Friday, August 23, 2013

Rotator cuff repair healing and clinical result of rotator cuff 'repair' - is there a relationship?

Arthroscopic Repair of Massive Contracted Rotator Cuff Tears: Aggressive Release with Anterior and Posterior Interval Slides Do Not Improve Cuff Healing and Integrity

This is a non-randomized study of forty-one patients with large-to-massive contracted rotator cuff tears, not amenable to complete repair with margin convergence alone. 22 patients underwent arthroscopic complete repair with a posterior interval slide and side-to-side repair of the interval slide edge and 19 patients had a partial repair with margin convergence. (nineteen patients; Group M).

No significant differences were detected between groups. At the two-year follow-up evaluation, the SST, ASES score, UCLA score, and range of motion had significantly improved (p < 0.001 for all) in both groups. The mean preoperative SST scores (and standard deviation) were 4.9 ± 1.3 in Group P and 4.7 ± 1.4 in Group M. The mean postoperative SST scores improved to 8.6 ± 1.6 in the posterior slide group (p < 0.001) and 8.8 ± 1.8 in the margin convergence group (p < 0.001) at the time of the two-year follow-up

91% of the patients with the posterior interval slide had a retear by MRI. 

So, once again, we are impressed with yet another article showing discordance: patients are improved clinically after rotator cuff surgery even when anatomical integrity is not achieved. It makes us wonder what is it about the surgery and aftercare that leads to the improvement, in that it is obviously not the integrity of the 'repair'. Perhaps a lesser surgery without postoperative immobilization could achieve the same result (see here)
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