Summary

Arthroscopic conversion of PTRCT to FTRCT followed by a suture bridge repair technique has provided significantly improvements in all three functional scores and very low retear rates suggesting that this technique is a highly effective treatment option when a surgical repair is required and an accelerated rehabilitation is safe and may assist in earlier return to preoperative activities.

Abstract

Introduction

Partial-thickness rotator cuff tears (PTRCT) are known to have a more significant role than previously recognized as the cause of long-term shoulder pain. The techniques for repairing PTRCTs, has remained controversial. The purpose of this study was to evaluate the functional outcome and retear rate of an arthroscopic conversion of PTRCT to full-thickness rotator cuff tear (FTRCT) following a suture-bridge repair.

Methods

Sixty-two patients with PTRCT that required an arthroscopic rotator cuff repair during the period between 2012 and 2020 with completed serial ultrasound examinations at weeks 6, 12, and 26 postoperatively were included. The time point for examination of cuff integrity was six months, chosen on the basis of rotator cuff repair healing process. Functional clinical scores were assessed by Constant score, Western Ontario Rotator Cuff Index (WORC), and Oxford score. Intraoperative findings were noted and evaluated. Details were retrieved from the Socrates Orthopaedic Outcomes Software database. Surgical procedures were performed by the same experienced senior surgeon (MH). Acromioplasty was not performed. All patients had undergone a suture bridge repair technique. A triple-loaded suture anchor was placed juxtachondral at the middle of the anteroposterior length of the footprint was placed and sutures passed through the medial portion of the tendon in a horizontal mattress configuration. Then without tying the sutures were fixed to two lateral knotless anchors as the standard configuration of our repair. A variable number of free-sutures passed through the tendon in a horizontal mattress suture configuration and then attached to the lateral row were used as needed.

Results

60 patients were included in this study. The mean age was 57 years old. The mean Constant score significantly improved from 51.89 preoperatively to 64.45 at week 26 postoperatively. The mean Oxford score significantly increased from 29.58 preoperatively to 39.60 at week 26 postoperatively. The mean WORC score significantly improved from 1115 preoperatively to 609.2 at week 26 postoperatively. 60 patients (96.77%) had an intact repair on ultrasound at weeks 6 and 26. Two patients (3.23%) had a PTRCT at week 6 and two patients (3.23%) had a FTRCT at week 26. The overall rate of retear was 3.23%

Discussion

Arthroscopic conversion of PTRCT to FTRCT followed by a suture bridge repair technique has provided functional significantly improvements in all three functional scores (Constant, Oxford, and WORC) and low rates of retear of 3.23%. The short-term clinical and functional outcomes are similar with other studies on the repair of PTRC. Although, our retear rate is lower compared to other studies, which reported a mean retear rate of 10.9%. The primary objective of the study was to assess retear of the surgical repair following conversion to FTRCT. These results suggest that this technique is a highly effective treatment option to be considered when a surgical repair of a PTRCT is required and accelerated rehabilitation is safe and may assist in earlier return to preoperative activities.