The purpose of this study is to analyze the technique and value of arthroscopically
assisted rotator cuff repair based on follow-up results after 3 years.
Type of study
Since the beginning of 1997, 216 patients included in a clinical case series at the
Department of Trauma Surgery of the Hospital of the Barmherzigen Brüder Eisenstadt
have undergone arthroscopically assisted rotator cuff repair. Radiographic, clinical,
and intraoperative parameters were carefully documented. All patients were treated
with an arthroscopically assisted transosseous technique, in which bone tunnels are
drilled with a target drill unit through the humeral head lateral to the biceps tendon
from a third ventrocaudal incision on the humerus. The nonresorbable sutures placed
into the cuff with a suture punch are passed transosseously and tied in the incision
directly on the humeral head using a knot pusher. In December 2000, 84 patients (average
age, 54.8 years; range, 28 to 74 years) underwent a clinical follow-up evaluation
after a mean follow-up time of 35 months (28 to 44 months).
The average Constant score improved from a preoperative rating of 44.9 to a postoperative
rating of 87.2. University of California, Los Angeles score was improved from 11.3
to 31.1 (P < .001). Time of preoperative history, tear size, and condition of the long biceps
tendon were found to have significant influence on results (P < .05). Thus, 20 patients with chronic, untreated tears of the long biceps tendon
showed significantly worse results with a score of 81.8. Patients with curved or hooked
acromion types (Bigliani II and III) showed significantly better results (P < .05) and patients with extensive tears had significantly worse results because
of a residual strength deficit. The essential determinant was achievement of a stable
tear closure with arthroscopic verification and documentation. Thus, 8 patients with
a documented small gap between repaired cuff and bone showed a significantly worse
rating in the Constant score, with 80.5 (P < .05). The complications encountered included development of seroma in one case
and one case with frozen shoulder symptoms.
Arthroscopically assisted repair of the rotator cuff was shown to be an effective
procedure, guaranteeing good clinical results for medium- and large-sized tears with
adequate mobility. Advantages include a primary stability comparable to that seen
with open repair. Minimized trauma to soft tissue is associated with a lesser degree
of postoperative pain and scarring and reduced hospitalization.
Level of evidence
Level IV, case series.