Clinical Outcomes and Sturctural Integrity of Rotor Cuff Tears after Arthroscopic Single Row Repair
Keywords:Rotator cuff tear, Shoulder Arthroscopy, Single row repair, Suture Anchors
Aim: To determine the functional and structural outcomes of rotator cuff tears after arthroscopic single row repair with biodegradable suture anchors.
Methods: This descriptive study was conducted in Hand & Upper Limb Surgery centre, CMH-Lahore Medical College, Lahore from 3rd January 2016 to 20th August 2019.All patients with rutator cuff tears fulfilling the inclusion criteria were operated arthroscopically with a single row(SR) technique using biodegradable suture anchors. Post operative functional outcomes were assessed at six months follow up with University of California Los Ageles score(UCLA), American Shoulder and Elbow Surgeon score(ASES) and pain assessment with Visual Analogue Scale(VAS).Post operative structural integrity of the rotator cuff was evaluated with ultrasonoghrapic examination. Pearson’s correlation test and Fisher’s exact test were applied to find the significant association between functional outcomes and different demographic variables. P value < 0.05 was considered significant.
Results: A total of 40 patients including 36(90%) male and 4(10%) female were included in our study. Mean age at the time of operation was 46.45±13.79 years (range 24-70 years). Right side was involved in 28 (70%) cases and left in 12(30%) patients. Traumatic and degenerative tears were noted in 28(70%) and 12(30%) patients respectively. Mean follow up peroid was 18.1± 6.17 (range 9-31) months. Functional outcomes at final follow up according to UCLA improved from 23.35±7.47 pre operatively to 33.51±1.1 post operatively while ASES score improved from 43.6±4 preoperatively to 70.45±19.87 post operatively.Pre-operative average shoulder pain on VAS was 5.9±0.69 (range 4-8). At last follow up average shoulder pain was 1.95±0.82 range (1-3) with average improvement of 3.95±1.5. Structural integrity on post operative ultrasonoghrapic examination revealed intact rotator cuff in 36 (80%) cases while 8 (20%) cases had re-tear.
Conclusion: Arthroscopic single row rotator cuff repair produced excellent functional and structural outcomes and significant pain reduction in majority of our patients. We therefore, recommend this intervention as a suitable treatment option for small to medium size rotator cuff tears.
Abechain JJK, Godinho GG, Matsunaga FT, Netto NA, Daou JP, Tamaoki MJS. Functional outcomes of traumatic and non-traumatic rotator cuff tears after arthroscopic repair. World J Orthop. 2017;8(8):631-7.
Randelli P, Stoppani CA, Zaolino C, Menon A, Randelli F, Cabitza P. Advantages of arthroscopic rotator cuff repair with a transosseous suture technique: a prospective randomized controlled trial Am J Sports Med. 2017;45(9):2000-9.
Donohue NK, Prisco AR, Grindel SI. Pre-operative corticosteroid injections improve functional outcomes in patients undergoing arthroscopic repair of high-grade partial-thickness rotator cuff tears. Muscles, Ligaments and Tendons Journal. 2017;7(1):34-9.
Gumina S, Izzo R, Pintabona G, Candela V, Savastano R, Santilli V. Mobility recovery after arthroscopic rotator cuff repair. European Journal of Physical and Rehabilitation Medicine. 2017;53(1):49-56.
Lee WH, Do HK, Lee JH, Kim BR, Noh JH, Choi SH, et al. Clinical Outcomes of Conservative Treatment and Arthroscopic Repair of Rotator Cuff Tears: A Retrospective Observational Study. Annals of Rehabilitation Medicine. 2016;40(2):252-62.
Liu J, Fan L, Zhu Y, Yu H, Xu T, Li G. Comparison of clinical outcomes in all-arthroscopic versus mini-open repair of rotator cuff tears: A randomized clinical trial. Medicine (Baltimore). 2017;96(11):63-68.
Black EM, Lin A, Srikumaran U, Jain N, Freehill MT. Arthroscopic transosseous rotator cuff repair: technical note, outcomes, and complications. Orthopedics. 2015;38(5):352-8.
Kakoi H, Izumi T, Fujii Y, Nagano S, Setoguchi T, Ishidou Y, et al. Clinical outcomes of arthroscopic rotator cuff repair: a retrospective comparison of double-layer, double-row and suture bridge methods. BMC Musculoskelet Disord. 2018;19(1):324.
Spiegl UJ, Euler SA, Millett PJ, Hepp P. Summary of meta-analyses dealing with single-row versus double-row repair techniques for rotator cuff tears. Open Orthop J. 2016;10(S9):330–338.
Tudisco C., Bisicchia S, Savarese E, Fiori R, Bartolucci DA, Masala S. Single-row vs. double-row arthroscopic rotator cuff repair: clinical and 3 Tesla MR arthrography results. BMC Musculoskelet Disord. 2013;14:43.
Park MC, Idjadi JA, Elattrache NS, Tibone JE, McGarry MH, Lee TQ. The effect of dynamic external rotation comparing 2 footprint-restoring rotator cuff repair techniques. Am J Sports Med. 2008;36(5):893–900.
Smith CD, Alexander S, Hill AM, Huijsmans PE, Bull AM, Amis AA. A biomechanical comparison of single and double-row fixation in arthroscopic rotator cuff repair. J Bone Joint Surg Am. 2006;88(11):2425–2431.
Senna LP, Ramos MR, Bergamaschi RF. Arthroscopic rotator cuff repair: Single-row vs. Double-row – clinical results after one to four years.Rev Bras Ortop. 2018; 53(4): 448–453.
Franceschi F,Ruzzini L, Longo UG, Martina FM, Zobel BB, Maffulli N et al.Equivalent clinical results of arthroscopic single-row and double-row suture anchor repair for rotator cuff tears: A randomized controlled trial. Am J Sports Med. 2007;35(8):1254-60.
Park JY, Lhee SH, Choi JH, Park HK, Yu JW, Seo JB. Comparison of the clinical outcomes of single- and double-row repairs in rotator cuff tears. Am J Sports Med.2008;36(7):1310-6.
Esch JC, Ozerkis LR, Helgager JA, Kane N, Lilliott N. Arthroscopic Subacromial Decompression: Results according to the Degree of Rotator Cuff Tear. Journal of Arthroscopic and Related Surgery. 4(4):241-249
Michener LA, McClure PW, Sennett BJ. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg. 2002;11(6):587-94.
Baums M, Kostuj T, Klinger H, Papalia R. Rotator cuff repair: single-vs double-row. Clinical and biomechanical results. Der Orthopade. 2016;45(2):118-24.
Dierckman BD, Ni JJ, Karzel RP, Getelman MH. Excellent healing rates and patient satisfaction after arthroscopic repair of medium to large rotator cuff tears with a single-row technique augmented with bone marrow vents. Knee Surg Sports Traumatol Arthrosc. 2018;26(1):136-45.
Ying ZM, Lin T, Yan SG. Arthroscopic single-row versus double-row technique for repairing rotator cuff tears: a systematic review and meta-analysis. Orthopaedic Surgery .2014;6(4):300-12.
Burks RT, Crim J, Brown N, Fink B, Greis PE. A prospective randomized clinical trial comparing arthroscopic single- and double-row rotator cuff repair: magnetic resonance imaging and early clinical evaluation. Am J Sports Med.2009;37(4):674-82.
Aydin N, Kocaoglu B, Guven O. Single-row versus double-row arthroscopic rotator cuff repair in small- to medium-sized tears. J Shoulder Elbow Surg.2010;19(5):722-5.
Lapner PL, Sabri E, Rakhra K, McRae S, Leiter J, Bell K, Macdonald P. A multicenter randomized controlled trial comparing single-row with double-row fixation in arthroscopic rotator cuff repair. J Bone Joint Surg Am.2012 ;94(14):1249-57.
Le BT, Wu XL, Lam PH, Murrell GA. Factors predicting rotator cuff retears: An analysis of 1000 consecutive rotator cuff repairs. Am J Sports Med.2014; 42: 1134-1142.
Rashid MS, Cooper C, Cook J, Cooper D, Dakin SG, Snelling S, Carr AJ. Increasing age and tear size reduce rotator cuff repair healing rate at 1 year. Acta Orthop.2017; 88: 606-611