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No difference in long-term outcome between open and arthroscopic rotator cuff repair: a prospective, randomized study

Anita Hasler, Silvan Beeler, Tobias Götschi, Sabrina Catanzaro, Bernhard Jost & Christian Gerber

abstract

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.
   
citation Hasler A, Beeler S, Götschi T, Catanzaro S, Jost B, Gerber C. No difference in long-term outcome between open and arthroscopic rotator cuff repair: a prospective, randomized study. JSES Int 2020; 4:818-825.
   
type journal paper/review (English)
date of publishing 18-09-2020
journal title JSES Int (4/4)
ISSN electronic 2666-6383
pages 818-825
PubMed 33345221
DOI 10.1016/j.jseint.2020.08.005