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Abstract
In this thesis, we test 3 hypotheses: 1. To evaluate how open and arthroscopic rotator cuff repairs may affect clinical outcomes and cuff integrity post repairs. 2. To introduce a new arthroscopic rotator cuff technique - undersurface repair and to evaluate its effect on operative time, clinical outcomes and cuff integrity. 3. To determine which intraoperative factor(s) predict an intact repair 6 months after arthroscopic rotator cuff repair.
Methods
All 3 studies were retrospective, cohort controlled studies. Standardized clinical outcomes were obtained preoperatively and at 6 weeks, 3 and 6 months, (and 2 years) postoperatively. Ultrasound evaluations of the cuff integrity were performed at 6 months (and 2 years) postsurgery. To test the first hypothesis, we compared three cohorts of patients: (1) open technique (n = 49); (2) arthroscopic knotted (n = 53); or (3) arthroscopic knotless (n = 57). To test the second hypothesis, we first described the new undersurface arthroscopic repair technique. We then compared the two groups of patients who had bursal side repair (n = 60) and undersurface repair (n = 50) respectively. To test our last hypothesis, we analysed a cohort of 500 consecutive patients who had an arthroscopic rotator cuff repair. Rotator cuff tear size, the quality of the tendon, tendon mobility and repair quality were assessed.
Results
Clinical outcomes were similar between open and arthroscopic rotator cuff repairs with the exception that the arthroscopic groups had, on average, 20% better ASES scores than the open group at 6 months and 2 years. Retear occurred more frequently after open repair (39%) than after arthroscopic knotted (25%) and arthroscopic knotless (16%) repair. The average operative time for the bursal repair group was 48 minutes and for the new undersurface repair was 16 minutes (P<0.001). Patients in the undersurface group showed earlier reduction in the frequency of pain during activity and less difficulty with reaching behind the back at 6 months (30% less difficult, P = 0.011). Ultrasonographic retear rate at 6 months was similar. The best predictor of rotator cuff integrity was preoperative tear size (correlation coefficient, r = 0.33; P<0.001). Patients with small (<2 cm2) rotator cuff tears were least likely to have retears (retear rate, 10%). As the tear size increased, the retear rate increased in a linear fashion. Other surgeon-ranked intraoperative assessments only had weak correlation with retears.