Open versus two forms of arthroscopic rotator cuff repair

Abstract

There have been technologic advances in the methods for repairing torn rotator cuffs. We compared the clinical and structural outcomes of three different forms of rotator cuff repair with up to 24 months' followup. We wished to assess how surgical technique affected clinical outcomes and see how these correlated to repair integrity. Three cohorts of patients had repair of a symptomatic rotator cuff tear using (1) an open technique (n = 49); (2) arthroscopic knotted (n = 53); or (3) arthroscopic knotless (n = 57) by one surgeon. Standardized patient- and examiner-determined outcomes were obtained preoperatively and at 6 weeks, 3 and 6 months, and 2 years postoperatively. Ultrasound studies were performed with a validated protocol at 6 months and 2 years postsurgery. Clinical outcomes were similar with the exception that the arthroscopic groups had, on average, 20% better American Shoulder and Elbow Surgeons scores than the open group at 6 months and 2 years. Retear correlated with tear size and operation time and occurred more frequently after open repair (39%) than after arthroscopic knotted (25%) and arthroscopic knotless (16%) repair. An intact cuff on ultrasound corresponded to better results for supraspinatus strength, patient outcomes, and rotator cuff functional ability.

Level of evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Fig. 1A–D

The graphs show comparisons among open, arthroscopic knotted, and arthroscopic knotless rotator cuff repairs (RCR) for (A) pain severity at rest, (B) overall shoulder function, (C) ASES score, and (D) supraspinatus strength. The data are displayed as mean ± standard error of the mean (n = 49 for open group, n = 53 for knotted arthroscopic group, and n = 57 for knotless arthroscopic group up to 6 months; n = 20 for open group, n = 27 for knotted arthroscopic group, and n = 38 for knotless arthroscopic group at 24 months). * = p < 0.05, ** = p < 0.01, *** = p < 0.001 compared with preoperative values using Mann-Whitney rank sum test. + = p < 0.05, ++ = p < 0.01, +++ = p < 0.001 comparing a = open versus arthroscopic knotted, b = open versus arthroscopic knotless, and c = knotted versus knotless arthroscopic using Kruskal-Wallis one-way analysis of variance on ranks and corrected for multiple comparison using Dunn’s method.

Fig. 2A–C

The graphs show comparisons between intact and retorn rotator cuff repairs at 2 years postsurgery for preoperative tear size in (A) open (n = 20), (B) arthroscopic knotted (n = 27), and (C) arthroscopic knotless (n = 27) rotator cuff repairs.

Fig. 3A–B

The graphs show comparisons between intact and retorn rotator cuff repairs (RCR) for (A) ASES score and (B) supraspinatus strength. The data are displayed as mean ± standard deviation of the mean (n = 119 for intact group and n = 41 for retorn group up to 6 months; n = 62 for intact group and n = 25 for retorn group at 24 months). * = p < 0.05, ** = p < 0.01, *** = p < 0.001 using Mann-Whitney rank sum test. + = p < 0.05, ++ = p < 0.01, +++ = p < 0.001 using Kruskal-Wallis one-way analysis of variance on ranks and corrected for multiple comparison using Dunn’s method.

Fig. 4A–C

The graphs compare preoperative tear size versus defect size at the 6-month ultrasound for (A) open (n = 49), (B) arthroscopic knotted (n = 53), and (C) arthroscopic knotless (n = 57) rotator cuff repairs (RCR). R = Pearson correlation coefficient.