0001). Anterior elevation, abduction and internal rotation improved significantly for subscapularis and supraspinatus repairs, but there was no significant change in external rotation. The overall rerupture rate was 12.5%. There was no significant improvement or recovery of muscular atrophy or fatty infiltration after tendon repair.

Thirty-two consecutive open repairs of a single tendon tear of the rotator cuff were analysed. The supraspinatus tendon was involved in twenty-two patients and the subscapularis tendon in ten patients. All tendons were repaired using an open technique, a modified Mason-Allen suturing technique, and transosseus fixation with non-absorbable suture material knotted over a bone augmentation device.