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abstract
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Background
Arthroscopic rotator cuff repair techniques have almost replaced
open repairs. Short- and mid-term studies have shown comparable
outcomes, with no clear superiority of either procedure. The aim of
this study was to compare the long-term clinical and imaging
outcomes following arthroscopic or open rotator cuff repair.
Methods
Forty patients with magnetic resonance imaging (MRI)-documented,
symptomatic supraspinatus or supraspinatus and infraspinatus tears
were randomized to undergo arthroscopic or open rotator cuff repair.
Clinical and radiographic follow-up was obtained at 6 weeks, 3
months, 1 year, 2 years, and >10 years postoperatively. Clinical
assessment included measurement of active range of motion, visual
analog scale score for pain, functional scoring according to the
Constant-Murley score (CS), and assessment of the Subjective
Shoulder Value. Imaging included conventional radiography and MRI
for the assessment of cuff integrity and alteration of the deltoid
muscle.
Results
We enrolled 20 patients with a mean age of 60 years (range, 50-71
years; standard deviation [SD], 6 years) in the arthroscopic surgery
group and 20 patients with a mean age of 55 years (range, 39-67
years; SD, 8 years) in the open surgery group. More than 10 years'
follow-up was available for 13 patients in the arthroscopic surgery
group and 11 patients in the open surgery group, with mean follow-up
periods of 13.8 years (range, 11.9-15.2 years; SD, 1.1 years) and
13.1 years (range, 11.7-15 years; SD, 1.1 years), respectively. No
statistically significant differences in clinical outcomes were
identified between the 2 groups: The median absolute CS was 79
points (range, 14-84 points) in the arthroscopic surgery group and
84 points (range, 56-90 points) in the open surgery group ( =
.177). The median relative CS was 94% (range, 20%-99%) and 96%
(range, 65%-111%), respectively ( = .429). The median
Subjective Shoulder Value was 93% (range, 20%-100%) and 93% (range,
10%-100%), respectively ( = .976). MRI evaluation showed a
retear rate of 30% equally distributed between the 2 groups. Neither
fatty infiltration of the deltoid muscle, deltoid muscle volume, nor
the deltoid origin were different between the 2 groups.
Conclusion
In a small cohort of patients, we could not document any difference
in clinical and radiographic outcomes at long-term follow-up between
arthroscopic and open rotator cuff repair. The postulated harm to
the deltoid muscle with the open technique could not be confirmed.
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