Our Recent Posts

Please reload

Archive

Please reload

Tags

Please reload

AAOS: Single- versus double-row rotator cuff repair: Optimal choice depends on tear size.

December 11, 2018

 

In our study @TheArmDoc, which we have presented our results in the American Academy of Orthopaedic Surgeons Meeting in New Orleans. 

80 patients with MRI-diagnosed full-thickness rotator cuff tears were randomized to undergo either single-row (SR) or transosseous-equivalent double-row (TEDR) arthroscopic rotator cuff repair, to compare these two treatment approaches with respect to clinical and functional outcomes at 18 months post-operation. Results indicated that, in tears that were less than 3 cm in length, Oxford Shoulder Scores (OSS), University of CA Los Angeles scores (UCLA), and Constant-Murley Outcome Scores (CMS) did not differ between groups. When tears were greater than 3 cm, transosseous-equivalent double-row repair resulted in significantly better OSS, UCLA and CMS scores compared to single-row repair. 

What was the principal research question?

How do the clinical and functional outcomes compare when patients with rotator cuff tears undergo either transosseous-equivalent double-row or single-row repair, assessed over 18 months?

Study Characteristics-

Population:

80 patients with MRI-diagnosed full-thickness rotator cuff tears, and who are symptomatic. Median age of all patients was 60.9 years.

Intervention:

TEDR group: Patients in this group (n=40) underwent transosseous-equivalent double-row rotator cuff repair by an experienced shoulder arthroscopist. Within this group, 23 patients had a tear greater than 3 cm long. (Median age: 60.4 years)

Comparison:

SR group: Patients in this group (n=40) underwent single-row rotator cuff repair by an experienced shoulder arthroscopist using suture anchor techniques. Within this group, 21 patients had a tear greater than 3 cm long. (Median age: 61.6 years)

Outcomes:

Primary outcomes: Oxford Shoulder Score (OSS), the University of CA Los Angeles score (UCLA), the Constant-Murley Outcome Score (CMS) and shoulder range of motion (ROM). Secondary outcomes: Visual Analog Scale (VAS) and quality of life (measured on the EuroQoL 5D scale).

Methods:

RCT

Time:

Follow-up assessments were conducted at 18 months post-operation. VAS was measured at 6 weeks postoperatively. 

What were the important findings?

  • Operative time and hospital stay were significantly lower in the SR group (60 minutes and 22 hours, respectively) compared to the TEDR group (120 minutes and 30 hours, respectively) (both p<0.001).

  • For the entire study population, there was a significant improvement in pre-operative median OSS scores (23.5 vs 42), UCLA scores (16 vs 32) and CMS scores (51 vs 80) following surgery (all p<0.001).

  • Those with tears >3 cm had significantly lower postoperative scores for OSS, UCLA and CMS than those with tears <3 cm. 

  • For the OSS, UCLA and CMS assessment tools, all three could distinguish between patients in the SR group, those with tears >3 cm, and patients in the remaining three subgroups (Wilk's Lambda: 0.66; p<0.001). 

  • For the entire study population, there was a significant improvement in pre-operative median forward flexion (100 vs 150 degrees), internal rotation (25 vs 34 degrees) and external rotation (57 vs 124 degrees) following surgery (all p<0.001). Those with tears >3 cm and who underwent TEDR repair had the worst forward flexion scores (145.9 degrees), and those with tears >3 cm who underwent SR repair had the worst external rotation scores (116.3 degrees),

  • VAS and EuroQoL 5D scores also displayed significant improvement following surgery within the study population (VAS: 10 vs 70; EuroQoL 5D: 0.36 vs 0.70; both p<0.001). 

What should I remember most?

In tears that were less than 3 cm in length, Oxford Shoulder Scores (OSS), University of CA Los Angeles scores (UCLA), and Constant-Murley Outcome Scores (CMS) did not differ between groups. When tears were greater than 3 cm, transosseous-equivalent double-row repair resulted in significantly better OSS, UCLA and CMS scores compared to single-row repair. 

How will this affect the care of my patients?

Results from this study suggest that the optimal treatment option for rotator cuff repair depends on the tear size. For small and medium tears, single-row repair seems to be sufficient in producing a good clinical outcome, whereas for massive tears, transosseous-equivalent double-row rotator cuff repair seems to be superior. Additional studies are needed to confirm these results. 

 

 

Please reload

©2018 by TheArmDoc.co.uk