Original article
Cuff integrity after arthroscopic versus open rotator cuff repair: A prospective study

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Arthroscopic rotator cuff repair (RCR) has been reported to have good clinical results but high retear rates by ultrasound. We prospectively assessed postoperative cuff integrity and outcome after arthroscopic RCR (40 patients) and compared these results with open RCR (32 patients). Evaluation preoperatively and at 1 year included a physical examination and magnetic resonance imaging. American Shoulder and Elbow Surgeons and Constant scores improved significantly in both groups (P < .0001). Overall, 69% of repairs in the open group and 53% in the arthroscopic group were intact by magnetic resonance imaging. Of tears less than 3 cm in size, 74% in the open group and 84% in the arthroscopic group were intact. Of tears greater than 3 cm in size, 62% in the open group and 24% in the arthroscopic group were intact (P < .036). In the arthroscopic group, patients with an intact cuff had significantly greater strength of elevation (P = .01) and external rotation (P = .02). We conclude that open and arthroscopic RCRs have similar clinical outcomes. Cuff integrity is comparable for small tears, but large tears have twice the retear rate after arthroscopic repair.

Section snippets

Patient enrollment

Institutional review board approval was obtained before patients were enlisted in both groups. Forty-seven consecutive patients subsequently provided informed consent and were enrolled in the open RCR group. These patients were a subset of a larger ongoing study evaluating outcomes after open RCR between 1996 and 1999. A power analysis revealed the need for at least 36 patients with postoperative MRI in the arthroscopic RCR group to claim statistical significance. The collection period for the

Results

A total of 47 patients were included in the open RCR group. Of the patients, 11 refused to undergo postoperative MRI, 3 were lost to follow-up, and 1 died, leaving 32 patients for evaluation. Of these, 24 underwent an open RCR and 8 had a miniopen RCR. Four patients had distal clavicle resection, and two underwent revision surgery. A total of 55 patients were enrolled in the arthroscopic RCR group. Seven patients refused to undergo postoperative MRI. Eight agreed but were unable to complete the

Discussion

The objective of rotator cuff surgery is to relieve pain and restore function. The abilities and limitations of open RCR have been well known and studied over the years. Arthroscopic RCR, on the other hand, has been the subject of less investigation. Although a few studies on arthroscopic RCR have reported good outcomes,6, 7, 22, 42, 51, 59 other studies have raised concerning issues with regard to the biomechanical strength of the repair48 and high failure rates of cuff integrity at follow-up.

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    Supported in part by a Prospective Clinical Research Grant from the Orthopaedic Research and Education Foundation (primary investigator, Evan L. Flatow, MD; 1996-1998; “Surgical repair of the torn rotator cuff tendon: a prospective analysis of function, quality of life, costs and factors that affect these analyses”) and by an Imaging Core Award from the National Institutes of Health and General Clinical Research Center, Mount Sinai Medical Center (primary investigator, Evan L. Flatow, MD).

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