The purpose of this study was to assess the clinical outcomes of three different rotator cuff repair techniques and to correlate these results with the integrity of the cuff as determined by ultrasonographic evaluation.

Three cohorts of patients had repair of a symptomatic rotator cuff tear using:

an open technique with Mitek RC Quickanchor double row, one mattress suture per anchor (n = 49);

Standardised patient and examiner determined outcomes were obtained prospectively pre-operatively and at 6 weeks, 3 months and 6 months post-operatively. Ultrasound studies were performed with a validated protocol at 6 months post surgery.

Arthroscopic knotless repair was, on average,14 minutes faster than both open cuff repair (p< 0.001) and arthroscopic knotted repair (p< 0.01).Clinical outcomes were similar with the exception that the arthroscopic groups had, on average, 20% better ASES scores than the open group at 6 months (p< 0.001). The only complication was re-tear, which correlated with tear size (r=0.5, p< 0.001) and operation time (r=0.3, p< 0.001) and occurred more frequently following open repair (39%) compared with arthroscopic knotted (25%) and arthroscopic knotless (16%) repair (p< 0.01). The retear rates of tears > 8cm2 were significantly greater (p< 0.01) when using an open (88%) or arthroscopic knotted (67%) technique compared to the arthroscopic knotless (25%) cohort.

Rotator cuff repair, whether performed via an open or arthroscopic technique resulted in improvements in pain, motion, strength and function. An intact cuff on ultrasound corresponded to better results with regard to supraspinatus strength, patient outcomes and rotator cuff functional ability. Tears > 8cm2 fixed with an arthroscopic knotless technique had better structural outcomes at 6 months.

Aim: The aim of our study was to review the massive rotator cuff tears that were repaired arthroscopically and evaluate the clinical results in respect to repair integrity as well as the effect on the progression of osteoarthritis. Materials and Methods: We reviewed 56 (39 male,17 female) consecutive patients who underwent arthroscopic repair of their massive rotator cuff tears using biodegradable anchors by the senior author. The technique relies on the suspension bridge principal as described by S.Burkhart (1997). The mean age was 68.2 years (30–86) with most patients between 75 and 85 years. The mean follow up was 31months (24–41). Objective evaluation was done using the Constant score and subjective with the Oxford score. Osteoarthritis was investigated with radiographs and repair integrity with ultrasound. SPSS 16 for Windows was used for the statistical analysis of out results. Results: 93% of the patients had good (11%) or excellent results according to the Oxford score and 91% had Constant score over 75. The improvement in the scores was significant statistically in all parameters (p=0.000, p for strength=0.001). Thirteen patients had postoperative OA, but this was not correlated with the results or the improvement and 11/13 had excellent Oxford scores and Constant scores over75. Seventeen patients had a re-tear which was not correlated with the results or the improvement and 15/17 had excellent Oxford scores and Constant scores over 75. Seven patients had both osteoarthritis and retear but again improvement and results were not affected. Conclusion: Arthroscopic repair of massive rotator cuff tears has excellent clinical results regardless of the development of osteoarthritis or the repair integrity and should be the first line of treatment

A prospective study was carried out to determine if recognised histological features seen at surgery could help predict those rotator cuff tendon repairs which re-ruptured. 40 rotator cuff tendon edge specimens from 40 patients’ shoulders were analysed histologically following routine mini-open rotator cuff repair. 32/40 underwent Ultrasonography, at a mean time of 35 months post-operatively, to determine repair integrity. The histological features seen at surgery were then compared to the repair integrity of the tendon from which it had been taken. Rotator cuff repairs that remained intact demonstrated a greater reparative response, in terms of increased fibrobast cellularity, cell proliferation and a thickened synovial membrane, than those repairs which reruptured. Larger tears which remained intact showed a higher degree of vasacularity and a significant inflammatory component than those that re-ruptured. Good tissue quality at the time of surgery allows the repair the best chance of remaining intact despite the size of the lesion. Routine histological analysis of the tissue biopsy, preformed in the post-operatively, can now aid the clinician in terms of early management and repair prognosis

Large and massive rotator cuff tears can cause persistent pain and significant disability. These tears are often chronic with substantial degeneration of the involved tendons. Surgical treatment is challenging and the functional outcome after repair less predictable then for smaller tears. The aim of this study was to determine the functional outcome and rate of re-rupture after mini-open repair of symptomatic large and massive rotator cuff tears using a modified two-row technique. Twenty-four patients, who were operated on under the care of a single surgeon between 2003 and 2006, were included in this study. Patients were assessed prospectively before and at a mean of 27 months after surgery using Constant Score and Oxford Shoulder Score. This assessment was carried out by an independent physiotherapist specialising in shoulder rehabilitation. At follow-up an ultrasound was carried out by a musculoskeletal radiographer to determine the integrity of the rotator cuff repair. Patient satisfaction was assessed using a simple questionnaire. The mean Constant Score improved significantly from 36 preoperatively to 68 postoperatively (p< 0.0001), the mean Oxford Shoulder Score from 39 to 20 (p< 0.0001). Four patients (16.7%) had a re-rupture diagnosed by ultrasound. 87.5% of patients were satisfied with the outcome of their surgery. Tear size and repair integrity did not significantly influence functional outcome. 87.5% of patients were satisfied or very satisfied with the outcome of their surgery. This study shows that the two-row repair of large and massive rotator cuff tears using a mini-open approach is an effective method of repair with a comparatively low re-rupture rate. It significantly improves the functional outcome and leads to a very high patient satisfaction. We conclude that these results justify repair of large to massive rotator cuff tears when possible, irrespective of chronicity of symptoms

Subscapularis repair and integrity after a primary total shoulder arthroplasty is critical for successful outcomes. One should be familiar with the 3 basic takedown and repair techniques commonly utilised. Subscapularis repair after reverse shoulder arthroplasty is not as critical and in some cases may be detrimental to return of external rotation strength and motion. Subscapularis tenotomy: The tendon is incised approximately 1 cm from the lesser tuberosity and an oblique incision is created from proximal lateral to distal medial stopping at the sentinel vessels. A combination of tendon-to-tendon figure of 8 sutures. Lesser tuberosity osteotomy: This approach is helpful not only in obtaining a bone-to-bone healing, but also in the exposure. Osteotomies range from a fleck of bone in patients with minimal deformity, to a C-shaped osteotomy including part of the head which facilitates exposure of the posterior glenoid. Despite an ability to document radiographic healing of the lesser tuberosity fragment, this technique does not prevent fatty infiltration of the subscapularis. Subscapularis Peel: This repair requires tendon healing to bone and probably incomplete, in most cases, reconstitution of a normal enthesis. External rotation can be gained by recessing the subscapularis insertion medially with the arm in external rotation. While bone-to-tendon sutures are the gold standard, augmentation of the sutures using a prosthesis as the anchor has led to the development of prostheses with multiple holes. Dual row repair of the tendon, however, may lead to medial rupture

The June 2012 Shoulder & Elbow Roundup³⁶⁰ looks at: reverse shoulder replacement; torn rotator cuffs and platelet-rich fibrin; rotator cuff repair; frozen shoulder; whether an arthroscopic rotator cuff repair actually heals; the torn rotator cuff’s effect on activities of daily living; subacromial impingement; how to improve the reliability of the Constant-Murley score; and failure of the Neer modification of an open Bankart procedure.

Objectives

The aim of this study was to determine whether there is any significant difference in temporal measurements of pain, function and rates of re-tear for arthroscopic rotator cuff repair (RCR) patients compared with those patients undergoing open RCR.