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Evaluation of Deltoid Origin Status Following Open and Arthroscopic Repair of Large Rotator Cuff Tears: A Propensity-Matched Case-Control Study

  • Kholinne, Erica (Department of Orthopedic Surgery, St. Carolus Hospital) ;
  • Kwak, Jae-Man (Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sun, Yucheng (Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong University) ;
  • Kim, Hyojune (Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Koh, Kyoung Hwan (Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jeon, In-Ho (Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2020.01.16
  • Accepted : 2020.02.15
  • Published : 2020.03.01

Abstract

Background: The purpose of this study was to evaluate and compare deltoid origin status following large rotator cuff repair carried out using either an open or an arthroscopic method with a propensity score matching technique. Methods: A retrospective review of 112 patients treated for full-thickness, large rotator cuff tear via either a classic open repair (open group) or an arthroscopic repair (arthroscopic group) was conducted. All patients included in the study had undergone postoperative magnetic resonance imaging (MRI) and clinical follow-up for at least 12 and 18 months after surgery, respectively. Propensity score matching was used to select controls matched for age, sex, body mass index, and affected site. There were 56 patients in each group, with a mean age of 63.3 years (range, 50-77 years). The postoperative functional and radiologic outcomes for both groups were compared. Radiologic evaluation for postoperative rotator cuff integrity and deltoid origin status was performed with 3-Tesla MRI. Results: The deltoid origin thickness was significantly greater in the arthroscopic group when measured at the anterior acromion (P=0.006), anterior third (P=0.005), and middle third of the lateral border of the acromion level (P=0.005). The deltoid origin thickness at the posterior third of the lateral acromion was not significantly different between the arthroscopic and open groups. The arthroscopic group had significantly higher intact deltoid integrity with less scarring (P=0.04). There were no full-thickness deltoid tears in either the open or arthroscopic group. Conclusions: Open rotator cuff repair resulted in a thinner deltoid origin, especially from the anterior acromion to the middle third of the lateral border of the acromion, at the 1-year postoperative MRI evaluation. Meticulous reattachment of the deltoid origin is as essential as rotator cuff repair when an open approach is selected.

Keywords

References

  1. Bayle X, Pham TT, Faruch M, Gobet A, Mansat P, Bonnevialle N. No difference in outcome for open versus arthroscopic rotator cuff repair: a prospective comparative trial. Arch Orthop Trauma Surg 2017;137:1707-12. https://doi.org/10.1007/s00402-017-2796-6
  2. Acevedo DC, Paxton ES, Williams GR, Abboud JA. A survey of expert opinion regarding rotator cuff repair. J Bone Joint Surg Am 2014;96:e123. https://doi.org/10.2106/JBJS.M.00399
  3. Snyder SJ. Evaluation and treatment of the rotator cuff. Orthop Clin North Am 1993;24:173-92. https://doi.org/10.1016/S0030-5898(21)00046-8
  4. Gartsman GM, Khan M, Hammerman SM. Arthroscopic repair of full-thickness tears of the rotator cuff. J Bone Joint Surg Am 1998;80:832-40. https://doi.org/10.2106/00004623-199806000-00007
  5. Baker CL, Liu SH. Comparison of open and arthroscopically assisted rotator cuff repairs. Am J Sports Med 1995;23:99-104. https://doi.org/10.1177/036354659502300117
  6. Fuchs B, Gilbart MK, Hodler J, Gerber C. Clinical and structural results of open repair of an isolated one-tendon tear of the rotator cuff. J Bone Joint Surg Am 2006;88:309-16. https://doi.org/10.2106/00004623-200602000-00009
  7. Mormino MA, Gross RM, McCarthy JA. Captured shoulder: a complication of rotator cuff surgery. Arthroscopy 1996;12:457-61. https://doi.org/10.1016/S0749-8063(96)90040-7
  8. Berth A, Neumann W, Awiszus F, Pap G. Massive rotator cuff tears: functional outcome after debridement or arthroscopic partial repair. J Orthop Traumatol 2010;11:13-20. https://doi.org/10.1007/s10195-010-0084-0
  9. Verma NN, Dunn W, Adler RS, et al. All-arthroscopic versus mini-open rotator cuff repair: a retrospective review with minimum 2-year follow-up. Arthroscopy 2006;22:587-94. https://doi.org/10.1016/j.arthro.2006.01.019
  10. Yoo JC, Ahn JH, Koh KH, Lim KS. Rotator cuff integrity after arthroscopic repair for large tears with less-than-optimal footprint coverage. Arthroscopy 2009;25:1093-100. https://doi.org/10.1016/j.arthro.2009.07.010
  11. Kim SH, Ha KI, Park JH, Kang JS, Oh SK, Oh I. Arthroscopic versus mini-open salvage repair of the rotator cuff tear: outcome analysis at 2 to 6 years' follow-up. Arthroscopy 2003;19:746-54. https://doi.org/10.1016/S0749-8063(03)00395-5
  12. Ide J, Maeda S, Takagi K. A comparison of arthroscopic and open rotator cuff repair. Arthroscopy 2005;21:1090-8. https://doi.org/10.1016/j.arthro.2005.05.010
  13. Bishop J, Klepps S, Lo IK, Bird J, Gladstone JN, Flatow EL. Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study. J Shoulder Elbow Surg 2006;15:290-9. https://doi.org/10.1016/j.jse.2005.09.017
  14. Buess E, Steuber KU, Waibl B. Open versus arthroscopic rotator cuff repair: a comparative view of 96 cases. Arthroscopy 2005;21:597-604. https://doi.org/10.1016/j.arthro.2005.01.002
  15. Gwark JY, Sung CM, Na JB, Park HB. Outcomes of arthroscopic rotator cuff repair in patients who are 70 years of age or older versus under 70 years of age: a sex- and tear size-matched case-control study. Arthroscopy 2018;34:2045-53. https://doi.org/10.1016/j.arthro.2018.02.047
  16. Severud EL, Ruotolo C, Abbott DD, Nottage WM. All-arthroscopic versus mini-open rotator cuff repair: A long-term retrospective outcome comparison. Arthroscopy 2003;19:234-8. https://doi.org/10.1053/jars.2003.50036
  17. Walton JR, Murrell GA. A two-year clinical outcomes study of 400 patients, comparing open surgery and arthroscopy for rotator cuff repair. Bone Joint Res 2012;1:210-7. https://doi.org/10.1302/2046-3758.19.2000072
  18. Sugaya H, Maeda K, Matsuki K, Moriishi J. Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair: a prospective outcome study. J Bone Joint Surg Am 2007;89:953-60. https://doi.org/10.2106/00004623-200705000-00006
  19. Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 1999;8:599-605. https://doi.org/10.1016/S1058-2746(99)90097-6
  20. Gerber C, Catanzaro S, Betz M, Ernstbrunner L. Arthroscopic correction of the critical shoulder angle through lateral acromioplasty: a safe adjunct to rotator cuff repair. Arthroscopy 2018;34:771-80. https://doi.org/10.1016/j.arthro.2017.08.255
  21. Wylie JD, Beckmann JT, Granger E, Tashjian RZ. Functional outcomes assessment in shoulder surgery. World J Orthop 2014;5:623-33. https://doi.org/10.5312/wjo.v5.i5.623
  22. Kukkonen J, Kauko T, Vahlberg T, Joukainen A, Aarimaa V. Investigating minimal clinically important difference for Constant score in patients undergoing rotator cuff surgery. J Shoulder Elbow Surg 2013;22:1650-5. https://doi.org/10.1016/j.jse.2013.05.002
  23. Tashjian RZ, Deloach J, Porucznik CA, Powell AP. Minimal clinically important differences (MCID) and patient acceptable symptomatic state (PASS) for visual analog scales (VAS) measuring pain in patients treated for rotator cuff disease. J Shoulder Elbow Surg 2009;18:927-32. https://doi.org/10.1016/j.jse.2009.03.021
  24. McGlothlin AE, Lewis RJ. Minimal clinically important difference: defining what really matters to patients. JAMA 2014;312:1342-3. https://doi.org/10.1001/jama.2014.13128
  25. Cho NS, Cha SW, Rhee YG. Alterations of the deltoid muscle after open versus arthroscopic rotator cuff repair. Am J Sports Med 2015;43:2927-34. https://doi.org/10.1177/0363546515603063
  26. Gumina S, Di Giorgio G, Perugia D, Postacchini F. Deltoid detachment consequent to open surgical repair of massive rotator cuff tears. Int Orthop 2008;32:81-4. https://doi.org/10.1007/s00264-006-0285-6
  27. de Jesus JO, Parker L, Frangos AJ, Nazarian LN. Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. AJR Am J Roentgenol 2009;192:1701-7. https://doi.org/10.2214/AJR.08.1241
  28. Katthagen JC, Marchetti DC, Tahal DS, Turnbull TL, Millett PJ. The effects of arthroscopic lateral acromioplasty on the critical shoulder angle and the anterolateral deltoid origin: an anatomic cadaveric study. Arthroscopy 2016;32:569-75. https://doi.org/10.1016/j.arthro.2015.12.019
  29. McDonald RJ, McDonald JS, Kallmes DF, Carter RE. Behind the numbers: propensity score analysis-a primer for the diagnostic radiologist. Radiology 2013;269:640-5. https://doi.org/10.1148/radiol.13131465
  30. Kessler KE, Robbins CB, Bedi A, Carpenter JE, Gagnier JJ, Miller BS. Does increased body mass index influence outcomes after rotator cuff repair. Arthroscopy 2018;34:754-61. https://doi.org/10.1016/j.arthro.2017.08.248

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