Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Better short-term outcomes of mini-open rotator cuff repair compared to full arthroscopic repair

  • Mehmet Akdemir (Department of Orthopedics and Traumatology, Izmir Ekol Hospital) ;
  • Ali Ihsan Kilic (Department of Orthopedics and Traumatology, Izmir Bakircay University) ;
  • Cengizhan Kurt (Department of Orthopedics and Traumatology, Izmir Bakircay University) ;
  • Sercan Capkin (Department of Orthopedics and Traumatology, Izmir Bakircay University)
  • Received : 2023.08.18
  • Accepted : 2024.02.15
  • Published : 2024.06.01
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Abstract

Background: Rotator cuff tears commonly cause shoulder pain and functional impairment, prompting surgical intervention such as mini-open and arthroscopic methods, each with distinct benefits. This study aimed to compare the clinical outcomes and complications of these two approaches. Methods: A retrospective analysis was conducted on 165 patients who underwent rotator cuff repair using either arthroscopic-assisted mini-open or full arthroscopic approaches. Patient demographics, tear characteristics, clinical outcomes, and complications were assessed, with statistical analyses conducted to discern differences between the groups. Results: Among the patients, 74 (53.2%) received the mini-open approach, while 65 (46.8%) underwent arthroscopic repair, with a mean follow-up of 19.91 months. The mini-open group exhibited significantly higher postoperative American Shoulder and Elbow Surgeons (ASES) scores compared to the arthroscopic group (P=0.002). Additionally, the mini-open group demonstrated a more significant improvement in ASES scores from preoperative to postoperative assessments (P=0.001). However, the arthroscopic method had a significantly longer operative time (P<0.001). Complications, including anchor placement issues, frozen shoulder, infection, and re-rupture, occurred in 17.3% of patients overall. Re-rupture rates were 13.5% for mini-open and 6.2% for full arthroscopic repair, with no significant difference between the two methods (P=0.317). Conclusions: Both the mini-open and arthroscopic methods yielded favorable clinical outcomes for rotator cuff tear treatment, but the mini-open group exhibited superior results. Surgeons should consider patient characteristics, tear attributes, and surgical expertise when selecting the appropriate technique.

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References

  1. Yamaguchi K, Ditsios K, Middleton WD, Hildebolt CF, Galatz LM, Teefey SA. The demographic and morphological features of rotator cuff disease: a comparison of asymptomatic and symptomatic shoulders. J Bone Joint Surg Am 2006;88:1699-704.
  2. Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg 1999;8:296-9.
  3. Nho SJ, Shindle MK, Sherman SL, Freedman KB, Lyman S, MacGillivray JD. Systematic review of arthroscopic rotator cuff repair and mini-open rotator cuff repair. J Bone Joint Surg Am 2007;89 Suppl 3:127-36.
  4. Kim KT, Kim GH, Cha DH, Lee JH, Lee YB. A comparison of clinical outcomes in rotator cuff re-tear patients who had either an arthroscopic primary repair or arthroscopic patch augmentation for large-to-massive rotator cuff tears. Diagnostics (Basel) 2023;13:1961.
  5. Lafosse L, Brzoska R, Toussaint B, Gobezie R. The outcome and structural integrity of arthroscopic rotator cuff repair with use of the double-row suture anchor technique: surgical technique. J Bone Joint Surg Am 2008;90 Suppl 2 Pt 2:275-86.
  6. Denard PJ, Burkhart SS. Techniques for managing poor quality tissue and bone during arthroscopic rotator cuff repair. Arthroscopy 2011;27:1409-21.
  7. Gartsman GM. Arthroscopic rotator cuff repair. Clin Orthop Relat Res 2001;(390):95-106.
  8. Galatz LM, Griggs S, Cameron BD, Iannotti JP. Prospective longitudinal analysis of postoperative shoulder function: a ten-year follow-up study of full-thickness rotator cuff tears. J Bone Joint Surg Am 2001;83:1052-6.
  9. Scheibel M, Lichtenberg S, Habermeyer P. Reversed arthroscopic subacromial decompression for massive rotator cuff tears. J Shoulder Elbow Surg 2004;13:272-8.
  10. Chung SW, Oh JH, Gong HS, Kim JY, Kim SH. Factors affecting rotator cuff healing after arthroscopic repair: osteoporosis as one of the independent risk factors. Am J Sports Med 2011;39:2099-107.
  11. Plachel F, Jo OI, Ruttershoff K, Andronic O, Ernstbrunner L. A systematic review of long-term clinical and radiological outcomes of arthroscopic and open/mini-open rotator cuff repairs. Am J Sports Med 2023;51:1904-13.
  12. Guo S, Zhu Y, Song G, Jiang C. Assessment of tendon retraction in large to massive rotator cuff tears: a modified patte classification based on 2 coronal sections on preoperative magnetic resonance imaging with higher specificity on predicting reparability. Arthroscopy 2020;36:2822-30.
  13. Somerson JS, Hsu JE, Gorbaty JD, Gee AO. Classifications in brief: Goutallier classification of fatty infiltration of the rotator cuff musculature. Clin Orthop Relat Res 2016;474:1328-32.
  14. McCreesh KM, Crotty JM, Lewis JS. Acromiohumeral distance measurement in rotator cuff tendinopathy: is there a reliable, clinically applicable method?: a systematic review. Br J Sports Med 2015;49:298-305.
  15. Shubin Stein BE, Ahmad CS, Pfaff CH, Bigliani LU, Levine WN. A comparison of magnetic resonance imaging findings of the acromioclavicular joint in symptomatic versus asymptomatic patients. J Shoulder Elbow Surg 2006;15:56-9.
  16. Ozcan MS, Varol A, Kilinc BE. Arthroscopic versus mini-open rotator cuff repair: should we ignore the mini-open surgery. Acta Chir Orthop Traumatol Cech 2021;88:369-74.
  17. Denard PJ, Jiwani AZ, Ladermann A, Burkhart SS. Long-term outcome of arthroscopic massive rotator cuff repair: the importance of double-row fixation. Arthroscopy 2012;28:909-15.
  18. Scheibel M, Tsynman A, Magosch P, Schroeder RJ, Habermeyer P. Postoperative subscapularis muscle insufficiency after primary and revision open shoulder stabilization. Am J Sports Med 2006;34:1586-93.
  19. Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am 2004;86:219-24.
  20. Nho SJ, Brown BS, Lyman S, Adler RS, Altchek DW, MacGillivray JD. Prospective analysis of arthroscopic rotator cuff repair: prognostic factors affecting clinical and ultrasound outcome. J Shoulder Elbow Surg 2009;18:13-20.
  21. Barnes LA, Kim HM, Caldwell JM, et al. Satisfaction, function and repair integrity after arthroscopic versus mini-open rotator cuff repair. Bone Joint J 2017;99:245-9.
  22. Migliorini F, Maffulli N, Eschweiler J, Schenker H, Tingart M, Betsch M. Arthroscopic versus mini-open rotator cuff repair: a meta-analysis. Surgeon 2023;21:e1-12.
  23. Lawrence RL, Moutzouros V, Bey MJ. Asymptomatic rotator cuff tears. JBJS Rev 2019;7:e9.
  24. Mandaleson A. Re-tears after rotator cuff repair: current concepts review. J Clin Orthop Trauma 2021;19:168-74.
  25. Xu M, Li Z, Zhou Y, Ji B, Tian S, Chen G. Correlation between acromiohumeral distance and the severity of supraspinatus tendon tear by ultrasound imaging in a Chinese population. BMC Musculoskelet Disord 2020;21:106.
  26. Kum DH, Kim JH, Park KM, Lee ES, Park YB, Yoo JC. Acromion index in Korean population and its relationship with rotator cuff tears. Clin Orthop Surg 2017;9:218-22.