Thursday, December 18, 2014

Anterosuperior rotator cuff tears - does repair technique matter?

Arthroscopic Repair of Anterosuperior Rotator Cuff Tears: In-Continuity Technique Vs. Disruption of Subscapularis-Supraspinatus Tear Margin

The defined an anterosuperior rotator cuff tear as a full-thickness subscapularis tear combined with a full-thickness supraspinatus tear, involving a medial biceps sling and formation of a tear margin between the two tendons.

In this series the patient age averaged 60 years and the time between symptom onset and surgery averaged 22 years. 22 were men and 37 women. 92% of the patients had a biceps lesion.

These authors compared the clinical outcomes and structural integrity after arthroscopic repair of the anterosuperior rotator cuff - either in continuity or with disruption of the tear margin.

At the two-year follow-up evaluation, VAS pain scores, SSVs, ASES scores, UCLA shoulder scores, subscapularis strength, and active range of motion were significantly improved in both groups compared, but there were no significant differences between groups for any of these follow-up measurements. 

The overall retear rate (by MRI or CT arthrogram)  did not differ significantly different between the group with marginal disruption (22%; five of twenty-three) and without marginal disruption (19%; six of thirty-two). Five patients did not have followup imaging.

Comment: This paper again shows (as we've noted before here) that the details of surgical technique seem to have little effect on the clinical or anatomic outcomes of rotator cuff repair.


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