Arthroscopic rotator cuff repair: a multicentric retrospective study of 87cases with anatomical assessment

Purpose of the study The aim of this study was to evaluate the anatomical and technical limits o f endoscopic rotator cuff repair. Anatomical results were also compared wit h functional assessment of the shoulder. Material and methods A multicentric serie of 87 patients presenting a full thickness rotator cuf f tear repaired endoscopically was retrospectively reviewed at 25.4 months (mean) post surgery. Limits of the surgical technique were studied in corre lation with functional results and anatomic radiographic evaluation (arthro scans in 93 p. 100). Results Anatomical repair (normal thickness and no contrast in the subacromial spac e on arthroscan) was achieved in 83 p. 100 of the rotator cuffs with limite d damage to the frontal part of the supra spinatus tendon, This percentage fell to 57.8 p. 100 in case of posterior extension of the tear to the supra spinatus tendon and further dropped to 40.8 p. 100 in case of retraction t o the apex of the humeral head. Functional outcome evaluated with the Const ant score was strongly related to the radiographic cuff condition (p < 0.05 ). For distal and anterior tears of the supra spinatus tendon, the Constant score at revision was 89.8 points in cases with anatomic repair at revisio n. This score fell to 75 when the rotator cuff tear was evidenced radiograp hically (p < 0.0001). For tears involving the entire supra spinatus tendon repaired by arthroscopy, the functional difference at revision was 8 points on the Constant scale. Objective and subjective analysts of the surgical p rocedure identified significant peroperative elements predictive of clinica l and anatomical outcome (difficult reduction, p < 0.05; subjective degree of solidity, p < 0.0001; anatomical aspect of the repaired cuff, p < 0.05). Discussion A comparison of our findings with data on equivalent lesions reported in th e literature suggests that endoscopic surgery for rotator cuff tears offers both functional and anatomic results equivalent to those achieved with con ventional open surgery. This assumes that the surgical procedure is carried out by surgeons experienced in shoulder arthroscopy who can precisely gaug e the posterior/anterior extension of the tears and the limits of the surgi cal technique.