Background
Isolated greater tuberosity (GT) fractures are a bony avulsion of the rotator cuff. A majority of these fractures can be managed non-operatively, but fractures with significant displacement can result in chronic pain, impingement, weakness, and shoulder dysfunction if not managed surgically. In the evolution of GT fracture fixation, double row fixation has been utilized to improve initial repair strength and restore normal anatomy, but the outcomes of these fractures relative to those with acute rotator cuff tears remains largely unknown.
Purpose
To evaluate and compare patient reported outcomes following isolated GT fracture fixation to acute rotator cuff repair (RCR) at a minimum of 2 years.
Methods
Patients who underwent isolated GT fracture fixation were compared in a 1-to-3 fashion with patients who underwent arthroscopic RCR for an acute rotator cuff tear by a single surgeon between January 2006 and July 2018. Data was prospectively collected and retrospectively reviewed. Patient reported outcomes (PROs) were compared pre- and post-operatively as well as between groups (ASES, SF-12 PCS, SANE, QuickDASH, and satisfaction). Reoperation rates were analyzed.
Results
A total of 56 patients, 15 isolated GT fracture fixation patients with a mean age of 48.3 years old and 41 acute RCR patients with a mean age of 57.2 years old were evaluated (p=0.038). ASES scores significantly improved from 43.6 to 91.3 (p=0.005) in the isolated GT fracture fixation group and from 51.4 to 95.2 (p<0.001) in acute RCR group. At final follow-up, mean QuickDASH scores were 10.6 and 7.9 (p=0.633) and SANE scores were 90.6 and 87.3 (p=0.846) for the GT and acute RCR groups, respectively. The median satisfaction for both groups was 10/10. Additional comparison of patients who underwent double row repair for an acute rotator cuff tear or isolated GT fracture revealed no significant difference in outcomes (p>0.185). There were no revisions in the GT fracture fixation group and one patient in the acute RCR group had recurrent shoulder pain and subsequently underwent revision surgery.
Conclusion
Isolated GT fractures show significantly improved patient reported outcomes to the same degree as acute rotator cuff tears when fixed arthroscopically. These results suggest that linked, double row repairs can result in rotator cuff tendon to bone healing which may be equivalent to bone-to-bone healing.