Arthroscopic repair of anterosuperior rotator cuff tears: in-continuity technique vs. disruption of subscapularis-supraspinatus tear margin: comparison of clinical outcomes and structural integrity between the two techniques.J Bone Joint Surg Am. 2014 Dec 17; 96(24):2056-61.JB
The purpose of this study was to compare the clinical outcomes and structural integrity after two techniques of arthroscopic anterosuperior rotator cuff repair: in continuity and disruption of the tear margin.
This study included fifty-nine patients who underwent arthroscopic repair of an anterosuperior rotator cuff tear that was done either by disrupting the margin between the subscapularis and supraspinatus tears (Group A) or by performing the repair in continuity without disrupting the margin (Group B). Clinical outcomes were assessed on the basis of a visual analog scale (VAS) pain score, subjective shoulder value (SSV), American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) shoulder score, and active range of motion of the shoulder. Subscapularis strength was assessed with use of the modified belly-press test. Magnetic resonance arthrography (MRA) or computed tomographic arthrography (CTA) was performed at six months after surgery to assess the structural integrity of the repair.
At the two-year follow-up evaluation, VAS pain scores, SSVs, ASES scores, UCLA shoulder scores, subscapularis strength, and active range of motion improved significantly in both groups compared with preoperatively (p < 0.001). There were no significant differences between groups for any of these follow-up measurements. On follow-up MRA or CTA, the overall retear rate did not differ significantly different between Group A (22%; five of twenty-three) and Group B (19%; six of thirty-two).
In conclusion, in patients treated with arthroscopic repair of anterosuperior full-thickness subscapularis and supraspinatus tears of the rotator cuff, the technique of in-continuity repair did not produce better clinical outcomes or structural integrity than the technique involving disruption of the tear margin. If the muscle in an anterosuperior rotator cuff tear is of good quality, it does not appear to matter whether the tear margin between the subscapularis and supraspinatus is preserved or disrupted.