SH9: DELAMINATION TEARING OF THE ROTATOR CUFF: PROSPECTIVE ANALYSIS OF THE INFLUENCE OF DELAMINATION TEARING ON THE OUTCOME OF ARTHROSCOPIC ASSISTED MINI OPEN ROTATOR CUFF REPAIR

Abstract

Introduction and aims: Good outcome for rotator cuff repair has been reported for open, arthroscopically assisted miniopen and arthroscopic techniques.

Patient outcomes are affected by tear characteristics, patient factors and surgical experience.

Little information is reported in literature on the affect on outcome in the presence of delamination tearing found at surgery.

This prospective study compares outcome of miniopen rotator cuff repairs with and without delamination.

Method: A prospective analysis between November 2004 and January 2008 allowed data collection on arthroscopically assisted miniopen rotator cuff repairs performed by a single surgeon using the same technique.

The Western Ontario Rotator Cuff score (WORC) was used as the measurement tool to assess outcome. Scores were recorded pre-operatively and at 6 months, 12 months and 2 years post-operatively.

Results: 229 arthroscopically assisted miniopen rotator cuff repairs were performed on 221 patients.

• Tear size and presence of delamination were recorded at the time of surgery.

• Incidence of delamination was 72%. The average age of patients was 58.6 years.

• There was no age difference in the incidence of delamination.

• Incidence of delamination was 72% in patients under 60 years (n=123) and 71% in patients over 60 years (106).

• 72% (of 62) female shoulders showed delamination and 71.5% (of 168) male shoulders showed delamination.

• Tears of less than 3cm had a 64% incidence of delamination. Tears greater than 3cm had 76% incidence of delamination.

• No difference in pre-operative WORC scores between delaminated group versus non-laminated group.

• Pre-operative WORC scores showed both delaminated and non-laminated tears had 40% of maximum score.

• Analysis at 2 years showed no difference in outcome of non-laminated tears (84% of maximum score) compared with delaminated tears (84% of maximum score).

• Size at time of repair did not affect outcome.

• Outcome showed slightly better results for delaminated tears in the older age group.

• Workers compensation patients achieved poorer outcomes than non workers compensation patients but there was no difference for delaminated versus non-laminated tears.

Conclusions: Prospective analysis of outcome on arthroscopic assisted minideltoid rotator cuff repairs demonstrates that both non-laminated and delaminated rotator cuff tears achieve excellent outcomes at 2 years.

There is no significant difference in outcome of repair when comparing workers compensation, size of tear or sex.

Increasing age was a positive predictor for outcome at 6 and 12 months.

It remains to be seen whether arthroscopic techniques can achieve similar results.