Evaluation of Deltoid Origin Status Following Open and Arthroscopic Repair of Large Rotator Cuff Tears: A Propensity-Matched Case-Control Study

Abstract

Background:The purpose of this study was to evaluate and compare deltoid origin status following large rotator cuff repair carried out using either an open or an arthroscopic method with a propensity score matching technique. Methods: A retrospective review of 112 patients treated for full-thickness, large rotator cuff tear via either a classic open repair (open group) or an arthroscopic repair (arthroscopic group) was conducted. All patients included in the study had undergone postoperative magnetic resonance imaging (MRI) and clinical follow-up for at least 12 and 18 months after surgery, respectively. Propensity score matching was used to select controls matched for age, sex, body mass index, and affected site. There were 56 patients in each group, with a mean age of 63.3 years (range, 50-77 years). The postoperative functional and radiologic outcomes for both groups were compared. Radiologic evaluation for postoperative rotator cuff integrity and deltoid origin status was performed with 3-Tesla MRI. Results: The deltoid origin thickness was significantly greater in the arthroscopic group when measured at the anterior acromion (P=0.006), anterior third (P=0.005), and middle third of the lateral border of the acromion level (P=0.005). The deltoid origin thickness at the posterior third of the lateral acromion was not significantly different between the arthroscopic and open groups. The arthroscopic group had significantly higher intact deltoid integrity with less scarring (P=0.04). There were no full-thickness deltoid tears in either the open or arthroscopic group. Conclusions: Open rotator cuff repair resulted in a thinner deltoid origin, especially from the anterior acromion to the middle third of the lateral border of the acromion, at the 1-year postoperative MRI evaluation. Meticulous reattachment of the deltoid origin is as essential as rotator cuff repair when an open approach is selected.

Comparison of clinical outcomes and repair integrity after arthroscopic versus mini-open rotator cuff repair: An observational study

“…The biggest advantage of ART surgery is that the deltoid muscle is not damaged, which allows early rehabilitation. [24] Acromiohumeral distance (AHD) is a diagnostic and prognostic parameter associated with rotator cuff disease and is often evaluated in a 2-dimensional plane. Absence of a typical AHD (<6 mm) suggests a complete tear with excellent specificity; AHD can be assessed using MRI, conventional radiography, and Usg.…”

“…The biggest advantage of ART surgery is that the deltoid muscle is not damaged, which allows early rehabilitation. [24]…”

Improvement in scapular dyskinesis after rotator cuff repair and subacromial decompression

“…SD adversely affects shoulder function because it decreases the subacromial space and increases external impingement, decreases rotator cuff strength, increases strain on the anterior glenohumeral ligament and scapular stabilizing muscles, and increases the risk of internal impingement [4]. SD is reportedly associated with various shoulder pathologies such as impingement syndrome, shoulder instability, acromioclavicular joint injury, clavicle fracture, and labral tears [11,[25][26][27]36]. Warner et al [36] revealed that 64% of patients with shoulder instability and 100% with shoulder impingement syndrome had SD.…”

How to Decrease Suture Tangling When Performing Supraspinatus Repair With a Single–Working Portal Technique

“…A rthroscopic rotator cuff repair techniques yield fewer surgical wound complications, faster rehabilitation, and better visualization. 1,2 Arthroscopic rotator cuff repair can now be performed with the patient in the beach-chair or lateral decubitus position. Standard posterior and anterior portals are established.…”