Arthroscopic Rotator Cuff Repair – A Prospective Evaluation of Tendon Integrity at 1- and 2-Years

massive RTC scope 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:image

  • 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

7 replies
  1. Bruce Wilk
    Bruce Wilk says:

    I know it was better when the pts went to PT for an extended about of time before surgeries like these. Over last 10 years I help many pts avoid scheduled sx. With a little PT in my office. there is no better outcome then a good none sx. outcome.

  2. Anonymous
    Anonymous says:

    Quick question, could you clarify this statement:

    “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!”

    I didn’t follow exactly what the “secret” was and wasn’t sure how it corresponded to patients improving whether the cuff was intact or not. Does that mean that even if they have a rupture again they will still get better? Sorry, I just didn’t completely follow that. But, I love the article, thanks!

  3. Mike Reinold
    Mike Reinold says:

    @Mark – great question. I agree with @Christie, I think you are right and I have had some succesful massive irrepairable cuff tears be able to elevate their arm, but it takes a lot of work and doesnt always work out. I would think it's always best to try to repair, but dont give up on your patients that have an irrepairable tear.

    @Christie – those with a healed cuff tendon had a mean tear size of 3 cm, those with a tear on re-eval had a mean of 4.4 cm, so not too small.

  4. Christie Downing, PT, DPT, Dip, MDT
    Christie Downing, PT, DPT, Dip, MDT says:

    Good post, and in response to Mark, yes I would say it's possible for patients to recover with cuff defects. I think that there is a study, however, that those who are unable to raise their arm overhead only have about a 10% chance of recovering it conservatively.

    Anecdotally, I had a patient about a year ago with a full thickness tear (albeit small in the x-axis) who was slated to have surgery. She insisted on PT first…good for her, she was back at Medinah swining the wrenches in two weeks.

    Which reminds me of a question: what was the typical size of the tear in the study mentioned? I know they were full thickness, but how wide?

  5. Mark Young
    Mark Young says:

    Great post Mike!

    I like the point you made about the patients improving whether or not the cuff is intact. Is it not then possible to help patients improve in the same manner without surgery?

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