Article

Open Versus Arthroscopic Rotator Cuff Repair: A Comparative View of 96 Cases

Orthopaedic Department, Regional Hospital Tafers, Fribourg, Switzerland.
Arthroscopy The Journal of Arthroscopic and Related Surgery (Impact Factor: 3.19). 06/2005; 21(5):597-604. DOI: 10.1016/j.arthro.2005.01.002
Source: PubMed

ABSTRACT This study was performed to review and compare the outcome of a consecutive series of 96 rotator cuff repairs performed with an open versus arthroscopic technique. The arthroscopic repairs include the beginning of the learning curve.
Case series.
In a 24-month period from 1999 to 2001, 95 patients underwent a cuff repair with bony reattachment by 1 surgeon; 4 patients had surgery on both shoulders. We present subjective outcome data from 96 of 99 operated shoulders by the use of a visual analog scale (VAS), the Simple Shoulder Test (SST), and the question of overall patient satisfaction. Thirty shoulders undergoing surgery before February 2000 had open cuff repair (12 classic open, 18 mini-open) and 66 shoulders undergoing surgery after February 2000 had an arthroscopic cuff repair with suture anchors. All but 3 shoulders had the supraspinatus/infraspinatus tendon refixed, 32% had a subscapularis reattachment, and 21% an additional SLAP repair.
Groups A (30 shoulders, open repair) and B (66 shoulders, arthroscopic repair) were comparable concerning tear size, cause of the tear, professional shoulder strain, and preoperative pain intensity. At follow-up evaluation (15-40 months after surgery), group B had significantly better pain relief on the VAS (P < .05), more yes answers in the SST (9.7 vs. 8.7, not significant), and a higher patient satisfaction rate of 92.4% versus 80% (not significant). From the 12 questions of the SST, all but 1 showed a higher percentage of yes answers in group B; for 3 questions concerning mobility the difference was significant (P < .07). There was no correlation between tear size and outcome in the SST.
Arthroscopic cuff repair yielded equal or better results than open repair, even at the beginning of the learning curve. Patients with an arthroscopic repair had a significantly better decrease in pain and a better functional result concerning mobility. Arthroscopic repair is successful for large and small tears. Biomechanically, large tears might even benefit more than small ones.
Level IV.

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    • "Dans cette optique, il est nécessaire de décrire précisément la douleur et pourtant, si l'arthroscopie d'épaule est réputée peu génératrice de douleurs postopératoires, aucune étude, à notre connaissance, ne s'est appliquée à cette description pendant les premiers jours suivant l'intervention. Seules existent les publications qui ont comparé les résultats douloureux des gestes arthroscopiques aux gestes à ciel ouvert [1] [2] au trentième ou au mieux au septième jour postopératoire. La recherche de ses causes et facteurs de risque doit compléter la description, permettant au chirurgien d'anticiper le résultat douloureux en fonction du contexte du patient, dès le stade de la consultation préopératoire. "
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    ABSTRACT: Introduction L’arthroscopie d’épaule est réputée douloureuse, mais l’évolution de la douleur postopératoire après ce type de chirurgie n’a jamais été décrite et analysée. Cette étude a un triple objectif, descriptif, de recherche de facteurs de risque, et d’analyse de l’impact à long terme de la douleur postopératoire. Patients et Méthodes Cette série prospective continue inclut 231 patients opérés d’une arthroscopie d’épaule. La douleur était évaluée de j1 à j3 puis à j7, j30 et un an. Trois critères de douleurs étaient relevés : EVA, consommation d’antalgiques morphiniques, et satisfaction sur la prise en charge de la douleur. Les interventions étaient pratiquées sous anesthésie générale et/ou bloc interscalénique. Un complément par anesthésique local pouvait être administré selon quatre modalités : injection unique sous-acromiale, cathéter sous-acromial, cathéter intra-articulaire ou aucun complément. Résultats Les valeurs d’EVA restent inférieures à 4/10 pendant toute la durée de l’étude. La douleur postopératoire immédiate est inférieure à la douleur préopératoire. Elle est suivie d’un rebond à j1 et j2 et ne redevient significativement inférieure à sa valeur préopératoire qu’à j30. La réparation de coiffe des rotateurs est le geste le plus douloureux dans les premiers jours postopératoires. Le principal facteur de risque de douleur est la prise en charge en accident de travail ou maladie professionnelle, associée à des EVA plus élevées de j1 à un an et une consommation de morphiniques plus importante. Il n’existe aucune corrélation entre les EVA postopératoires immédiats et l’EVA à un an. Discussion, conclusion L’arthroscopie d’épaule est une intervention peu douloureuse et durablement efficace sur le symptôme douleur. Un rebond douloureux apparaît à j1, qu’il faut prendre en compte notamment dans le cadre d’une chirurgie ambulatoire. Le recours aux techniques d’anesthésie locorégionale trouve là son principal intérêt. Malgré leur grande efficacité, l’effet de l’antalgie postopératoire sur le long terme n’est pas démontré. Niveau de preuve Étude de cohorte descriptive IV.
    Resuscitation 05/2011; 97(3):253-259. DOI:10.1016/j.rcot.2011.02.015 · 3.96 Impact Factor
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    • "Therefore, pain must be described precisely and yet, although shoulder arthroscopy is reputed to generate less postoperative pain than open surgery, to our knowledge, no study has described pain during the first days after this intervention. The only publications available have compared the pain results of arthroscopic and open surgery procedures [1] [2] at the 30th or at best the 7th postoperative day. "
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    ABSTRACT: Shoulder arthroscopy is reputed to be painful, but progression of postoperative pain after this type of surgery has never been described and analyzed. This study had a triple objective: the description, search for risk factors, and analysis of the long-term impact of postoperative pain. This continuous prospective series includes 231 patients who underwent arthroscopic shoulder surgery. Pain was evaluated from D-1 to D3, then at D7, D30, and 1 year. Three pain criteria were noted: visual analog scale (VAS), morphine intake, and satisfaction with pain management. Surgery was performed under general anesthesia and/or interscalene block. A local anesthetic complement was administered in one of four modes: single subacromial injection, subacromial catheter, intra-articular catheter, or no complement. The VAS values remained less than 4 out of 10 during the entire study. Immediate postoperative pain was less than preoperative pain. It was followed by a pain bounce on D1 and D2 and did not return to a level significantly lower than its preoperative value until D30. Rotator cuff repair is the most painful surgery in the first postoperative days. The main risk factor for pain is a work related accident or occupational disease, associated with higher VAS values from D1 to 1 year and greater morphine intake. There was no correlation between immediate postoperative and 1-year VAS values. DISCUSSION, CONCLUSION: Pain after shoulder arthroscopy is relatively low and the efficacy of the intervention is long-lasting in terms of pain symptom. A pain bounce appears on D1, which must be taken into account, notably in the context of outpatient surgery. The use of local anesthesia is therefore advantageous. Despite the efficacy of postoperative pain relief protocols, their effect on longer term perspective was not demonstrated.
    Orthopaedics & Traumatology Surgery & Research 03/2011; 97(3):260-6. DOI:10.1016/j.otsr.2011.02.003 · 1.17 Impact Factor
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