Original Article
Clinical and Ultrasonographic Outcomes of Arthroscopic Suture Bridge Repair for Massive Rotator Cuff Tear

https://doi.org/10.1016/j.arthro.2012.09.008Get rights and content

Purpose

The purpose of this study was to analyze the outcomes of arthroscopic suture bridge repairs of massive rotator cuff tears.

Methods

Thirty-six patients with massive rotator cuff tears that had been repaired by arthroscopic suture bridge repair were enrolled in this study. The mean follow-up period after surgery was 37.6 ± 8.9 months (range, 25 to 56). Arthroscopic en masse suture bridge repair was used in delaminated tears. The integrity of the repaired rotator cuff was examined by ultrasonography 4.5 months, 1 year, and 2 years after surgery. Functional outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) shoulder score, Constant score, range of motion, and muscle power.

Results

Twenty-seven cases (75%) showed complete healing on serial ultrasonography, whereas recurrent tears were detected in the remaining 9 cases (25%). Five retears were smaller than, and the other 4 were the same as or larger than, the initial tear. Overall mean functional scores and values improved after surgery. Although the 4 larger retears had a poorer outcome with respect to ASES score than the healed group (P = .005), the Constant score for these 4 retears did not significantly differ at the last follow-up (P = .175). Mean ASES and Constant scores for the larger tear group were also relatively satisfactory (64.2 and 63.0, respectively). Fatty degeneration of the supraspinatus on preoperative magnetic resonance images was associated with a high retear rate (P = .003, odds ratio = 13.664).

Conclusions

Massive rotator cuff tears can be treated successfully by arthroscopic en masse suture bridge repair with satisfactory results. Larger retears had some adverse effects on functional outcome, whereas patients with smaller retears did not significantly differ in functional outcome from the healed group. Fatty degeneration of the supraspinatus on preoperative magnetic resonance images is a poor prognostic indicator.

Level of Evidence

Level IV, therapeutic case series.

Section snippets

Methods

Between August 2006 and February 2009, arthroscopic repairs of 33, 143, 62, and 55 small, medium, large, and massive rotator cuff tears, respectively, were performed.16, 17 There were 18, 59, 2, and 0 partial-thickness tears in the small, medium, large, and massive rotator cuff tears, respectively.18 The other tears were full-thickness tears. In addition, arthroscopic suture bridge repairs of 9 subscapularis tears without supraspinatus or infraspinatus tears were performed. In this study, a

Results

Percentage agreement and k coefficient for detection of retear by ultrasonography showed “almost perfect” intrarater reliability (0.905). Twenty-seven cases (75%) showed complete healing on serial ultrasonography, whereas recurrent tears were detected in the remaining 9 cases (25%). Five retears (13.9%) were smaller retears; the other 4 (11.1%) were larger retears. All retears occurred on the dominant side (Table 2). Four of 23 patients >60 years of age had retears (17.4%), which were all

Discussion

In the present study, complete healing occurred in 75% of patients and failure in only 11.1%, mainly because of the rate of larger retears in repair of massive rotator cuff tears observed on serial ultrasonography. Overall postoperative functional outcome improved irrespective of the presence of retear. Although several functional values in the smaller and larger retear groups increased without statistical significance, all functional parameters in the 2 groups improved markedly after surgery.

Conclusions

Massive rotator cuff tears can be treated successfully by arthroscopic en masse suture bridge repair with satisfactory results. The larger retears had some adverse effects on functional outcome, whereas the smaller retear group showed no significant differences in functional outcome compared with the healed group. Fatty degeneration of the supraspinatus on preoperative magnetic resonance images is a poor prognostic indicator.

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    The authors report that they have no conflicts of interest in the authorship and publication of this article.

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