Abstract
Introduction: The treatment of symptomatic rotator cuff rupture is a common therapeutic challenge in our ageing population with high functional demands. We reviewed our results of arthroscopic treatment (introduced in our department in October 2005) and compared the outcome with that of open repair.
Material and Methods: The 73 patients of the open group were operated between October 1998 and October 2006. Treatment consisted of classic open repair done by a parasagital incision with transosseous sutures in 69 and titanium anchors in 4 cases. All patients were immobilised in an abduction splint for 6 weeks and only passive exercises were performed during this period. Strengthening exercises were allowed after 3 month. The arthroscopic group included 30 patients operated between October 2005 and June 2008. A single row repair using 1–3 titanium anchors was performed via 3 to 5 incisions. The abduction splint was used for 4 weeks and strengthening exercises were allowed after 2 month. Standard x-rays in 3 planes were performed praeop, postop and at the latest follow up examination. A praeop MRI was done in all cases. Clinical examination used the non age adapted Constant score and complications were recorded.
Results: Follow up was possible for 29 men and 36 women with a mean age of 57 years (35 to 78) in the open versus 15 men and 13 women with a mean age of 59 years (44 to 74) in the arthroscopic group. Mean follow up averaged 36 month (3–102) in the open and 15 month (3–35) in the arthroscopic group. One tendon was affected in 45% versus 75%, two tendons in 45% versus 25% and three tendons in 10% versus 0% in the open and arthroscopic groups. The mean Constant score could be improved from 50 (29–68) praeop to 71 (39–97) postop in the open and 52 (28–62) praeop to 80 (45–98) postop in the arthroscopic group. If only one and two tendon ruptures were recorded in the open group the mean postop Constant score was 76. Four complications were encountered in the open group. One patient had to be revised due to deep infection and one because of wound healing problems. Two cases of frozen shoulder could be managed conservatively. In the arthroscopic group one patient showed a temporal irritation of the ulnar nerve and another a frozen shoulder. Both cases could be managed conservatively.
Conclusion: Short to mid term results showed no difference in clinical outcome comparing open and arthroscopic procedures. The higher mean postop Constant score of the arthroscopic group was mainly due to the lager tears sizes of the open group. Advantages of the arthroscopic procedure are the possibility of faster rehabilitation and that the operation seems less prone to infection and wound healing problems.
Correspondence should be addressed to: EFORT Central Office, Technoparkstrasse 1, CH – 8005 Zürich, Switzerland. Email: office@efort.org
