Subacromial decompression including acromioplasty is routinely performed in rotator cuff repair. However, many studies revealed that the cause of rotator cuff tear is more closely related to internal factors than external factors, which makes it worthwhile to investigate further the effectiveness of subacromial decompression. This study prospectively compared the clinical results of arthroscopic rotator cuff repair with and without acromioplasty.
Materials and Methods
Forty-one patients with arthroscopic subacromial decompression and coracoacromial ligament resection with rotator cuff repair (group 1) and 43 patients with arthroscopic rotator cuff repair without acromioplasty (group 2) were included. Patients with the rotator cuff repair caused by massive rotator cuff tear or partial tear and patients with subacromial decompression due to osteophytes under the acromion were excluded in this study. The mean age at the operation was 56 years old (38-76 years old) in group 1 and 57 years old (45-75 years old) in group 2. Degenerative rotator cuff tear was the most common cause of injury in both groups. The duration of symptom was 14 months in group 1 and 16 months in group 2. The shape of acromion was type 2 in 32 patients (78% of group 1) and 35 patients (81% of group 2). All rotator cuff repairs were done arthroscopically and postoperative pain was managed using patient controlled analgesia system. The pain was measured by visual analogue scale (VAS) every 6 hours for 3 days after the operation, then subsequently measured in 1, 3, 6 and 12 months postoperatively. Clinical evaluation was done using Constant score and UCLA score. Average follow up period was 22 months.
The mean size of rotator cuff tear was 2.2 cmX1.6 cm in group 1 and 1.9 cmX1.4 cm in group 2. VAS was higher in group 1 for 3 days postoperatively, but there were no significant differences statistically between the two groups. VAS at final follow up was similar in two groups. The mean range of forward elevation improved from 127° preoperatively to 162° postoperatively in group 1 and 130° preoperatively to 167° postoperatively in group 2. Constant scores in both groups improved significantly to 79 in group 1 and 83 in group 2 at final follow up. In group 1, 34 patients revealed good or excellent results in UCLA score and 38 patients in group 2. One patient in each group had postoperative adhesive capsulitis.
Clinical results revealed similar pain score, range of motion and strength regardless of acromioplasty. Although this study requires a long term follow up, acromioplasty does not seem to affect clinical results in rotator cuff repair.
© 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.