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Outcomes from Arthroscopic Rotator Cuff Repair: Dependent Upon Age and Tear Size

Success rate from arthroscopic rotator cuff repair depends on what is being measured. Patient satisfaction is the most common reported outcome from arthroscopic rotator cuff repair. Patient satisfaction is measured with standardized tests based upon patient responses to questions regarding their pain levels following surgery and their ability to carry out daily household, work, and sporting activities. Additional data is derived from physician measures of shoulder motion and rotator cuff strength.

Patient satisfaction is rated excellent and good for 93 to 97% of patients after arthroscopic rotator cuff repair in recent studies from Flurin et al in Arthroscopy 2007, Burns and Snyder in Journal of Shoulder and Elbow Surgery (JSES) 2008, and Charosset et al in American Journal of Sports Medicine (AJSM) 2007.

Success measures of patient satisfaction after rotator cuff repair depend upon age. Looking specifically at patients over 62 years of age, 87% had good to excellent results in a study by Grondel and Savoie in JSES 2004. Whereas, 100% of patients less than 40 years old had pain relief and 95% had improved function after arthroscopic single row repair in Krishnan Arthroscopy 2008.

While improvements of pain and return of function are clearly important to both patients and surgeons, healing of the arthroscopically repaired rotator cuff tendon may be a better measure of a successful outcome of the planned surgical anatomic goal. On closer inspection of the data, patients with an intact, healed rotator cuff repair had higher scores than those with a recurrent tear in the Flurin study. That study reported a 15% retear rate. Sugaya in Arthroscopy 2005 reported a retear rate of 25% for patients repaired with a single row of anchors, but that rate was lowered to 10% for those patients who had a dual row arthroscopic rotator cuff repair. Dual row arthroscopic repair uses two sets of anchors and does increase the area with which the rotator cuff has to heal. Lafosse in JBJS 2007 reported a 0% retear rate for small and medium sized tears after arthroscopic dual row rotator cuff repair. 

Rotator cuff tears are described as small or medium if they are less than 3 centimeters, about 1 inch. Sugaya in Journal of Bone and Joint Surgery (JBJS) 2007 reported a 5% retear rate for small and medium sized tears. Gladstone in AJSM 2007 reported a 39% retear rate, and stated that size of the tear was the only single variable that predicted retear.

Rotator cuff tears are described as large or massive when they are larger than 3 to 5 centimeters or involve 2 or more of the 4 rotator cuff tendons. Outcomes of arthroscopic repair of large and massive tears are less successful than repair of small and medium rotator cuff tears, but nonoperative treatments have even lower success rates in patients who desire to regain or retain function in Zingg JBJS 2007. Galatz in JBJS 2004 reported good functional results and patient satisfaction despite a 94% retear rate based upon ultrasound for patients with massive rotator cuff repair. Based upon MRI and CT arthrogram, Sugaya reported a 40% retear rate for large and massive tears, and Lafosse reports only a 17% retear rate for large and massive rotator cuff tears that underwent arthroscopic dual row repair.

Investigational techniques to reduce the retear rates for arthroscopic rotator cuff repair of large and massive tears have been reported. Park in AJSM 2008 reported improved results in patients with large and massive cuff tears with a dual row arthroscopic repair. Burkhead in Seminars in Arthroplasty 2007 reported on 17 patients with massive tears greater than 5 centimeters that underwent open rotator cuff repair with allograft patch augmentation of the repair with a 25% retear rate. Snyder and Bond in International Journal of Shoulder Surgery 2007 describe a technique of allograft patch rotator cuff replacement for irreparable rotator cuff tears measuring greater than 5 centimeters and report only 3 recurrent defects in 16 patients. Doctors Taylor Brown and Marc Labbe are currently using arthroscopic dual row rotator cuff repair as well as arthroscopic allograft augmentation and replacement to help improve the outcomes and success rates for their patients at the Bone and Joint Clinic of Houston. Please contact the clinic to determine if you may benefit from arthroscopic rotator cuff repair as well as one of these new techniques.