Friday, January 11, 2013

Does cuff integrity of cuff repair matter?

Functional outcomes and structural integrity after double-pulley suture bridge rotator cuff repair using serial ultrasonographic examination

These authors evaluated the functional outcomes and the repair integrity by ultrasound at a minimum of 2 years after a double-pulley suture bridge rotator cuff repair. After surgery patients wore an abduction brace for 6 weeks.

The overall retear rate was 19.5% (50% for massive tears, 18% ( for large tears, 17% for medium tears, and no failures for small tears).  Seventy-five percent  of retears were identified within 6 months after operation and 25% were identified more than 1 year after repair. The functional outcomes of the intact group and the retear group were not different according to the ASES score, the Constant score, the KSS, and the UCLA score.

The authors concluded that the outcome improved independent of the tear size and the cuff integrity. This result is very similar to those shown here, here, here, here, here, here, and here.

Here is a plot of their data comparing Constant Scores for intact and retorn repairs.

While there is much discussion about the relative value of single row, double row, triple row, double-pulley, and transosseous equivalent repairs, the results of these studies that show little difference between intact and retorn repairs pose the question: "what is it about cuff surgery that leads to improved function?".

See also the evidence supporting the idea of stress relaxation after cuff repair.


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