Sunday, June 1, 2014

Does rotator cuff repair integrity influence the clinical results?

Factors associated with clinical and structural outcomes after arthroscopic rotator cuff repair with a suture bridge technique in medium, large, and massive tears

These authors evaluated 147 patients after arthroscopic rotator cuff repair using the suture bridge technique. An abduction brace was used for 4 to 6 weeks postoperatively. For the ensuing 6 weeks, "active motion of the shoulder was slightly increased".

25 (17.0%) shoulders had retears. Larger intraoperative tear sizes were correlated with higher retear rates. The incidence of retear was also higher in cases in which the preoperative fatty degeneration grade was higher. The retear rate was 10.6% (10 of 94) in medium tears, 18.4% (7 of 38) in large tears, and 53.3% (8 of 15) in massive tears. A larger intraoperative tear size was associated with higher rate of retear (P < .001). The heavy workers returned to work at an average of 3.2 months (range, 2-6 months) postoperatively with a retear rate of 18.7% (14 cases).

"Clinical symptoms improved regardless of structural status, which is similar to the findings of other studies."

Comment: Indeed. Using their data, we compared the functional outcome scores reported for the retear group and the overall group. As the graphs shown below demonstrate, the clinical results for the return repairs were not substantially different from those of the overall group. These data make one wonder whether the effort, time and cost expended to regain cuff integrity in cuff repair and post surgical rehabilitation is merited by the clinical results, especially in larger, chronic tears.

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