The amount of arthroscopic rotator cuff repairs being performed has skyrocketed in recent years. The last 20 years or so have seen the transition from a full open approach, to a combined arthroscopic and mini-open technique, to the current all-arthroscopic technique. The implications on rehabilitation are enormous, as patients are recovering faster with less pain and surrounding tissue involvement.
Initially, the strength of these arthroscopic rotator cuff repairs was in question and still lagged behind the strength of the mini-open procedure. But recently, more and more studies are being published that show the strength of the new techniques are comparable.
A recent study in AJSM prospectively evaluated the integrity of the rotator cuff repair in 127 patients at the 1-year and 2-year postoperative marks. The authors used ultrasound to evaluate the tendons.
Results showed that:
- At one year, 68% had an intact rotator cuff. 32% had a full thickness tear again.
- All the tendons that were intact at 1-year were still intact at 2-years.
- Interestingly, 8% of the tendons that were not intact at 1-year were intact at 2-years.
- All patients demonstrated significant improvement in ASES scores from baseline to 2-year follow-up. Patients with intact cuffs had ASES scores of ~95 in comparison to ~86 with tendon defects.
Clinical Implications
The finding that all patients with an intact cuff at 1 year still were intact at 2-years is significant, showing that the repairs are providing good results over a decent amount of time. In general, characteristics that led to more cases of intact rotator cuffs were:
- Age – the younger the better. All patients with cuff defects were > 60 years old.
- Tear size – the smaller the better. All patients with cuff defects had tears > 4cm.
- Tendon involvement – the less the better. 75% of patients with cuff defects had more than one rotator cuff tendon intact.
It should also be noted that patients with an intact cuff demonstrated significantly great external rotation strength.
The finding that 32% had cuff tears sounds alarming at first but is in line with past reports on rotator cuff repairs. This is a little known secret that we don’t promote to our patients, because, as this study and several other studies have shown, patients improve regardless of whether or not the cuff is intact. The key comes down to rehab after surgery, as usual!
Nho SJ, Adler RS, Tomlinson DP, Allen AA, Cordasco FA, Warren RF, Altchek DW, & MacGillivray JD (2009). Arthroscopic rotator cuff repair: prospective evaluation with sequential ultrasonography. The American journal of sports medicine, 37 (10), 1938-45 PMID: 19531660
