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Arthroscopy. 2018 Jul;34(7):2063-2073. doi: 10.1016/j.arthro.2018.02.013. Epub 2018 May 2.

Arthroscopic Incomplete Repair Using a "Hybrid Technique" for Large to Massive Rotator Cuff Tears: Clinical Results and Structural Integrity.

Author information

1
Department of Radiology, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea.
2
Division of Sports Medicine, Department of Physical Medicine and Rehabilitation, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea.
3
Department of Orthopedic Surgery, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea.
4
Department of Orthopedic Surgery, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea. Electronic address: shoulderyoo@gmail.com.

Abstract

PURPOSE:

The first aim of this study was to introduce the concept of hybrid repair (incomplete repair) for large to massive rotator cuff tears and to report clinical results and structural integrity of patients with a minimum 2-year follow-up. The second aim was to compare arthroscopic hybrid repair with partial repair for large to massive rotator cuff tears.

METHODS:

We retrospectively evaluated 65 patients who underwent arthroscopic incomplete (hybrid) repair (45 patients) or partial repair (20 patients) for large to massive cuff tears from March 2011 to January 2015. The pain visual analog scale, function visual analog scale, American Shoulder and Elbow Surgeons, and Constant scores and range of motion (ROM) (active flexion, elevation, abduction, external rotation, and internal rotation) were assessed preoperatively, at first follow-up (approximately 6 months postoperatively), at second follow-up (1 year postoperatively), and at final follow-up (2 years postoperatively). The healing status of the repaired tendon was evaluated with postoperative magnetic resonance imaging, with a focus on tendon integrity.

RESULTS:

Comparisons of the preoperative values and final follow-up results of hybrid repair showed significant improvement in the mean pain visual analog scale score (5.56 and 0.93, respectively), mean function visual analog scale score (4.77 and 8.59, respectively), and questionnaire results (American Shoulder and Elbow Surgeons score, 44.89 and 84.67, respectively; Constant score, 44.27 and 73.46, respectively) (all P ≤ .001). Most shoulder ROM measures showed some improvement compared with presurgical ROM at last follow-up (≥2 years). However, there was no statistical significance. Retears occurred in 9 patients (20%) in the hybrid-repair group. Most of the postoperative clinical outcomes showed excellent results with hybrid repair compared with partial repair.

CONCLUSIONS:

Arthroscopic incomplete repair (hybrid technique) showed more satisfactory clinical trial outcomes than partial repair of large to massive rotator cuff tears. Therefore, we propose the use of incomplete repair, which provides improvements in both pain and functional outcomes, as another repair option for large to massive rotator cuff tears.

LEVEL OF EVIDENCE:

Level III, retrospective comparative study.

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