AN ANALYSIS OF OUTCOME OF ARTHROSCOPIC VERSUS OPEN ROTATOR CUFF REPAIR USING BOTH SUBJECTIVE AND OBJECTIVE SCORING TOOLS.

Abstract

Objective: An open procedure has long been the gold standard for the repair of rotator cuff tears. Increasingly arthroscopic repair is taking the place of open surgery. This study is a comparative analysis of open and arthroscopic rotator cuff repair.

Methodology: 113 (57 female, 56 male; mean age 58 years) consecutive patients undergoing rotator cuff repair performed between 2003 and 2006 in one centre were studied prospectively. 92 were arthroscopic (48 female, 44 male; mean age 57 years) whilst 21 used a mini-open technique (9 female, 12 male; mean age 62). The determinant for which procedure was employed was solely clinical, whereby tears greater than 30mm dictated an open procedure. Assessments were made using the Oxford Shoulder Questionnaire (OSQ), DASH and Constant Scores pre-operatively, at three and six post-operative months, and six-monthly thereafter. Correlation coefficients (Pearson’s) were used to analyse and compare the post-operative course for each intervention, and the student’s t test was used to compare the mean scores for each treatment at each time point.

Results: Strong correlation was demonstrated between the rates of recovery with each surgery (Constant r=0.94; DASH r=0.96; OSQ r=0.94). Although the absolute scores were better for the arthroscopic group at each time-point with all assessment tools, these differences were statistically significant only pre-operatively with each score, and at one year with the Constant score.

Conclusion: Whilst the open repair group had poorer scores pre-operatively reflecting an initial difference in tear severity, the rates of improvement were identical with either treatment modality, as were the one year outcomes measured with the OSQ and DASH. This study demonstrates arthroscopic rotator cuff repair to be comparable with open, although we acknowledge that at one year a significant difference was evident with the Constant score.