ARTHROSCOPIC ROTATOR CUFF REPAIR Disclosures LEADS TO LESS POSTOPERATIVE FATTY INFILTRATION THAN OPEN REPAIR John Costouros, MD: Consultant: Zimmer, Arthrex, Tornier, Depuy-Mitek, Shoulder • Options, Inc. Royalties: Arthrex, Tornier, Shoulder Options, Inc. • BOD: Northern California Orthopaedic Society, Leroy C. • Abbott Orthopaedic Society Christian Gerber, MD: John Costouros MD, Consultant/Royalties: Zimmer • Garet Comer MD, and Christian Gerber MD Other authors: None Department of Orthopaedic Surgery Stanford University School of Medicine Rotator Cuff Tears Rotator Cuff Tears in the United States Can be associated with significant pain and Account for $3 to $5 billion • • disability per year in medical costs and decreased productivity Rotator cuff repair has been demonstrated to • Rotator cuff tears affect improve pain and function • 50% the population aged older than 60. Significant impact on • overall function, comfort, general health, and quality of life of our population 1892 1934 E.A. Codman, 1909 Bey and Derwin, JSES 21:147, 2012 Page 1
Evolution of Rotator Cuff Repair Advances in Technique • Improved suturing techniques – Suture pattern – Knot types – Marginal convergence – Double row fixation • Improved anchor design • Improved anchor placement site • Biologics? The Weak Link: Open vs. Arthroscopic RCR Muscle and Tendon Quality • Comparable success • Correlation rates: between fatty – Pain infiltration of the – Function RTC and: – Patient satisfaction – Functional and • Integrity of the repair: clinical outcome – Elevation – Risk of structural – Strength failure following Baker and Liu, AmJSM 23: 99-104, 1995. Severud et al., Arthroscopy 19:234-38, 2003. RCR Sauerbrey et al., Arthroscopy 21:1415-20, 2005. Flurin et al., Rev Chir Orthop 91:31-42, 2005. Warner et al., Arthroscopy 21:328-32, 2005. Fuchs et al., JBJS Am 88:309-16, 2006. Page 2
Fatty Infiltration and RCT • Irreversible consequence of tendon tearing • Fiber shortening & increase in pennation angle • Suprascapular nerve compression Meyer et al., JOR 22:1004-1007, 2004. Objective Methods • Retrospective review • To compare fatty infiltration and • 37 consecutive patients with isolated, outcomes in patients with isolated, full- surgically treated, full-thickness SST thickness tears of the supraspinatus: without retear on postop MRI – Open RCR • Postoperative Assessment: – Arthroscopic RCR – Clinical (Constant score, SSV) • Structurally intact repairs only – Radiographic (Fatty Infiltration) – Postop MRI at minimum 1yr postop Goutallier et al., CORR 304:78-93, 1994 Fuchs et al., JSES 8:599-605, 1999. Page 3
Clinical Results Study Cohort 160 Group 1 (Open): Group 2 (Arthro): • N=19 (14 ♂ ♂ ♂ ♂ , 5 ♀ ♀ ) ♀ ♀ • N=18 (12 ♂ ♂ , 6 ♀ ♂ ♂ ♀ ♀ ) ♀ 140 120 Percent/Degrees 100 • Mean age 57 (40-75) • Mean age 54 (34-65) 80 • F/u 24 mos (12-48) • F/u 18 mos (12-42) 60 40 20 0 CS CS% SSV FE ABD Clinical Results Radiographic Results 14 1.4 Mean Fatty Infiltration 12 1.2 10 1 8 0.8 6 0.6 4 0.4 0.2 2 0 0 FI SSP FI ISP Fi SSC Pain Strength Page 4
THANK YOU Conclusions • Isolated full-thickness supraspinatus tears can be treated equally well with either open or arthroscopic surgery. • Open repair is associated with an increased risk of progression of FI of the supraspinatus. • Repair of the supraspinatus is associated with progression of FI in the infraspinatus using either method. Page 5
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