Monday, June 23, 2014

Acromioplasty does not improve the clinical results of rotator cuff repair

These authors reported the clinical outcomes of 95 patients undergoing arthroscopic repair of full-thickness rotator cuff tears with (52) and without (43) acromioplasty.
There were no significant differences in baseline characteristics, including number of tendons torn, repair configuration, concomitant procedures, and acromion type and angles.

There were no significant differences in Simple Shoulder Test score, American Shoulder and Elbow Surgeons score, University of California–Los Angeles score, or visual analog scale pain score between nonacromioplasty and acromioplasty groups or between

There were 4 revision cuff repairs, 3 in the nonacromioplasty group and 1 in the acromioplasty group. One patient in the nonacromioplasty group had a capsular release and biceps tenotomy. However, this study did not include follow-up imaging to determine if there was an effect of acromioplasty on retear rates,

This study found no significant effect of acromioplasty on the clinical outcomes of arthroscopic cuff repair at two years after surgery.

In the normal shoulder the articulation between the coracoacromial arch and the rotator cuff provides an important stabilizing function. While in the past it was thought that rotator cuff tears resulted from ‘impingement’ of the acromion on the cuff, the use ofacromioplasty to treat the ‘impingement sydrome’ is not supported by theevidence currently available.

Previous studies demonstrated that good outcomes from open cuff repair are obtained without acromioplasty – in fact, our approach to cuff repair specifically avoids acromioplasty in order to preserve the function of the coracoacromial arch. 

We reported the results of 96 consecutive primary repairs of full-thickness tears of the rotator cuff that were performed through a deltoid-muscle-splitting incision that preserved the integrity of the acromion and the coracoacromial arch. Thirty-four of the tears involved the supraspinatus tendon alone; sixteen involved the supraspinatus and infraspinatus tendons; and eleven involved the supraspinatus, infraspinatus, and subscapularis tendons. The percentage of shoulders that could be used to perform each of the twelve functions on the Simple Shoulder Test (SST) was significantly increased postoperatively (p < 0.002). Men and women had different degrees of function preoperatively (p < 0.00000001) and postoperatively (p < 0.001), but the improvement in function was essentially identical for the two genders. The mean improvement in the number of SST shoulder functions that could be performed was best for the patients with one-tendon tears (4.9 functions), next best for those with two-tendon tears (3.6 functions), and worst for those with three-tendon tears (3.3 functions . SF-36 scores for physical role (p < 0.003) and comfort (p < 0.0001) were significantly improved postoperatively. We concluded that significant improvement in self-assessed shoulder comfort and in each of the twelve shoulder functions was observed after rotator cuff repairs performed without acromioplasty.


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