Mini-open versus all-arthroscopic rotator cuff repair: Comparison of the operative costs and the clinical outcomes

Department of Orthopaedics and Traumatology, Afyon Kocatepe University Faculty of Medicine, Afyon, Turkey.
Advances in Therapy (Impact Factor: 2.27). 04/2008; 25(3):249-59. DOI: 10.1007/s12325-008-0031-0
Source: PubMed


Rotator cuff injury is one of the most frequently encountered problems of the shoulder in the daily practice of orthopaedic surgeons. This study compared all-arthroscopic cuff repair (ARCR) and mini-open rotator cuff repair (MORCR) methods in regard to clinical outcomes and costs.
Fifty patient charts and operative repairs were analysed (25 ARCR and 25 MORCR). Pre-and postoperative Constant-Murley and UCLA scores along with factors such as tear size, tear type, pre-operative physical therapy, motion and satisfaction levels were compared for the two procedures. Cost-benefit analysis was also performed for comparison between procedures. The duration of follow-up was 31.20 and 21.56 months for MORCR and ARCR groups, respectively.
Tear sizes (P=0.68), pre-and postoperative Constant-Murley and UCLA scores (P=0.254) and satisfaction levels were not significantly different between groups. However, the differences between pre-and postoperative Constant-Murley and UCLA scores were statistically significant within both groups (P<0.01). The MORCR group stayed 1 day longer in hospital than the ARCR group, which was statistically significant (P=0.036). The differences regarding mean pain scores, abductions, internal and external rotations in Constant-Murley scores and forward flexion scores in UCLA scores were not significant. The ARCR group cost more, leaving less profit.
Results suggest that ARCR yields similar clinical results but at a higher cost compared with MORCR.

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    • "7 studies [8]–[10], [12], [14], [17], [18] using different score systems were involved when comparing the function score between two groups. There was no difference in the function outcome scores between the two groups. "
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    ABSTRACT: The purpose of this study was to compare clinical outcomes of patients with full-thickness small to large sized tears undergoing all-arthroscopic versus mini-open rotator cuff repair. A literature search for electronic databases and references for eligible studies was conducted through Medline, Embase and Cochrane library between 1969 and 2013. A total of 12 comparative studies (n = 770 patients) were included. Pooled results showed: there were no differences in function outcome, pain scores, retear rate or the incidence of adhesive capsulitis between all arthroscopic and mini-open repair groups. There were no differences in outcomes between the arthroscopic and mini-open rotator cuff repair techniques, they should be considered alternative treatment options. Level IV, Meta analysis.
    PLoS ONE 04/2014; 9(4):e94421. DOI:10.1371/journal.pone.0094421 · 3.23 Impact Factor
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    • "Two years after our procedure, the mean UCLA total shoulder score was 32.7 points. This is comparable to other series that have reported this end point at a minimum of 2 years after suture-anchor repairs [5, 7, 10, 11]. "
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    ABSTRACT: Although arthroscopic anchor suturing is commonly used for rotator cuff repair and achieves good results, certain shortcomings remain, including difficulty with reoperation in cases of retear, anchor dislodgement, knot impingement, and financial cost. In 2005, we developed an anchorless technique for arthroscopic transosseous suture rotator cuff repair. After acromioplasty and adequate footprint decortication, three K-wires with perforated tips are inserted through the inferior margin of the greater tuberosity into the medial edge of the footprint using a customized aiming guide. After pulling the rotator cuff stump laterally with a grasper, three K-wires are threaded through the rotator cuff and skin. Thereafter, five Number 2 polyester sutures are passed through three bone tunnels using the perforated tips of the K-wires. The surgery is completed by inserting two pairs of mattress sutures and three bridging sutures. We investigated the retear rate (based on MR images at least 1 year after the procedure), total score on the UCLA Shoulder Rating Scale, axillary nerve preservation, and issues concerning bone tunnels with this technique in 384 shoulders in 380 patients (174 women [175 shoulders] and 206 men [209 shoulders]). Minimum followup was 2 years (mean, 3.3 years; range, 2-7 years). Complete followup was achieved by 380 patients (384 of 475 [81%] of the procedures performed during the period in question). The remaining 91 patients (91 shoulders) do not have 1-year postsurgical MR images, 2-year UCLA evaluation or intraoperative tear measurement, or they have previous fracture, retear of the rotator cuff, preoperative cervical radiculopathy or axillary nerve palsy, or were lost to followup. Retears occurred in 24 patients (24 shoulders) (6%). The mean overall UCLA score improved from a preoperative mean of 19.1 to a score of 32.7 at last followup (maximum possible score 35, higher scores being better). Postoperative EMG and clinical examination showed no axillary nerve palsies. Bone tunnel-related issues were encountered in only one shoulder. Our technique has the following advantages: (1) reoperation is easy in patients with retears; (2) surgical materials used are inexpensive polyester sutures; and (3) no knots are tied onto the rotator cuff. This low-cost method achieves a low retear rate and few bone tunnel problems, the mean postoperative UCLA score being comparable to that obtained by using an arthroscopic anchor suture technique. Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 07/2013; 471(11). DOI:10.1007/s11999-013-3148-7 · 2.77 Impact Factor
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