Outcomes after arthroscopic rotator cuff repairs

doi:10.1016/j.jse.2006.04.007

Journal of Shoulder and Elbow Surgery

Volume 16, Issue 1, January–February 2007, Pages 1-5

https://doi.org/10.1016/j.jse.2006.04.007 Get rights and content

Recently, advances in arthroscopic techniques have allowed shoulder surgeons to perform fully arthroscopic repair of full-thickness tears. Outcome data have shown that improvement is inconsistent between studies. We performed a retrospective review of 105 consecutive patients who underwent arthroscopic rotator cuff repair from 1999 to 2002. Preoperative and postoperative evaluation consisted of a history, questionnaire, and examination to determine American Shoulder and Elbow Surgeons, Constant, and visual analog pain scores. Complete data were available for a minimum of 12 months (range, 12-45 months) for 71 patients. Increases in range of motion and outcome scores and associated reductions in visual analog scores were all significant. With massive tears, scores and pain were significantly improved. Arthroscopic rotator cuff repair reliably improves functional deficits and pain regardless of tear size. Smaller tears yield significant improvement in American Shoulder and Elbow Surgeons, Constant, and pain scores. Functional improvement was seen with massive tears, but gains in strength and motion were less dramatic.

Section snippets

Materials and methods

We conducted a retrospective review of 105 consecutive patients who underwent arthroscopic rotator cuff repair between 1999 and 2002. None of the patients had previous surgery on the affected shoulder. Preoperative and postoperative evaluation consisted of a history, patient questionnaire, and physical examination by an independent examiner. Operative reports were reviewed for concomitant procedures, releases performed, tear size, and type and method of fixation. Physical examination included

Overall results

In total, 71 patients (29 men and 42 women) returned for follow-up examination and completion of a questionnaire, with a minimum follow-up of 12 months (range, 12-45 months; mean, 16.5 months). The mean patient age was 63 years (range, 36-86 years). The mean overall tear size was 2.6 cm as measured by the length of the region of uncovered tuberosity as noted at arthroscopy. The dominant arm was affected in 62 patients (87%). The mean symptom duration before presentation was 14.5 months (range,

Discussion

Since Codman’s description in 1934,⁶ open repair of rotator cuff tears has been well studied, with predictable results based on pain relief and function.1, 7, 9, 14, 21 For many investigators, there is growing enthusiasm for all-arthroscopic techniques as an alternative to the traditional open and mini-open rotator cuff repair.²⁴ Currently, we perform virtually all rotator cuff surgeries arthroscopically. These data, taken from the initial transition to arthroscopic repairs, may serve as a

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Cited by (64)

Outcomes of subacromial balloon spacer implantation for irreparable rotator cuff tears: a systematic review and meta-analysis
2023, Journal of Shoulder and Elbow Surgery
The management of irreparable rotator cuff tears remains a topic of considerable debate among orthopedic surgeons. Currently, there is little consensus regarding the gold-standard treatment; however, an emerging option involves the use of a biodegradable subacromial spacer. The purpose of this study, therefore, was to systematically review and synthesize the current literature reporting on the clinical outcomes following implantation of a subacromial balloon spacer (SABS) for the treatment of patients with irreparable rotator cuff tears.
A systematic review of the PubMed Central, MEDLINE, Embase, Scopus, and Cochrane Library databases from inception through December 2022 was performed. Clinical outcome studies reporting on functional and clinical outcomes, as well as postoperative complications, were included.
A total of 127 studies were initially identified, of which 28 were deemed eligible for inclusion in our review. Of these studies, 17 reported adequate preoperative and postoperative data (mean and a measure of variance) and thus were included in the meta-analysis. Among the included studies, a total of 894 shoulders (886 patients) were included; the mean age was 67.4 years (range, 61.7-76.2 years). The average follow-up period was 30.4 months (range, 12-56 months). All postoperative patient-reported outcomes improved significantly from baseline, including the Constant score (mean difference, 33.53; P < .001), American Shoulder and Elbow Surgeons score (mean difference, 40.38; P < .001), Oxford Shoulder Score (mean difference, 12.05; P = .004), and visual analog scale pain score or Numeric Pain Rating Scale score (mean difference, –3.79; P < .001). Forward elevation (mean difference, 24°; P < .001), abduction (mean difference, 52°; P = .02), and external rotation (mean difference, 15°; P < .001) improved. Device-related complications occurred at a rate of 3.6%, the most common of which were balloon migration (1.0%) and synovitis (0.6%). Ultimately, 5% of patients required salvage reverse shoulder arthroplasty.
Short-term outcomes suggest that SABS implantation can be a safe and effective treatment and appears to be associated with early improvements in postoperative pain and function. Clinical heterogeneity, use of concomitant procedures, and variations in patient selection limit our ability to conclusively interpret the available evidence. We do not yet know the potential therapeutic value of SABS implantation relative to other currently accepted treatment strategies, the length of symptomatic improvement that can be expected, or the long-term implications of SABS use on the outcomes of further salvage procedures.
Arthroscopic Rotator Cuff Repair Results in Improved Clinical Outcomes and Low Revision Rates at 10-Year Follow-Up: A Systematic Review
2023, Arthroscopy - Journal of Arthroscopic and Related Surgery
Citation Excerpt :
ARCR has emerged in recent years as the gold standard procedure for patients with RCTs that warrant surgical intervention. Although reported long-term functional outcomes of ORCR in the literature are acceptable to patients and surgeons alike, the less-invasive nature of ARCR has resulted in significantly lower postoperative pain levels, shortened recovery times, and improved cosmesis in the short-term postoperatively.23,24 In their systematic review, Spennacchio et al.11 reported that ARCR represents a safe and effective option to treat symptomatic RCTs, which provides acceptable functional outcomes at minimum 5-years follow-up.
To study the literature to evaluate the functional outcomes, radiologic outcomes, and revision rates following arthroscopic rotator cuff repair (ARCR) at a minimum of 10-years follow-up.
Two independent reviewers performed a literature search of PubMed, Embase, and Scopus using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Only studies reporting on outcomes of ARCR with a minimum 10-year follow-up were considered for inclusion. Patient demographics, satisfaction, and clinical, radiologic, and surgical outcomes were evaluated.
Our search found 9 studies including 455 shoulders in 448 patients (51.6% male patients), with age at time of surgery ranging from 45 to 90 years met our inclusion criteria. Overall follow-up ranged from 10 to 18 years. At final follow-up, the ranges of American Shoulder & Elbow Surgeons, age- and sex-adjusted Constant–Morley, and University of California Los Angeles scores were reported in 5, 6, and 3 studies, respectively, as 79.4 to 93.2, 73.2 to 94, and 26.5 to 33, respectively. Of the included studies, satisfaction rates varied in 6 studies from 85.7% to 100% in the long-term. Additionally, the overall radiologic retear rate ranged from 9.5% to 63.2%. The overall surgical revision rates ranged in 6 studies from 3.8% to 15.4%, with from 0% to 6.7% requiring revision ARCR and from 1.0% to 3.6% requiring revision subacromial decompression in 6 and 2 studies, respectively, at minimum 10-years’ follow-up.
In this study, we found that ARCR results in high rates of patient satisfaction, satisfactory clinical outcomes with respect to patient-reported functional outcomes and range of motion, and low revision rates at minimum 10-years’ follow-up. However, an overall 30% retear rate was observed in asymptomatic patients.
Level IV, systematic review of Level II-IV studies.
The effect of age on risk of retear after rotator cuff repair: a systematic review and meta-analysis
2020, JSES International
The purpose of this study was to perform a systematic review and meta-analysis to determine the effect of age on rotator cuff repair failure. The hypothesis of this study was that increased patient age would lead to a higher rate of retears and/or repair failures after rotator cuff repair.
We conducted a systematic review and meta-analysis of level I and II studies evaluating patients undergoing rotator cuff repair that also included an imaging assessment of the structural integrity of the repair. Univariate and multivariate meta-regression was performed to assess the dependence of the retear rate on the mean age of the cohort, imaging modality, time to imaging, and publication year.
The meta-regression included 38 studies with a total of 3072 patients. Significant heterogeneity in retear rates was found among the studies (Q = 209.53, I² = 82.34, P < .001). By use of a random-effects model, the retear rate point estimate was 22.1% (95% confidence interval [CI], 18.6%-26.0%). On univariate analysis, type of imaging modality did not significantly influence the retear rate (P = .188). On univariate analysis, mean age (odds ratio [OR], 1.05 [95% CI, 1.01-1.09]; P = .027) and mean time to imaging (OR, 1.04 [95% CI, 1.01-1.08]; P = .006) were associated with the retear rate. Publication year (OR, 0.94 [95% CI, 0.88-1.01]; P = .083) demonstrated a trend toward significance. On multivariate analysis, increased age was associated with a 5%/yr increased odds of retear (OR, 1.05 [95% CI, 1.01-1.08]; P = .025). The risk of retear doubled from 15% at age 50 years to >30% at age 70 years. Time to imaging demonstrated a trend toward increased odds of retear (OR, 1.03 [95% CI, 1.00-1.07]; P = .056). Publication year was not associated with the retear rate on multivariate analysis (OR, 0.96 [95% CI, 0.90-1.02]; P = .195).
The risk of retear after rotator cuff repair is associated with increased age and doubles between the ages of 50 and 70 years.
The natural course of and risk factors for tear progression in conservatively treated full-thickness rotator cuff tears
2020, Journal of Shoulder and Elbow Surgery
Citation Excerpt :
In addition, they reported that 50% of tears graded as reparable at the time of diagnosis were irreparable at the time of the final follow-up. Thus, physicians should be aware that nonoperative treatment of full-thickness tears always includes risks of tear progression and irreversible muscle changes that can affect subsequent reparability of tears.21,32 A few studies have identified risk factors associated with the progression of FTRCTs.
The natural course of and risk factors for tear progression in full-thickness rotator cuff tears (FTRCTs) have not been clarified yet. The study's purpose was to retrospectively evaluate tear progression in FTRCTs by using magnetic resonance imaging (MRI) and to identify risk factors that are relevant to such tear progression.
Between June 2010 and September 2019, a total of 345 patients with FTRCTs who had been diagnosed via MRI were treated conservatively. Of these, 48 patients who underwent post-treatment follow-up MRI were retrospectively enrolled. Tear progression was defined as significant when the tear size increased by >5 mm.
The mean MRI follow-up duration was 22 ± 14 months (range, 12-65 months). Among the 48 patients (mean age, 69 years; range, 53-81), 26 (54%) and 20 (41%) showed medial-lateral (M-L) and anterior-posterior (A-P) tear progression on MRI follow-up. Multivariate analysis revealed that MRI follow-up duration (P = .011), diabetes mellitus (P = .017), and infraspinatus muscle atrophy (P = .011) were independent risk factors for tear progression in the A-P plane. A high critical shoulder angle (P = .011) and supraspinatus (P = .024) and infraspinatus (P = .020) muscle atrophy were risk factors associated with M-L tear progression.
Among the assessed patients, a considerable number of FTRCTs increased in size during the follow-up period. Severe infraspinatus muscle atrophy was the independent risk factor for exacerbation of A-P and M-L tear progression.
Arthroscopic Correction of the Critical Shoulder Angle Through Lateral Acromioplasty: A Safe Adjunct to Rotator Cuff Repair
2018, Arthroscopy - Journal of Arthroscopic and Related Surgery
Citation Excerpt :
It did not significantly damage the deltoid origin or muscle or generate other complications. The procedure was associated with a clinical outcome of RCR, which is at least comparable to that of other RCR techniques reported.37,38 The ultimate strength for abduction in healed repairs was greater if the CSA was reduced to 33° or below and the repairs, which had failed to heal, had larger (preoperative and) postoperative CSAs.
To investigate whether arthroscopic lateral acromioplasty reliably decreases the critical shoulder angle (CSA) and whether it is associated with damage to the deltoid or other complications.
Patients undergoing arthroscopic rotator cuff repair (RCR) with lateral but without anterior acromioplasty for degenerative, full-thickness rotator cuff tears and a CSA of 34° or greater were retrospectively reviewed. Patients with traumatic or irreparable rotator cuff tears, osteoarthritis, or previous surgery were excluded. Clinical and radiographic outcomes were assessed at a minimum of 12 months' follow-up.
We reviewed 49 consecutive patients (mean age, 56 years; age range, 39-76 years) at a mean of 30 months (range, 12-47 months). There were 7 RCR failures (14%). The mean CSA was reduced from 37.5° preoperatively (95% confidence interval [CI], 36.7°-38.3°) to 33.9° postoperatively (95% CI, 33.3°-34.6°; P < .001). There were no cases of dehiscence, increases in fatty infiltration, or significant atrophy of the deltoid. Scarring at the deltoid origin was noted in 18 patients (37%). The mean absolute and relative Constant scores increased from 59 points (95% CI, 54-64 points) to 74 points (95% CI, 70-78 points) and from 66% (95% CI, 61%-71%) to 83% (95% CI, 79%-87%) respectively, and the Subjective Shoulder Value increased from 45% (95% CI, 39%-50%) to 80% (95% CI, 74%-86%) (P < .001 for all 3 improvements). The postoperative CSA was significantly larger in failed than in healed repairs (P = .026). Patients with a healed RCR and a CSA corrected to 33° or less (n = 22) had 25% more abduction strength than patients with a healed cuff and a CSA corrected to 35° or greater (n = 14, P = .04).
Arthroscopic lateral acromioplasty performed in addition to arthroscopic RCR can reduce the CSA without significantly compromising the deltoid origin, deltoid muscle, or function. It is not associated with any additional complications of arthroscopic RCR. Insufficiently corrected, abnormally large CSAs are associated either with a higher retear rate or with inferior strength of abduction if the tears heal.
Level IV, case series, treatment study.
Proximal ingrowth coating decreases risk of loosening following uncemented shoulder arthroplasty using mini-stem humeral components and lesser tuberosity osteotomy
2017, Journal of Shoulder and Elbow Surgery
Citation Excerpt :
For the VAS pain score, patients were asked to rate their level of pain from 0 to 10, with 10 being the worst pain they could imagine and 0 indicating no pain. The ASES score,22 which has a maximum score of 100 and has been validated in numerous prior studies,16,18,23 corresponds to pain, instability, and proficiency with activities of daily living. Previous studies have indicated a mean ASES score of 92.2 in patients with uninjured shoulders,23 whereas the minimal clinically important difference of this scoring system is 6.4 points.18
Mini-stem humeral component (MSHC) use during total shoulder arthroplasty (TSA) provides bone preservation and ease of revision. MSHCs rely solely on proximal metaphyseal fixation; some early reports have demonstrated an unacceptably high rate of early loosening. To our knowledge, no study analyzing the effect of proximal porous coating on MSHCs has been performed.
We performed a retrospective review of consecutive patients who underwent anatomic TSA using coated or uncoated MSHCs with minimum 2-year follow-up. Postoperative radiographs were assessed for risk of or frank stem loosening, subsidence, and presence of radiolucencies. Range of motion, outcome scores (visual analog scale pain, American Shoulder and Elbow Surgeons, and Single Assessment Numeric Evaluation), and any complications were noted.
We analyzed 68 shoulders with a mean follow-up of 27.3 months (range, 24-50 months). Of these, 34 had proximal coating and 34 were uncoated. In the coated group, no stems loosened, 1 (2.9%) subsided, and 7 (20.6%) developed radiolucencies. In the uncoated group, 1 stem (2.9%) became aseptically loose (requiring revision after 26 months), 7 (20.6%) were judged at risk of loosening (2 because of subsidence), and 15 (44.1%) developed radiolucencies. There was also an increased risk of proximal medial humeral radiolucencies among uncoated MSHCs. There were no significant differences in final range of motion or outcome scores.
MSHC use is appropriate for TSA, achieving desired pain relief and functional improvement. Overall, component loosening appears uncommon at early follow-up; however, uncoated stems appear to be at greater risk of loosening and developing radiolucencies. Selecting an MSHC with proximal porous coating may decrease the risk of implant-related complications.

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Original articleOutcomes after arthroscopic rotator cuff repairs

Section snippets

Materials and methods

Overall results

Discussion

J Shoulder Elbow Surg

J Shoulder Elbow Surg

Arthroscopy

Arthroscopy

J Shoulder Elbow Surg

J Shoulder Elbow Surg

J Shoulder Elbow Surg

Arthroscopy

J Shoulder Elbow Surg

Arthroscopy

Arthroscopy

Results of nonoperative management of full-thickness tears of the rotator cuff

Clin Orthop Relat Res

Original article
Outcomes after arthroscopic rotator cuff repairs