Arthroscopic Repair of Large U-Shaped Rotator Cuff Tears Without Margin Convergence Versus Repair of Crescent- or L-Shaped Tears
Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea.The American Journal of Sports Medicine (Impact Factor: 4.36). 10/2013; 42(1). DOI: 10.1177/0363546513505425
BACKGROUND:For large-sized tears of the rotator cuff, data according to the tear shape have not yet been reported for repair methodology, configuration, and subsequent integrity. HYPOTHESIS:The retear rate after the repair of large mobile tears, such as crescent- or L-shaped tears, is believed to be lower compared with retear rates after the repair of large U-shaped tears that are accompanied by anterior or posterior leaves of the rotator cuff. STUDY DESIGN:Cohort study; Level of evidence, 3. METHODS:Data were collected and analyzed from 95 consecutive patients with a large-sized rotator cuff tear who underwent arthroscopic suture-bridge repair. Patients were divided into 2 groups: those having crescent- or L-shaped tears (mobile tear group, 53 patients) and those having U-shaped tears (U-shaped tear group, 42 patients). The integrity of the repaired constructs was determined by ultrasonography at 4.5, 12, and 24 months. Moreover, clinical evaluations were performed by using the Constant score, the American Shoulder and Elbow Surgeons (ASES) score, and muscle strength at intervals of 3, 6, 12, and 24 months postoperatively. RESULTS:On ultrasonography at 4.5, 12, and 24 months, a retear was detected in 6, 2, and 1 patients in the mobile tear group and in 5, 2, and 1 patients in the U-shaped tear group, respectively. Significant differences in retear rates were not detected between the groups overall or at each time point. Moreover, clinical scores were similar between groups, except for the presence of a temporarily higher Constant score at 12 months in the mobile tear group. With regard to shoulder strength, between-group comparisons indicated no statistically significant difference, either in abduction or external rotation, except for the presence of temporarily higher external rotation strength at 3 months in the mobile tear group. CONCLUSION:Arthroscopic repair of large-sized rotator cuff tears yielded substantial improvements in shoulder function, regardless of tear retraction, during midterm follow-up. Moreover, the findings did not indicate significant differences in retear rates between the repair of crescent- or L-shaped tears and that of U-shaped tears either overall or at a particular time point.
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ABSTRACT: The purpose of this article is 2-fold: To report the long-term functional results of arthroscopic rotator cuff repair (average, 3.5 years in this study), and to analyze results by tear size and repair technique (margin convergence v direct tendon-to-bone repair). Type of Study: Case series. Between September 1993 and April 1997, 62 patients had an arthroscopic rotator cuff repair performed by the senior author (S.S.B.). Of this group, 59 patients (59 shoulders) were available for follow-up. Preoperative and postoperative function were assessed by means of a modified UCLA scoring system. Tears were categorized according to size (greatest diameter, number of tendons involved, and pattern of tear [crescent shape v U-shape]). Crescent-shaped tears were repaired in a direct tendon-to-bone fashion and U-shaped tears were repaired by a margin-convergence technique. Good and excellent results were achieved in 95% of the cases, regardless of tear size. The large and massive tears did as well as the small and medium-sized tears. That is, results were independent of tear size (P >.05). Results of tears repaired by margin convergence were not significantly different statistically from those repaired by direct tendon-to-bone repair (P >.05), validating the selection criteria of U-shaped tears for repair by margin convergence. There is a rapid return to full overhead function after arthroscopic rotator cuff repair (average, 4 months for each tear size). Delay from injury to surgery, even of several years, did not adversely affect surgical outcome. (1) Arthroscopic rotator cuff repair can achieve good and excellent results in a large percentage of patients (95% in this series). (2) Results of arthroscopic rotator cuff repair are independent of tear size. (3) U-shaped tears repaired by margin convergence have results comparable to those of crescent-shaped tears repaired directly by a tendon-to-bone technique. (4) There is a rapid return to full overhead function after arthroscopic rotator cuff repair (average, 4 months for all tear sizes). (5) A delay from injury to diagnosis, even of several years, is not a contraindication to arthroscopic rotator cuff repair.Arthroscopy The Journal of Arthroscopic and Related Surgery 12/2001; 17(9):905-12. DOI:10.1053/jars.2001.26821 · 3.21 Impact Factor
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ABSTRACT: The author has previously elucidated and advocated various biomechanical principles for application in rotator cuff repair. This article is an attempt to link all these concepts together into a unified stepwise approach to arthroscopic rotator cuff repair that will maximize the strength of the repair for all tear configurations.Arthroscopy The Journal of Arthroscopic and Related Surgery 01/2000; 16(1):82-90. DOI:10.1016/S0749-8063(00)90133-6 · 3.21 Impact Factor
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ABSTRACT: Arthroscopic rotator cuff repair (RCR) has been reported to have good clinical results but high retear rates by ultrasound. We prospectively assessed postoperative cuff integrity and outcome after arthroscopic RCR (40 patients) and compared these results with open RCR (32 patients). Evaluation preoperatively and at 1 year included a physical examination and magnetic resonance imaging. American Shoulder and Elbow Surgeons and Constant scores improved significantly in both groups (P < .0001). Overall, 69% of repairs in the open group and 53% in the arthroscopic group were intact by magnetic resonance imaging. Of tears less than 3 cm in size, 74% in the open group and 84% in the arthroscopic group were intact. Of tears greater than 3 cm in size, 62% in the open group and 24% in the arthroscopic group were intact (P < .036). In the arthroscopic group, patients with an intact cuff had significantly greater strength of elevation (P = .01) and external rotation (P = .02). We conclude that open and arthroscopic RCRs have similar clinical outcomes. Cuff integrity is comparable for small tears, but large tears have twice the retear rate after arthroscopic repair.Journal of Shoulder and Elbow Surgery 05/2006; 15(3):290-9. DOI:10.1016/j.jse.2005.09.017 · 2.29 Impact Factor
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