Mini-open transosseous repair with bursal augmentation improves outcomes in massive rotator cuff tears

Abstract

Treatment of Massive rotator cuff tears (MRCT) is difficult, with high rates of retears. Using biological augmentation in the form of the highly vascular subacromial bursa, was used to improve tendon healing. This work aimed to evaluate the results of arthroscopic guided mini-open transosseous repair with bursal augmentation in the treatment of MRCTs in a five-step approach. Forty-eight patients, with a mean age of 63.15 years, were treated with this technique. The patients were evaluated with the constant, UCLA and VAS scores. Plain X-rays were performed to evaluate the CSA and MRI was done to confirm the diagnosis of MRCT and determine the degree of fatty degeneration. Ultrasound was done at 1 year post-operative to determine any retears. The mean follow-up period was 29 months ± 4.95. The Constant and UCLA mean scores improved from (52.52) to (89) and (13.2) to (30.5) respectively (p < 0.0001). The post-operative active flexion and abduction improved from a mean of (112° to 170°) and (136.2° to 167°) respectively, while ER improved from (62.8° to 70°) with their p values (p < 0.0001). Pain improved from a mean VAS of (5.85) to (0.5) (p < 0.0001). No deterioration of function was noted throughout the follow-up period, and no retears occurred on post-operative ultrasound evaluation. Mini-open transosseous repair with bursal augmentation in the treatment of MRCT is an effective and low-cost method that achieves satisfactory results with no retears.

Keywords: Biological bursa; Massive rotator cuff tear; Mini-open.

Fig. 1

MRI coronal cut section showing a complete tear of the suprapinatus tendon.

Fig. 2

Photograph showing the exposure of the torn tendon after applying a blunt retractor to retract the deltoid muscle. A Cobb dissector is a useful tool to gently mobilize the tendon to its footprint.

Fig. 3

I) Photo shows the rotator cuff tear and the subacromial bursa after mobilization; II) Passing the sutures through the tendon and bone then retrieving its end superficial to the bursa; III) Pushing the sliding knot at the lateral side of the humerus so the bursa overlaps the repair; IV) Final coverage of the tendon with the bursa.

Fig. 4

I) Diagram shows passing the FiberWire® through the tendon and then a giant needle is introduced to penetrate the bone with the distal strand of the sutures; II) The suture is pulled subdeltoid superficial to the bursa with a right-angled hook; III) Tightening the knot pushes the bursa to cover the repair without extra sutures. [Ac:Acromion; D:Deltoid; B:Bursa; RCT:Rotator Cuff Tendon; H:Humerus].