Clinical and Structural Outcomes after Arthroscopic Repair of Medium- to Massive-Sized Delaminated and Nondelaminated Rotator Cuff Tears

Abstract

Introduction: Current evidence is controversial about the outcomes after the repair of the delaminated versus nondelaminated rotator cuff tears. The objective of this study was to evaluate the factors affecting delamination of the cuff and clinical and structural outcomes after en masse arthroscopic repair of delaminated versus nondelaminated cuff of varying sizes. Materials and Methods: A total of 233 patients with full-thickness posterosuperior cuff tears were divided in two groups: Group 1: Delaminated tears ( n = 131) and Group 2: Nondelaminated tears ( n = 102) of medium, large, and massive sizes. Both groups were evaluated by clinical scores (Constant–Murley [CM], American shoulder and elbow score [ASES]) and ultrasonography (USG), at a minimum followup of 2 years. Results: The mean followup was 45.47 months. There was a weak but statistically significant linear correlation ( P = 0.02) between the increasing size of tear and delamination, whereas increasing age and duration of symptoms did not correlate with increasing tendency of delamination. Final followup USG analysis revealed that there was no significant difference ( P = 0.55) between healing rates of Group 1 and Group 2. Further taking various tear sizes into account, USG revealed no significant difference between the healing rates of two groups. The mean overall final postoperative CM and ASES scores of two groups did not show any significant difference (CM; P = 0.36, ASES; P = 0.4). However, the clinical outcome was significantly better in the completely healed group as compared to partially healed or retear group. Conclusions: A weak linear correlation between delamination and increasing size of the tear was noted. Although overall structural and clinical outcome is no different between two groups, the clinical outcomes of completely healed tear are better than partially healed ones. Level of Evidence: Level III, Retrospective comparative.

Delamination of rotator cuff tears impairs healing after repair: a systematic review and meta‐analysis

“…The full texts of the remaining 24 articles were further assessed, resulting in the exclusion of 14 articles owing to a lack of data. Finally, a total of ten studies [10, 13–16, 18, 24–27] were included (Fig. 1).…”

“…Data on the retear rate were reported in seven studies [10, 14–16, 18, 26, 27], and median heterogeneity was observed across the included studies ( I 2 = 60.6%). In the assessment of potential publication bias, the Harbord test was employed on the binary variable “retear.” The resulting P value showed no significant difference from zero, indicating an absence of publication bias.…”

“…Six studies [13–15, 18, 26, 27] provided data provided data on preoperative clinical outcome scores. The minimum follow‐up period was 24 months in five studies and 12 months in one study (Table 1).…”

“…Two reviewers independently extracted, summarized, and tabulated the following data using a standard form: (1) basic characteristics, such as publication year, study design, country, number of participants, type of surgery, follow‐up time, and imaging method; (2) retear rate, evaluated using ultrasound, magnetic resonance imaging, and computed tomography arthrography; (3) complete healing rate evaluated using ultrasound and computed tomography arthrography [15, 18]; (4) patient‐reported clinical scores, such as the Constant score, American Shoulder and Elbow Surgeons (ASES) score, and visual analog scale (VAS) score; (5) shoulder joint range of motion, including external, internal rotation, and forward elevation. Discrepancies in the extracted data were resolved through discussion.…”

“…Delamination is a risk factor for poor clinical and anatomical outcomes after rotator cuff repair [2, 13, 14]. However, the presence of delamination tears does not affect the outcome of rotator cuff repair [4, 10, 15, 16]. Despite the importance of determining the effect of delamination on the outcome of rotator cuff repair, only a few systematic reviews have been published to date.…”