Summary

Arthroscopic repair of PTRCTs results in excellent clinical outcomes and high patient satisfaction at minimum 10-year follow-up.

Abstract

Background

With the increased use of magnetic resonance imaging and the rise of arthroscopic shoulder surgery, the prevalence of partial thickness rotator cuff tears (PTRCTs) has been reported to be from 13 to 40% within the adult population, accounting for 70% of all rotator cuff tears. Furthermore, approximately 29% of PTRCTs will progress to full-thickness tears if left untreated.

Purpose

The purpose of this study was to investigate minimum 10-year patient-reported outcomes (PROs) after arthroscopic rotator cuff repair (ARCR) of the supraspinatus tendon and to report survivorship, reoperation, and complication rates.

Methods

Data was collected prospectively and retrospectively reviewed for this IRB approved study. Patients were included if they underwent ARCR of a PTRCT and were a minimum of 10 years out from surgery. Procedures were performed by a single surgeon between October 2005 through October 2011. ARCR of the PTRCT was performed either with a PASTA repair or conversion into a full thickness tear and repair. Patients were included if they had a partial (articular or bursal sided) cuff tear diagnosed at surgery with or without biceps tenodesis/tenotomy and subacromial decompression. Patients were excluded if they had osteoarthritis, fatty infiltration, or had concomitant pathologies that led to additional surgical procedures. Patient reported outcome (PRO) data was collected preoperatively and at a minimum of 10 years postoperatively. PROs utilized in this study included the American Shoulder and Elbow Surgeons Score (ASES), Single Assessment Numeric Evaluation Score (SANE), Quick Disabilities of the Arm, Shoulder and Hand Score (QuickDASH), the Short Form 12 physical component summary (SF-12 PCS), and patient satisfaction with surgical outcomes at final follow-up. Kaplan-Meier survivorship analysis was performed, with failure defined as revision surgery. Retears, progression to full-thickness tears, revision surgeries, and surgical complications were recorded.

Results

In total, 121 patients who underwent ARCR for treatment of a PTRCT and were at least 10 years out from surgery were identified. After application of exclusion criteria, 34 patients (mean age: 50 years, range 23 - 68; 22 males, 12 females, all unilateral) with a mean follow-up of 12 years (range 10-15) were included in this study. Further, 22 PTRCTs were articular sided, and 12 PTRCTs were bursal sided. At final follow-up, the mean PROs were significantly improved when compared to preoperative levels for all PRO measures. The ASES score improved from 67.3 to 93.7 (p<0.001), SANE improved from 70.9 to 91.2 (p=.004), QuickDASH improved from 22.3 to 6.6 (p<.004) and SF-12 PCS improved from 44.8 to 54.2 (p<.001). Median postoperative satisfaction was 10 (range 5-10). Kaplan-Meier analysis demonstrated 93.3% survivorship at 10 years. Neither age nor tear location were correlated with the clinical outcome.

Conclusion

Arthroscopic repair of PTRCTs results in excellent clinical outcomes and high patient satisfaction at minimum 10-year follow-up. Furthermore, the procedure is highly durable with a survivorship rate of 93.3% at 10 years. These results are independent of tear pattern or patient age at surgery.
Keywords: Arthroscopic rotator cuff repair; partial rotator cuff repairs; minimum 10-year outcomes; shoulder surgery