Arthroscopic repair of large and massive rotator cuff tears using the side-to-side suture technique. Mid-term clinical and anatomic evaluation - 02/06/12

Doi : 10.1016/j.otsr.2012.04.010

T. Rousseau ^a,^⁎ , X. Roussignol ^a, S. Bertiaux ^a, F. Duparc ^a, F. Dujardin ^a, O. Courage ^b
^a Department of orthopaedic and trauma surgery, Rouen University Hospital, 1, rue de Germont 76031 Rouen cedex, France
^b Private Hospital of l’Estuaire, HPE, 505, rue Irène-Joliot-Curie, 76620 Le Havre, France

Corresponding author. Tel.: +33 9 50 85 82 81.

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Summary

Preamble

Arthroscopic repair is our treatment of choice for massive rotator cuff tears. In order to reduce tension, we perform a side-to-side suture technique. The purpose of our work was to study the outcome of such technique by evaluating functional score and rotator cuff integrity using ultrasound at 2-year follow-up.

Hypothesis

The “side-to-side” arthroscopic repair of large and massive rotator cuff tears provides a long-term continuity of rotator cuff mechanism, enhances function and relieves pain with low morbidity.

Type of study

Retrospective monocenter study.

Material and methods

We included a continuous series of 50 patients of mean age 66.6 years (46–80), operated on between January 2007 and March 2008 for full-thickness retracted tears of the supraspinatus extending or not to the infraspinatus tendon. Management consisted of arthroscopic subacromial bursectomy, acromioplasty and side-to-side repair of the rotator cuff tendons with secure anchor fixation to the tuberosity. The relative Constant score was used for clinical evaluation preoperatively and at a minimum of 24 months after surgery. The continuity of rotator cuff mechanism was evaluated using ultrasound.

Results

The mean relative Constant score improved significantly (p<0.05) from 40% (18–67) preoperatively to 91.7% (40–107) postoperatively. Fifty-six percent of the rotator cuffs from this series demonstrated continuity with a postoperative relative Constant score of 98.4% (74–121) and an increase in the shoulder strength score of 3.6kg (1–6). Forty-four percent of the rotator cuffs had recurrent tear with an overall relative Constant score of 83.6% (4–126) and we did not observe any improvement in the strength score in this sub-group. Eighty-eight percent of the patients were satisfied or very satisfied with their outcome.

Discussion

At a minimum 24-month follow-up, the side-to-side suturing technique reported excellent functional results with a very high satisfaction rate. For these large and massive rotator cuff tears sometimes considered as irreparable, ultrasound confirmed the continuity of the repair in 56% of the cases. Unhealed patients were not disadvantaged since they experienced pain relief and functional improvement. However, in this sub-group of patients, recovery of shoulder strength was poor.