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Arthroscopic Side-to-side Repair for Large U-shaped Full-Thickness Rotator Cuff Tears: Is the Repair Integrity Actually Maintained?

Published:November 07, 2019DOI:https://doi.org/10.1016/j.arthro.2019.07.010

      Purpose

      To evaluate the clinical and structural outcomes of arthroscopic side-to-side repair of large U-shaped full-thickness rotator cuff tears (FTRCTs) by assessing the functional score of the patients and the integrity of the tendon repair using magnetic resonance imaging with a minimum follow-up duration of 2 years.

      Methods

      In this case series, 59 consecutive patients who underwent arthroscopic side-to-side repair of large U-shaped FTRCTs, with a minimum follow-up duration of 2 years (range 25 to 72 months), were retrospectively enrolled. The mean patient age was 58.6 years. Patients' functional scores and integrity of the tendon repairs were evaluated.

      Results

      The mean visual analog scale score improved from 5.7 ± 2.1 preoperatively to 2.4 ± 1.3 postoperatively (P < .001). The mean range of motion (forward flexion) improved from 152.7° ± 11.4° to 164.5° ± 9.5° (P < .001). The mean Constant-Murley score improved from 57.3 ± 7.2 preoperatively to 77.8 ± 6.9 postoperatively (P < .001). Postoperative magnetic resonance imaging examinations demonstrated cuff integrity with a retear rate of 54.2%. The retear rate of patients who underwent anchor fixation to the medial row (45%) was significantly lower than that of patients who underwent simple side-to-side repair (73.7%) (P = .039). The University of California at Los Angeles shoulder rating and Constant-Murley scores were not significantly different between the healed and retear groups (P = .639 and P = .863, respectively).

      Conclusions

      Arthroscopic side-to-side repair of large U-shaped FTRCTs demonstrated satisfactory clinical outcomes. However, the retear rate was higher than expected when simple side-to-side fixation was performed without footprint fixation. Therefore, medial row fixation is recommended if arthroscopic side-to-side repair is performed.

      Level of Evidence

      III, comparative therapeutic trial.
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      Linked Article

      • Editorial Commentary: Side-to-side Rotator Cuff Repairs—Are Perfectly Placed Sutures Enough?
        ArthroscopyVol. 35Issue 12
        • Preview
          Arthroscopic side-to-side rotator cuff repair of large U-shaped tears should incorporate repair of the greater tuberosity. Recent research has found that pain at rest and with motion, range of motion, strength, and University of California–Los Angeles and Constant scores improved overall in patients with side-to-side repairs. Although the clinical results were quite good overall, rotator cuff healing was found to be significantly better, with 28% improvement confirmed by magnetic resonance imaging evidence of healing when the side-to-side repair was further repaired to the tuberosity.
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