[Open transosseous reconstruction of the rotator cuff: clinical outcome, influencing factors and complications]

Abstract

Background: Open transosseous rotator cuff reconstruction (RCR) still plays a prominent role in current treatment of rotator cuff tears. This study aimed to examine mid-term and long-term results of clinical outcome, determine influencing factors and analyze complications.

Patients: This retrospective cohort study included 104 Patients following standardized open transosseous RCR. After a mean follow-up period of 38.3 months (range 12-71 months) 88 Patients (89 shoulders) were available for examination. The mean age of Patients at surgery was 57.1 years (range 29-83 years). Standardized clinical examination included sonography and assessment of the absolute, relative and intra-individual constant scores (CS(abs), CS(rel), CS(intra)), Oxford shoulder score (OSS), American shoulder and elbow surgeons' score (ASESS) and single assessment numeric evaluation score (SANES). The level of significance for analysis of variance (ANOVA) was set at p < 0.05 (95% confidence interval).

Results: Mean values and standard deviations (σ) were: CS(abs) = 71 points (σ: 20.3), CS(rel) = 76 points (σ: 20.7), CS(intra) = 86 % (σ: 19.5), OSS(mod) = 77 points (σ: 20.6), ASESS = 73 points (σ: 23.3) and SANES = 72 % (σ: 22.0). Clinical results were superior when the complaints were initiated by trauma (p < 0.05). Patients with massive tears showed inferior results relative to all outcome measures (p < 0.05). Concomitant pathologies even without surgical relevance were associated with inferior outcome (p < 0.05). The factors surgeon, suture material and acromioplasty did not exert a significant influence. Revision surgery was required in 12 out of 89 (13.5 %) cases and re-ruptures occurred in 19.1%.

Conclusions: Objective and subjective clinical results following open transosseous RCR were comparable to those of previously described open and arthroscopic techniques. Results were superior when the complaints were initiated by trauma. Massive tears and concomitant pathologies even without surgical relevance were associated with inferior clinical outcome. Open or arthroscopic acromioplasty did not add further benefits. A standardized operative procedure led to reproducible results irrespective of the factor surgeon.