Arthroscopic versus mini-open rotator cuff repair: A comparison of clinical outcomes and patient satisfaction

Youm, Thomas; Murray, Doug H.; Kubiak, Erik N.; Rokito, Andrew S.; Zuckerman, Joseph D.

doi:10.1016/j.jse.2005.02.002

Cited by 116 publications

(76 citation statements)

References 12 publications

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“…There is conflicting evidence regarding the effectiveness of open and arthroscopic repair. 12,[45][46][47] Proponents of arthroscopic rotator cuff surgery suggest that the procedure may have advantages over standard open techniques by causing less trauma to the deltoid muscle and overlying soft tissue. Arguably, this causes less postoperative patient discomfort together with earlier return of movement.…”

Section: Rationale For the Study Designmentioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of open and arthroscopic rotator cuff repair [the UK Rotator Cuff Surgery (UKUFF) randomised trial]

Carr

Cooper

Campbell

et al. 2015

Health Technol Assess

111

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BackgroundUncertainty exists regarding the best management of patients with degenerative tears of the rotator cuff.ObjectiveTo evaluate the clinical effectiveness and cost-effectiveness of arthroscopic and open rotator cuff repair in patients aged ≥ 50 years with degenerative rotator cuff tendon tears.DesignTwo parallel-group randomised controlled trial.SettingNineteen teaching and district general hospitals in the UK.ParticipantsPatients (n = 273) aged ≥ 50 years with degenerative rotator cuff tendon tears.InterventionsArthroscopic surgery and open rotator cuff repair, with surgeons using their usual and preferred method of arthroscopic or open repair. Follow-up was by telephone questionnaire at 2 and 8 weeks after surgery and by postal questionnaire at 8, 12 and 24 months after randomisation.Main outcome measuresThe Oxford Shoulder Score (OSS) at 24 months was the primary outcome measure. Magnetic resonance imaging evaluation of the shoulder was made at 12 months after surgery to assess the integrity of the repair.ResultsThe mean OSS improved from 26.3 [standard deviation (SD) 8.2] at baseline to 41.7 (SD 7.9) at 24 months for arthroscopic surgery and from 25.0 (SD 8.0) at baseline to 41.5 (SD 7.9) at 24 months for open surgery. When effect sizes are shown for the intervention, a negative sign indicates that an open procedure is favoured. For the intention-to-treat analysis, there was no statistical difference between the groups, the difference in OSS score at 24 months was –0.76 [95% confidence interval (CI) –2.75 to 1.22;p = 0.452] and the CI excluded the predetermined clinically important difference in the OSS of 3 points. There was also no statistical difference when the groups were compared per protocol (difference in OSS score –0.46, 95% CI –5.30 to 4.39;p = 0.854). The questionnaire response rate was > 86%. At 8 months, 77% of participants reported that shoulder problems were much or slightly better, and at 24 months this increased to 85%. There were no significant differences in mean cost between the arthroscopic group and the open repair group for any of the component resource-use categories, nor for the total follow-up costs at 24 months. The overall treatment cost at 2 years was £2567 (SD £176) for arthroscopic surgery and £2699 (SD £149) for open surgery, according to intention-to-treat analysis. For the per-protocol analysis there was a significant difference in total initial procedure-related costs between the arthroscopic group and the open repair group, with arthroscopic repair being more costly by £371 (95% CI £135 to £607). Total quality-adjusted life-years accrued at 24 months averaged 1.34 (SD 0.05) in the arthroscopic repair group and 1.35 (SD 0.05) in the open repair group, a non-significant difference of 0.01 (95% CI –0.11 to 0.10). The rate of re-tear was not significantly different across the randomised groups (46.4% and 38.6% for arthroscopic and open surgery, respectively). The participants with tears that were impossible to repair had the lowest OSSs, the participants with re-tears had slightly higher OSSs and the participants with healed repairs had the most improved OSSs. These findings were the same when analysed per protocol.ConclusionIn patients aged > 50 years with a degenerative rotator cuff tear there is no difference in clinical effectiveness or cost-effectiveness between open repair and arthroscopic repair at 2 years for the primary outcome (OSS) and all other prespecified secondary outcomes. Future work should explore new methods to improve tendon healing and reduce the high rate of re-tears observed in this trial.Trial registrationCurrent Controlled Trials ISRCTN97804283.FundingThis project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 19, No. 80. See the NIHR Journals Library website for further project information.

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Section: Rationale For the Study Designmentioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of open and arthroscopic rotator cuff repair [the UK Rotator Cuff Surgery (UKUFF) randomised trial]

Carr

Cooper

Campbell

et al. 2015

Health Technol Assess

111

View full text Add to dashboard Cite

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“…Arthroscopic shoulder surgery became popular in the 1980s and, like many new techniques, was initially looked upon somewhat skeptically [46]. Debates continued throughout the 1990s, comparing open versus arthroscopic rotator cuff repair [9,28,30,48,49,59,62]. The millennium ushered in a new brand of surgeons who, during their residencies, made the transition to arthroscopic shoulder surgery [10,19,38,42].…”

Section: Introductionmentioning

confidence: 99%

“…The millennium ushered in a new brand of surgeons who, during their residencies, made the transition to arthroscopic shoulder surgery [10,19,38,42]. Arthroscopic surgery reportedly provides similar functional scores, pain relief, clinical tests of motion and strength, and patient satisfaction to open rotator cuff repair [28,30,38,42,44,49,55,59,62]. Two recent reviews of the arthroscopic and mini-open rotator cuff repair literature reported that both techniques resulted in similar UCLA scores, mean ASES scores, patient satisfaction ratings, complications, active elevation, and active external rotation [38,42].…”

Section: Introductionmentioning

confidence: 99%

Indications for Reverse Total Shoulder Arthroplasty in Rotator Cuff Disease

Drake¹,

O’Connor

Edwards

2010

Clinical Orthopaedics &Amp; Related Research

220

129

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Background Reverse total shoulder arthroplasty (RTSA) was introduced to treat rotator cuff tear arthropathy but is now used to treat a variety of problems. Although its use has expanded substantially since the FDA's approval in 2004, the appropriateness in patients with rotator cuff disease is unclear. Questions/purposes We review the use of RTSA in patients with rotator cuff disease to (1) describe classification of rotator cuff tear reparability and the concept of a balanced shoulder; (2) explore the theory behind RTSA design relative to rotator cuff arthropathy; (3) discuss the indications and contraindications for RTSA; and (4) review published outcomes of RTSA for rotator cuff arthropathy.Methods We performed a selective review of the literature on the use of RTSA in the treatment of rotator cuff disease.Results Modern RTSA designs restore deltoid tension and a functional fulcrum to the rotator cuff deficient shoulder, which allows recovery of active shoulder elevation and effectively restores function in short-and mediumterm followup studies. Conclusions In short-term followup the RTSA relieves symptoms and restores function for patients with cuff tear arthropathy and irreparable rotator cuff tears with pseudoparalysis (preserved deltoid contraction but loss of active elevation). Severely impaired deltoid function, an isolated supraspinatus tear, and the presence of full active shoulder elevation with a massive rotator cuff tear and arthritis are contraindications to RTSA. Clinical Relevance For properly selected patients who have symptomatic and disabling rotator cuff deficiency, RTSA can result in life-changing improvements in pain, motion, function, and patient satisfaction. Level of Evidence Level V therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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“…With the evolution of all-arthroscopic (ASC) techniques there is a strong tendency to perform this procedure arthroscopically [7]. Possible advantages of the ASC technique include less trauma to the deltoid, less risk of axillary nerve palsy and better cosmetic results [5,[8][9][10][11][12]. This technique has to be evaluated in comparison to established and successful open techniques [8,9] Recent mainly retrospective comparative studies of RCR have demonstrated a similar outcome of ASC compared to MO refixation of RCR.…”

Section: Introductionmentioning

confidence: 99%

Prospective randomised comparison of arthroscopic versus mini-open rotator cuff repair of the supraspinatus tendon

Kasten

Keil

Grieser

et al. 2011

International Orthopaedics (SICOT)

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Purpose The aim of the study was to evaluate whether arthroscopic (ASC) repair of rotator cuff ruptures causes less postoperative pain and better range of motion (ROM) in the early postoperative period than a mini-open (MO) technique. Methods Inclusion criteria were a rupture of the supraspinatus tendon with retraction with a maximum to the apex of the humeral head and minor fatty degeneration and atrophy of the muscle. Each group (n=17) had similar demographics and preoperative magnetic resonance imaging (MRI) findings (mean age 60.1 years, SD 8.8, range 43-71). The ASC group underwent double-row repair with resorbable anchors; the MO group received a transosseous repair. The postoperative rehabilitation was standardised and equivalent in both groups. Results In the first week fewer nonsteroidal anti-inflammatory drug (NSAID) tablets were needed in the ASC group. Pain scores on the visual analogue scale were similar in the first three weeks; however, from week four to eight the MO group had less pain (p<0.05). After six months, the ConstantMurley score and the ROM improved significantly (p<0.05) in both groups without differences between the groups. Postoperative MRI revealed in three of 16 patients a discontinuity of the tendon in both groups; in the ASC group there were more patients (n=9) with a thinning of the tendon compared to the MO group (n=6). Conclusions There was less use of NSAIDs in the first postoperative week in the ASC group, indirectly indicating less pain, but higher pain scores in the later course (weeks four to eight) compared to the MO group. ROM, MRI findings and the scores were similar after six months, demonstrating that both techniques are equivalent regarding the outcome in this period.

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Arthroscopic versus mini-open rotator cuff repair: A comparison of clinical outcomes and patient satisfaction

Cited by 116 publications

References 12 publications

Clinical effectiveness and cost-effectiveness of open and arthroscopic rotator cuff repair [the UK Rotator Cuff Surgery (UKUFF) randomised trial]

Clinical effectiveness and cost-effectiveness of open and arthroscopic rotator cuff repair [the UK Rotator Cuff Surgery (UKUFF) randomised trial]

Indications for Reverse Total Shoulder Arthroplasty in Rotator Cuff Disease

Prospective randomised comparison of arthroscopic versus mini-open rotator cuff repair of the supraspinatus tendon

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