Functional and Radiographic Outcomes After Arthroscopic Transosseous Suture Repair of Medium Sized Rotator Cuff Tears.

ABSTRACT

PURPOSE: To evaluate the functional and anatomical outcomes after arthroscopic transosseous suture (TOS) repair of 2 to 4 cm sized rotator cuff tears and to identify preoperative factors influencing repair failure. METHODS: From May 2013 to August 2014, patients with symptomatic 2 to 4 cm full-thickness tears underwent arthroscopic TOS repair, and those who could be followed up for a minimum of 2 years were included in this retrospective study. Functional and anatomical outcomes were analyzed up to 2 years postoperatively. Factors affecting cuff repair failure were evaluated, using both univariate and multivariate analyses. RESULTS: Twenty-seven patients were included. On preoperative magnetic resonance imaging data, the mean anteroposterior dimension tear size was 27.0 ± 3.3 mm and mean retraction was 30.7 ± 3.1 mm. Anatomic failure (Sugaya III, IV, and V) rate was 33% with arthroscopic TOS repair; however, significant improvements were found regardless of cuff healing. Mean American Shoulder and Elbow Surgeons score (range, 0-100) improved from 48.8 ± 16.6 preoperatively to 80.1 ± 11.1 postoperatively (P < .001), mean Constant score (range, 0-100) improved from 54.5 ± 11.8 to 73.7 ± 8.5 (P < .001), and mean pain visual analog scale score (range, 0-10) improved from 3.9 ± 1.7 to 2.0 ± 1.1 (P < .001). These changes reached each minimal clinically important difference previously reported. Greater tear size in anteroposterior dimension (P = .034), decreased acromiohumeral distance (P = .022), and higher fatty infiltration of supraspinatus (P = .011) were independent preoperative factors associated with repair failure. Twelve patients (44%) experienced intraoperative bone laceration. CONCLUSIONS: Arthroscopic TOS repair was a reliable technique for patients with 2 to 4 cm size rotator cuff tear. Preoperative factors associated with cuff repair failure were greater tear size in anteroposterior dimension, decreased acromiohumeral distance, and higher fatty infiltration of supraspinatus. LEVEL OF EVIDENCE Level III, retrospective comparative study.