Saturday, September 19, 2020

Rotator cuff repair - does the repair method matter?

Three-year functional outcome of transosseous equivalent double-row vs. single-row repair of small and large rotator cuff tears: a double-blinded randomized controlled trial

                             


These authors sought to prospectively compare the functional outcomes of patients undergoing arthroscopic rotator cuff repair using transosseous-equivalent double-row (TEDR) or single-row (SR) suture anchor techniques at 3 years postoperatively for both large (>3 cm) and small (<3 cm) tears in 80 patients with a symptomatic and magnetic resonance imaging (MRI)–proven full-thickness rotator cuff tear, who had failed conservative management of at least 6 months’ duration and who had a complete passive range of motion of the affected shoulder.


Patient were randomized to TEDR repair (n = 40) or SR repair (n = 40). 



For tears >3 cm, mean postoperative scores were significantly higher in the TEDR group.


However, as can be seen in the plots below the differences were not large and not particularly consistent among different scoring methods.






The mean number of anchors used (i.e. procedure cost) was significantly higher in TEDR repairs compared with SR repairs. TEDR repairs also had greater the length of hospital stay,  operative time and immediate postoperative pain.


Unfortunately, these authors did not obtain follow-up MRI scans to assess the integrity of the rotator cuff repairs. "This was not possible because of the associated costs and the high demand for this imaging study at our institution"


Thus it is not possible to know the retear rate or the degree success of the two approaches in achieving a durable repair for the two repair methods. It is also not possible to know the relationship between the integrity of the repair and the functional outcome.


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