Mid-term functional and structural analysis arthroscopic single-row repair in full thickness rotator cuff tear
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20251138Keywords:
Arthroscopic rotator cuff, Sugaya grading, Constant Murley score, Single row repair, Cost effectiveAbstract
Background: Purpose is to analyse functional scores and structural integration of cuff in Full thickness cuff tear patients treated with single row Arthroscopic rotator cuff repair (SR-ARCR) making it cost effective surgery in developing countries. Additionally, evaluation of Fatty atrophy, Glenohumeral arthritis, importance of subscapularis repair and role of biceps tenotomy was done.
Methods: 60 rotator cuff repairs with minimum 12 months follow-up and all treated by SR-ARCR. Functional Assessment by Constant Murley Score (CMS), UCLA score and structural assessment by Sugaya grading.
Results: Mean follow-up 35.93± 26.24 months with post operative mean constant murley (CMS) was 94.83±7.78 (p<0.001), mean UCLA 33.82±6.7 (p<0.001). Active forward flexion (AFF) 166.5±11.62(p<0.001), External rotation 79.17±10.13 (p<0.001), Muscle strength (0-25) 22.78±3.32(p<0.001), VAS 1.2±0.75(p<0.001), restoration of Acromio-humeral-distance (AHD) to 8.8±1.79(p<0.001). Sugaya 1(85%) having CMS 97.06±5.21 (p<0.001), Sugaya 2(10%) having CMS 82.67±9.42(p<0.001), Sugaya 3 (5%) having 81.33±6.35 (p<0.001).
Conclusion: Single row arthroscopic rotator cuff repair offers excellent outcomes cost effectively by reducing number of anchors and with supervised physiotherapy and rehabilitation protocols. Good structural integration of rotator cuff ensures better functional outcomes. Repair of Subscapularis to balance force couple, biceps tenotomy to decrease pain and medialised repair to decrease tension of repaired cuff improves functional scores. Restoration of acromio-humeral-distance decreases progression of gleno-humeral arthritis.
Metrics
References
Gazielly DF, Gleyze P, Montagnon C. Functional and anatomical results after rotator cuff repair. Clin Orthop Relat Res. 1994;304:43-53. DOI: https://doi.org/10.1097/00003086-199407000-00009
Davey MS, Hurley ET, Carroll PJ, Galbraith JG, Shannon F, Kaar K, Mullett H. Arthroscopic rotator cuff repair results in improved clinical outcomes and low revision rates at 10-year follow-up: a systematic review. Arthrosc J Arthrosc Rel Surg. 2023;39(2):452-8. DOI: https://doi.org/10.1016/j.arthro.2022.11.002
Jesus JO, Parker L, Frangos AJ, Nazarian LN. Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: A meta-analysis. Am J Roentgenol. 2009;192(6):1701–7. DOI: https://doi.org/10.2214/AJR.08.1241
Huang R, Wang S, Wang Y, Qin X, Sun Y. Systematic review of all-arthroscopic versus mini-open repair of rotator cuff tears: a meta-analysis. Scientific Reports. 2016;6(1):22857. DOI: https://doi.org/10.1038/srep22857
Severud EL, Ruotolo C, Abbott DD, Nottage WM. All-arthroscopic versus mini-open rotator cuff repair: A long-term retrospective outcome comparison. Arthrosc J Arthrosc Rel Surg. 2003;19(3):234–8. DOI: https://doi.org/10.1053/jars.2003.50036
Jost PW, Khair MM, Chen DX, Wright TM, Kelly AM, Rodeo SA. Suture number determines strength of rotator cuff repair. J Bone Joint Surg. 2012;94(14):100(1):34. DOI: https://doi.org/10.2106/JBJS.K.00117
Mazzocca AD, Millett PJ, Guanche CA, Santangelo SA, Arciero RA. Arthroscopic single-row versus double-row suture anchor rotator cuff repair. Am J Sports Med. 2005;33(12):1861–8. DOI: https://doi.org/10.1177/0363546505279575
Nicholas SJ, Lee SJ, Mullaney MJ, Tyler TF, Fukunaga T, Johnson CD, et al. Functional Outcomes After Double-Row Versus Single-Row Rotator Cuff Repair: A Prospective Randomized Trial. Orthop J Sports Med. 2016;4(10):45. DOI: https://doi.org/10.1177/2325967116667398
Faulkner ND, Getelman MH, Burns JP, Bahk MS, Karzel RP, Snyder SJ. Regarding “Meta-analysis comparing single-row and double-row repair techniques in the arthroscopic treatment of rotator cuff tears”. J Should Elbow Surg. 2014;23(9):223-5. DOI: https://doi.org/10.1016/j.jse.2014.06.027
Millett PJ, Hussain ZB, Fritz EM, Warth RJ, Katthagen JC, Pogorzelski J. Rotator Cuff Tears at the Musculotendinous Junction: Classification and Surgical Options for Repair and Reconstruction. Arthrosc Tech. 2017;6(4):1075–85. DOI: https://doi.org/10.1016/j.eats.2017.03.023
Barlow JD, Everhart JS. Arthroscopic Subscapularis Repair Through a Single Anterior Portal. Arthrosc Tech. 2017;6(5):1593–8. DOI: https://doi.org/10.1016/j.eats.2017.06.014
Barth J, Audebert S, Toussaint B, Charousset C, Godeneche A, Graveleau N, et al. Diagnosis of subscapularis tendon tears: are available diagnostic tests pertinent for a positive diagnosis. Orthop Traumatol: Surg Res. 2012;98(8):178-85. DOI: https://doi.org/10.1016/j.otsr.2012.09.008
Ticker JB, Burkhart SS. Why repair the subscapularis. A logical rationale. Arthroscopy: The J Arthrosc Related Surg. 2011;27(8):1123-8. DOI: https://doi.org/10.1016/j.arthro.2011.03.001
Cigolotti A, Biz C, Lerjefors E, de Iudicibus G, Belluzzi E, Ruggieri P. Medium- To long-term clinical and functional outcomes of isolated and combined subscapularis tears repaired arthroscopically. Arch Med Sci. 2021;17(5):1351–64. DOI: https://doi.org/10.5114/aoms.2020.97714
Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R. Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg. 2007;89(6):1184–93. DOI: https://doi.org/10.2106/JBJS.F.00007
Toussaint B, Audebert S, Barth J, Charousset C, Godeneche A, Joudet T, et al. Arthroscopic repair of subscapularis tears: preliminary data from a prospective multicentre study. Orthop Traumatol: Surg Res. 2012;98(8):193-200. DOI: https://doi.org/10.1016/j.otsr.2012.10.004
Veen EJD, Boeddha A V., Diercks RL, Kleinlugtenbelt YV, Landman EBM, Koorevaar CT. Arthroscopic isolated long head of biceps tenotomy in patients with degenerative rotator cuff tears: mid-term clinical results and prognostic factors. Euro J Orthop Surg Traumatol. 2021;31(3):441–8. DOI: https://doi.org/10.1007/s00590-020-02787-z
Walch G, Edwards TB, Boulahia A, Nové-Josserand L, Neyton L, Szabo I. Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: Clinical and radiographic results of 307 cases. J Shoulder Elbow Surg. 2005;14(3):238–46. DOI: https://doi.org/10.1016/j.jse.2004.07.008
Busconi BB, Deangelis N, Guerrero PE. The Proximal Biceps Tendon: Tricks and Pearls. 2008. DOI: https://doi.org/10.1097/JSA.0b013e318183c134
Boileau P, Ahrens PM, Hatzidakis AM. Entrapment of the long head of the biceps tendon: the hourglass biceps - a cause of pain and locking of the shoulder. J Shoulder and Elbow Surg. 2004;13(3):249–57. DOI: https://doi.org/10.1016/j.jse.2004.01.001
Frost A, Zafar MS, Maffulli N. Tenotomy versus tenodesis in the management of pathologic lesions of the tendon of the long head of the biceps brachii. Am J Sports Med. 2009;37(4):828–33. DOI: https://doi.org/10.1177/0363546508322179
Moorthy V, Tan AH. Should long head of biceps tenodesis or tenotomy be routinely performed in arthroscopic rotator cuff repairs. J Orthop. 2020;21:161-5. DOI: https://doi.org/10.1016/j.jor.2020.03.033
Osbahr DC, Diamond AB, Speer KP. The cosmetic appearance of the biceps muscle after long-head tenotomy versus tenodesis. Arthrosc. 2002;18(5):483–7. DOI: https://doi.org/10.1053/jars.2002.32233
Davidson J, Burkhart SS. The geometric classification of rotator cuff tears: a system linking tear pattern to treatment and prognosis. Arthroscopy J Arthrosc Related Surg. 2010;26(3):417–24. DOI: https://doi.org/10.1016/j.arthro.2009.07.009
Osti L, Buda M, Buono A Del. Fatty infiltration of the shoulder: diagnosis and reversibility. Ligaments Tendons J. 2013;3:67-9.
Burkhart SS, Barth JRH, Richards DP, Zlatkin MB, Larsen M. Arthroscopic repair of massive rotator cuff tears with stage 3 and 4 fatty degeneration. Arthros J Arthrosc Related Surg. 2007;23(4):347–54. DOI: https://doi.org/10.1016/j.arthro.2006.12.012
Yeo MHX, Seah SJS, Lee M, Lie DTT. Different types of rotator cuff tear morphology do not affect post-repair clinical outcomes in large to massive tears. J ISAKOS. 2024;9(1):25–33. DOI: https://doi.org/10.1016/j.jisako.2023.10.014
Herve A, Thomazeau H, Favard L, Colmar M, Mansat P, Walch G, et al. Clinical and radiological outcomes of osteoarthritis twenty years after rotator cuff repair. Orthop Traumatol: Surg Res. 2019;105(5):813–8. DOI: https://doi.org/10.1016/j.otsr.2019.02.013
Kim YK, Jung KH, Kim JW, Kim US, Hwang DH. Factors affecting rotator cuff integrity after arthroscopic repair for medium-sized or larger cuff tears: a retrospective cohort study. J Shoulder Elbow Surg. 2018;27(6):1012–20. DOI: https://doi.org/10.1016/j.jse.2017.11.016
Goutallier D, Postel JM, Gleyze P, Leguilloux P, Van Driessche S. Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg. 2003;12(6):550–4. DOI: https://doi.org/10.1016/S1058-2746(03)00211-8
Malavolta EA, Assuncao JH, Andrade-Silva FB, Gracitelli ME, Kiyomoto HD, Ferreira Neto AA. Prognostic factors for clinical outcomes after arthroscopic rotator cuff repair. Orthop J Sports Med. 2023;11(4):60738. DOI: https://doi.org/10.1177/23259671231160738
Sugaya H, Maeda K, Matsuki K, Moriishi J. Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: Single-row versus dual-row fixation. Arthrosc J Arthroscop Rel Surg. 2005;21(11):1307–16. DOI: https://doi.org/10.1016/j.arthro.2005.08.011
Yoshida M, Collin P, Josseaume T, Lädermann A, Goto H, Sugimoto K, et al. Post-operative rotator cuff integrity, based on Sugaya’s classification, can reflect abduction muscle strength of the shoulder. Knee Surg Sports Traumatol Arthroscop. 2018;26(1):161–8. DOI: https://doi.org/10.1007/s00167-017-4608-5
Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am. 2004;2:219–24. DOI: https://doi.org/10.2106/00004623-200402000-00002
Russell RD, Knight JR, Mulligan E, Khazzam MS. Structural integrity after rotator cuff repair does not correlate with patient function and pain: A meta-analysis. J Bone Joint Surg. 2014;96(4):265–71. DOI: https://doi.org/10.2106/JBJS.M.00265