Sunday, May 27, 2018

Rotator cuff repair - does the method of repair matter?

Clinical and radiologic outcome of arthroscopic rotator cuff repair: single-row versus transosseous equivalent repair

These authors state that "there is ongoing controversy regarding the ideal repair modality for rotator cuff tear, with single-row (SR) repair and double-row transosseous equivalent (TOE) repair as the main contenders". They reviewed  415 patients who underwent arthroscopic rotator cuff type I (complete coverage of the greater tuberosity footprint) or II (incomplete coverage) repair between January 2006 and December 2012 by an individual surgeon. The rationale for the choice of repair method is not stated; the surgeon switched his preferred method in 2009.

SR and TOE repairs were performed in 46% and 54% of patients, respectively. Type I and type II repairs were performed in 87% and 13% of patients, respectively. The overall incidence of retear assessed on postoperative magnetic resonance imaging was 6.74%. The incidence of retear in the SR group was statistically significantly higher only in large-sized tears (28.57% vs. 4.5%; P = .028).

Comment: The clinical results need to be viewed not by the postoperative scores but by the improvement in the scores. Note that the preoperative scores for the SR group were lower than those for the TOE group. The improvement in the SR group was not inferior to that of the TOE group.

The retear rate was not adjusted for duration of followup (53 months for the SR repair and 32 months for the TOE repair) - longer periods of followup are known to be associated with higher re-tear rates.

Information on relative costs of the two methods was not provided.

 In summary, this study does not provide evidence that the transosseous equivalent method of repair is of greater value to the patient than a single row repair.

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