Mini-Open Rotator Cuff Repair
Mini-Open Rotator Cuff Repair
Abstract & Commentary
Synopsis: Mini-open rotator cuff repairs have 93% good-to-excellent UCLA Shoulder scores regardless of tear size.
Source: Shinners TJ, et al. Arthroscopically assisted mini-open rotator cuff repair. Arthroscopy. 2002;18(1):21-26.
The efficacy of the arthroscopically assisted, mini-open rotator cuff repair technique is well established. This can largely be attributed to improved joint visualization, decreased deltoid muscle takedown, reduction of pain, decreased length of hospitalization, and more rapid return to baseline shoulder function. In a retrospective clinical review, a single surgeon performed 63 arthroscopically assisted, mini-open rotator cuff repairs. Twenty-two patients were lost to follow-up leaving 41 patients reviewed for the study. Preoperative and postoperative shoulder function and pain were evaluated with the UCLA Shoulder rating system.
Shinners and colleagues describe a technique involving an arthroscopic subacromial decompression with or without arthroscopic distal clavicle excision. The rotator cuff was visualized through a 4-6 cm lateral incision beginning at the acromion and extending distally. A bony trough was created off the articular surface of the greater tuberosity with a motorized burr. The Concept rotator cuff instrumentation (Linvatec, Largo, Fla.) was used to place staggered holes, sutures were tied over bone bridges, and the free edges of the tendon were pulled into the trough.
According to the UCLA scoring system, 20 patients had excellent scores (49%), 18 good scores (44%), and 3 fair scores (7%). Workers’ Compensation patients had scores that were 4 points lower than the rest of the patients (P < 0.0001). The average UCLA scores for small (< 1 cm, n = 8), moderate (1-3 cm, n = 28), and large (> 3 cm, n = 5) tears were 33.4, 31.8, and 32.8, respectively (P < 0.4286). No massive tears were encountered (> 5 cm).
Although there were no massive tears, their series compared favorably to previously published series, leading Shinners et al to conclude that the arthroscopically assisted mini-open repairs are as effective as open techniques. The ability to visualize the glenohumeral joint allows the surgeon to treat concomitant intra-articular pathology that would not otherwise be addressed with open repairs. Minimal deltoid takedown contributes to less pain and discomfort, optimal rehabilitation, and more rapid return to work or recreational activities.
Comment by Brian J. Cole, MD, MBA
Shinners et al have done an excellent job in the analysis of their arthroscopically assisted mini-open repair series. They report a greater number of excellent scores (63%) for small tears. This observation is significant because this trend is consistent with previously published series of mini-open repairs.1,2 This series did not have any patients with massive tears, and Shinners et al defer comment on massive tear repairs. They do, however, refer to other mini-open series which suggest that massive tears be repaired with open techniques.2,3 Burkhart and associates4 recently published arthroscopic rotator cuff repair series comparing tear size and repair techniques. They reported that arthroscopic rotator cuff repair yields 95% good-to-excellent outcomes regardless of tear size, and massive tears repaired by the margin convergence technique is superior to open repair of large and massive tears. The superiority of the all-arthroscopic approach compared to mini-open techniques, however, remains to be demonstrated in any objective fashion.
Dr. Cole, Assistant Professor, Orthopaedic Surgery, Rush Presbyterian Medical Center, Midwest Orthopaedics, Chicago, IL, is Associate Editor of Sports Medicine Reports.
Author Acknowledgments: The reviewer would like to acknowledge Shane Nho, MS, for his assistance in preparation of this report.
References
1. Levy HJ, et al. Arthroscopic assisted rotator cuff repair: Preliminary results. Arthroscopy. 1990;6:55-60.
2. Seltzer DG, et al. Arthroscopic assisted rotator cuff repair: Two year follow-up. Orthop Trans. 1993;17:234.
3. Paulos LE, Kody MH. Arthroscopically enhanced "miniapproach" to rotator cuff repair. Am J Sports Med. 1994;22:19-25.
4. Burkhart SS, et al. Arthroscopic rotator cuff repair: Analysis of results by tear size and by repair technique-margin convergence versus direct tendon-to-bone repair. Arthroscopy. 2001;17:905-912.
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