A Randomized Controlled Trial to Assess the Efficacy of Arthroscopic Subacromial Decompression with and without Rotator Cuff Repair Using a Mini-open Technique

Abstract

Background Management of degenerate rotator cuff tears associated with subacromial impingement is debatable. Methods We performed a prospective, randomised controlled trial to assess the efficacy of arthroscopic subacromial decompression (ASD) with or without repair of the rotator cuff using a mini‐open technique. Results 42 patients (29 males and 13 females) with a mean age of 64 years (range 54–77 years) were recruited. 25 patients underwent ASD and cuff repair using mini‐open technique whereas 17 patients had only ASD alone. All the patients were followed for a minimal of 1 year post‐operatively. At final follow‐up the mean Constant scores and patient satisfaction scores were not different between the groups (p value 0.06 and 0.44 respectively). The mean DASH scores were marginally significant (p value 0.05) and mean ASES scores were significant (p value 0.03). A 38% cuff rerupture rate was noted in the cuff repair group. Conclusions Our study demonstrates that in short‐term the results of ASD with or without rotator cuff repair are not significantly different, however positive trends were noted in the cuff repair group. Although a significant rerupture rate was noted (38%) this had little effect on the outcome.

Rotator Cuff Tears : Short- and long-term aspects on treatment outcome

“…It is very important not to discard the method of cuff repair for all patients with a cuff tear, based on the results from above mentioned studies and the results in paper IV. The tear sizes per group in each study is 8.7-10 mm in paper IV, 14.3-15.6 mm in Moosmayer et al 197 , 8.5-9.6 in Kukkonen et al 154 , "supraspinatus" in Lambers-Heerspink et al 160 and 17.6-18.3 in Odak et al 217 . Consequently the results are mainly applicable to small tears, and the 2 studies with slightly larger tears 197,217 , also have a larger between-group difference in Constant score.…”

“…In a 5 to 11 year follow-up of the cohort from Odak et al 217 , a mean Constant score of 78 in the repair group and 61 in the acromioplasty group was found, a difference which was not significant 21 . This study may, however, have been underpowered to detect a real difference, with a follow-up of only 33 of the original 42 patients.…”

“…In the existing prospective randomised studies comparing rotator cuff repair to a treatment without repair, 89 % of included patients have had degenerative non-traumatic tears 154,160,197,217 . A traumatic tear could be regarded as an avulsion of a healthy tendon, due to the energy in a trauma, and it should therefore have a good healing capacity and yield a good clinical result if repaired.…”

“…Four previous prospective randomised studies have published 12month results, in which comparisons were made between repair and nonrepair treatment 154,160,197,217 . Moosmayer et al randomised 103 patients to mini-open repair or physiotherapy and included both traumatic and degenerative tears, with 38% having an adequate trauma 197 .…”

“…Lambers-Heerspink at al. examined degenerative non-traumatic tears and found Constant scores of mean 81.9 in the repair group vs. 73.7 in the non-repair group (P=0.08) 160 217 .…”