Sung-Jae Kim1, Yun-Rak Choi1, Hyun-Hee Lee1, Yong-Min Chun2. 1. Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. 2. Department of Orthopaedic Surgery, Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea min1201@hanmail.net.
Abstract
BACKGROUND: There are no known studies that have investigated the effect on delaminated rotator cuff tears of bursal layer-only repair when full-thickness repair would put the articular layer under tension, compared with all-layers repair when full-thickness repair is feasible. HYPOTHESIS: Better outcomes will be seen in the bursal layer-only repair, as the articular layer would be under tension when repaired onto its footprint during the all-layers repair. STUDY DESIGN: Cohort study; Level of evidence 3. METHODS: This study included 112 patients who underwent arthroscopic rotator cuff repair for posteriorly delaminated tears of either all layers (group A) or the bursal layer alone (group B). If the articular layer was able to be reduced onto its footprint, the patient was assigned to group A; if such reduction was not possible or was only marginally possible under significant tension, the patient was assigned to group B. Pain scored on a visual analog scale (VAS) was assessed, as were subjective shoulder value (SSV), University of California, Los Angeles (UCLA) shoulder score, American Shoulder and Elbow Surgeons (ASES) score, and shoulder active range of motion (ROM). Postoperative magnetic resonance arthrography (MRA) or computed tomographic arthrography (CTA) was undertaken 6 months postoperatively for structural integrity assessment. RESULTS: After 2 years, the VAS pain score (group A, from 6.5 to 1.2; group B, from 6.4 to 1.2), SSV (group A, from 38.3 to 89.4; group B, from 38.0 to 90.1), ASES score (group A, from 36.4 to 90.4; group B, from 38.0 to 90.8), UCLA shoulder score (group A, from 15.3 to 30.7; group B, from 15.0 to 31.3), and ROM improved significantly in both groups compared with preoperative values (P < .001). However, none of these values differed significantly between groups. On follow-up MRA or CTA images, there was no significant difference in the retear rate between group A (28%; 16/57) and group B (24%; 11/45). CONCLUSION: The all-layers repair did not produce better clinical outcomes or structural integrity than the bursal layer-only repair. The study findings indicate that if repair of the articular layer is possible only under significant tension or is not reparable, rather than all-layers repair by force, bursal-layer repair without incorporating the articular layer may produce comparable clinical outcomes and structural integrity in the delaminated rotator cuff tear.
BACKGROUND: There are no known studies that have investigated the effect on delaminated rotator cuff tears of bursal layer-only repair when full-thickness repair would put the articular layer under tension, compared with all-layers repair when full-thickness repair is feasible. HYPOTHESIS: Better outcomes will be seen in the bursal layer-only repair, as the articular layer would be under tension when repaired onto its footprint during the all-layers repair. STUDY DESIGN: Cohort study; Level of evidence 3. METHODS: This study included 112 patients who underwent arthroscopic rotator cuff repair for posteriorly delaminated tears of either all layers (group A) or the bursal layer alone (group B). If the articular layer was able to be reduced onto its footprint, the patient was assigned to group A; if such reduction was not possible or was only marginally possible under significant tension, the patient was assigned to group B. Pain scored on a visual analog scale (VAS) was assessed, as were subjective shoulder value (SSV), University of California, Los Angeles (UCLA) shoulder score, American Shoulder and Elbow Surgeons (ASES) score, and shoulder active range of motion (ROM). Postoperative magnetic resonance arthrography (MRA) or computed tomographic arthrography (CTA) was undertaken 6 months postoperatively for structural integrity assessment. RESULTS: After 2 years, the VAS pain score (group A, from 6.5 to 1.2; group B, from 6.4 to 1.2), SSV (group A, from 38.3 to 89.4; group B, from 38.0 to 90.1), ASES score (group A, from 36.4 to 90.4; group B, from 38.0 to 90.8), UCLA shoulder score (group A, from 15.3 to 30.7; group B, from 15.0 to 31.3), and ROM improved significantly in both groups compared with preoperative values (P < .001). However, none of these values differed significantly between groups. On follow-up MRA or CTA images, there was no significant difference in the retear rate between group A (28%; 16/57) and group B (24%; 11/45). CONCLUSION: The all-layers repair did not produce better clinical outcomes or structural integrity than the bursal layer-only repair. The study findings indicate that if repair of the articular layer is possible only under significant tension or is not reparable, rather than all-layers repair by force, bursal-layer repair without incorporating the articular layer may produce comparable clinical outcomes and structural integrity in the delaminated rotator cuff tear.
Authors: Philipp R Heuberer; Leo Pauzenberger; Michael S Gruber; Bernhard Kriegleder; Roman C Ostermann; Brenda Laky; Werner Anderl Journal: Knee Surg Sports Traumatol Arthrosc Date: 2019-05-06 Impact factor: 4.342
Authors: Vivek Pandey; C J Joseph; Naveen J Mathai; Kiran K V Acharya; Lakshmikanth H Karegowda; W Jaap Willems Journal: Indian J Orthop Date: 2019 May-Jun Impact factor: 1.251