[Arthro-C-scan analysis of rotator cuff tears healing after arthroscopic repair: analysis of predictive factors in a consecutive series of 167 arthroscopic repairs]

Abstract

Purpose of the study: Arthroscopic repair of rotator cuff tears is a well described technique with good clinical results. The purpose of this work was to use the arthro-CT-scan to evaluate tendon healing after arthroscopic repair and search for epidemiological, anatomic and technical factors predictive of tendon healing.

Material and method: This prospective consecutive series included 167 non-randomized shoulders. All patients underwent a preoperative assessment using the crude Constant score and a standard x-ray protocol to evaluate cuff status. Cuff repairs were all performed arthroscopically. The crude Constant score was used to follow patients. A control arthroscan was obtained in 148 patients.

Results: Mean patient age was 59 years, 46% men and 77% dominant side. Mean duration of symptoms before repair was nine months. The tears resulted from trauma in 28%, including 9% occupational accidents. The preoperative mean crude Constant score was 52.4 (range 15-77). An isolated tear of the supraspinatus was observed in 68%. Frontal retraction of the supraspinatus was distal in 74%. In 29 cases, reduction was difficult. The quality of the tendon was considered normal in 56 cases and non-anatomic repair was necessary in six. At last follow-up (19 months on average) the mean crude Constant score was 80 (range 49-95). Arthro-CT-scan was performed to control healing in 148 patients and revealed anatomic healing in 69, defective healing in 27, and repeated tears in 52 shoulders. Factors predictive of healing were: tear less than six months old, sedentary occupational activity, non-dominant side, young patient, female gender, isolated small non-retracted tear of the supraspinatus, normal appearance of an easily reduced tendon, and good bone quality.

Discussion: Time from tear to repair was long in this series. Tendon and muscle changes occurring after the injury could explain in part the healing failures.

Conclusion: But this study confirmed good functional and anatomic results given by arthroscopic repair of rotator cuff tears.