Introduction
Arthroscopic rotator cuff repair (ARCR) has recently become the mainstream means of repairing full-thickness rotator cuff tears. However, few reports have evaluated the long-term clinical outcomes. We evaluated the long-term clinical outcomes and the state of the rotator cuff more than 10 years after ARCR.
Patients and methods
We registered 21 shoulders with full-thickness rotator cuff tears that had been repaired with ARCR. The patients’ mean age was 60.7years, and the mean duration of follow-up was 127.0months. We evaluated the clinical status (Japanese Orthopedic Association [JOA] score and Constant score), active flexural range of motion (ROM), fatty infiltration of muscle, atrophy of the rotator cuff before and after surgery, and re-tear rate. Fatty infiltration was evaluated using the global fatty degeneration index (GFDI), which is the average value of the Goutallier stage of the supraspinatus, infraspinatus, and subscapularis muscles by magnetic resonance imaging (MRI). Muscle atrophy was evaluated using the percentage of the cross-sectional area(PCSA) of the three muscles in the supraspinous fossa by MRI. The MRI Sugaya classification was used to evaluate the occurrence of re-tear, which was defined as type IV and V. For statistical examination, the Mann–Whitney U test was used for comparison between the two groups, and the risk rate was 5%.
Results
The mean JOA score significantly improved from 57.4 points preoperatively to 90.6 points 1 year postoperatively, the mean Constant score significantly improved from 53.1 points preoperatively to 88.4 points 1 year postoperatively, and the mean active flexural ROM significantly improved from 108.7° preoperatively to 145.0° 1 year postoperatively. All of these improvements were maintained until the final follow-up. The re-tear rate was 40%. The shoulders were divided into two groups based on the presence of re-tear( Group N without re-tear, and Group R with re-tear). There was no statistically significant difference in the JOA score, Constant score, or active flexural ROM between the two groups. The average GFDI significantly worsened in all cases. A significant change in the GFDI was not detected in Group N, but the GFDI significantly worsened in Group R. The GFDI was significantly higher in Group R than in Group N at the final follow-up. A negative correlation was detected between the JOA score and GFDI and between the Constant score and GFDI. No significant change was detected in the PCSA in Group N. Although the PCSA tended to decrease in Group R, the change was not statistically significant. The PCSA was significantly lower in Group R than in Group N at all time points. No correlation was found between the JOA score and PCSA or between the Constant score and PCSA.
Conclusion
The long-term clinical outcomes more than 10 years after ARCR were good. The re-tear rate was 40%. The long-term clinical outcomes were not affected by re-tears. A negative correlation was detected between the clinical status and GFDI.