ARTHROSCOPIC-ASSISTED ROTATOR CUFF REPAIR - PATIENT SELECTION AND TREATMENT OUTCOME

Over a 4-year period 24 patients out of 376 who required a rotator cuf f repair were selected for arthroscopic-assisted rotator cuff repair. Preoperative selection criteria were refractory pain in the setting of good range of motion and strength (after an impingement test), absenc e of radiographic superior humeral head translation, and magnetic reso nance imaging evidence of minimally retracted tear without rotator cuf f muscle atrophy. Intraoperative selection criteria were the findings of an avulsion-type tear configuration with good tendon quality and ab sence of subscapularis tendon involvement. Based on these intraoperati ve criteria, 7 of the 24 patients were converted to an open approach t o mobilize retracted and friable tendon tissue in a complex tear confi guration. The remaining 17 patients underwent a transosseous arthrosco pic-assisted rotator cuff repair with an average postoperative follow- up of 23 months. Evaluation by an independent therapist determined the postoperative American Shoulder and Elbow Surgeons Shoulder Function Index of 96 +/- 3 for the operative shoulder. The Functional Rating Sc ores For Activities of Daily living and Sports Activity Score were 89% +/- 10% and 87% +/- 12%, respectively. instrumented isometric strengt h for abduction and external rotation strength in the operated shoulde r were 94% +/- 20% and 93% +/- 20%, respectively, compared with the co ntralateral unoperated side. Five of eight patients who performed over head sports returned to a premorbid level of performance, and 14 of 15 patients available for Follow-vp believed that their result was excel lent. We conclude that through careful selection one can identify pati ents optimally suited for arthroscopic-assisted rotator cuff repair, b ut some may have to be converted to an open end approach because of th e quality of the tendon tissue and configuration of the tear requiring soft tissue releases.