A Comparison of Outcomes After Arthroscopic Repair of Partial Versus Small or Medium-Sized Full-Thickness Rotator Cuff Tears - JBJS
Over two decade ago, Harryman et al found that 80% of repairs of cuff tears confined to the supraspinatus were intact by ultrasound. The 2012 JBJS paper, using modern arthroscopic repair methods found that 80% of supraspinatus-only tears were intact by ultrasound at 24 months after surgery. Are we getting better or not?
Unfortunately, the authors did not compare shoulder function in the retear group with that of the cuff intact group.
These authors found that on reexploration, "all retears had occurred by sutures pulling through the tendon", speaking to tendon quality as a major determinant of the durability of repair. Of interest is that the retear rate was 10% at 6 months and that it was twice that at two years after surgery, suggesting that a 'healed' tear may not be as strong as we would wish.
The authors compared the results of repair of full thickness supraspinatus tears to the results of partial thickness tears of the supraspinatus which were converted to full thickness tears and subsequently repaired. The retear rate in these surgically created full thickness tears was half that of the shoulders presenting with full thickness tears, although these differences were not statistically significant.
Of interest is that postoperative stiffness was noted in half of the shoulders at six weeks after surgery and progressively improved over the subsequent 6 months.
Of final note is that in this group of patients with repairs of small cuff tears, the ASES scores were only 75% of normal at 24 months, the supraspinatus strength only 70% of normal, and the overall shoulder function rated by the patients was on average only 'fair' at 24 months.
Thus, in spite of much work on refining the treatment of rotator cuff disease, we still fall short of the goal of restoring the shoulder to its pre-injury condition.
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