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The Arthroscopic Partial Repair for Massive Rotator Cuff Tears
Effect of Preoperative Rehabilitation on Postoperative Outcomes in Patients Undergoing Surgery for Anterior Cruciate Ligament (ACL) Reconstruction
Introduction
– The paper is a systematic review evaluating the clinical outcomes and methodological quality of studies on arthroscopic partial repair for massive rotator cuff tears.
– Massive rotator cuff tears are challenging to treat surgically. While complete anatomical repair is ideal, it is not always possible. In such cases, partial repair may be performed to improve pain and function.
– Massive rotator cuff tears are challenging to treat surgically. While complete anatomical repair is ideal, it is not always possible. In such cases, partial repair may be performed to improve pain and function.
Methods
– PRISMA guidelines were followed for the systematic search.
– Studies with minimum 12 months follow-up and reporting clinical outcomes were included.
– Methodological quality was assessed using the modified Coleman methodology score.
– Studies with minimum 12 months follow-up and reporting clinical outcomes were included.
– Methodological quality was assessed using the modified Coleman methodology score.
Results
– 11 studies with 643 patients were included. Mean age was 63-68 years and mean follow-up was 16-93 months.
– All studies reported significant improvement in clinical scores and range of motion postoperatively.
– The re-tear rate ranged from 41-49% based on postoperative imaging.
– The reoperation rate was 2.9%. The most common reason was glenohumeral arthritis.
– The mean Coleman score was 58/100 indicating overall low to moderate quality of studies.
– All studies had high risk of performance bias and most had risk of selection or detection bias.
– All studies reported significant improvement in clinical scores and range of motion postoperatively.
– The re-tear rate ranged from 41-49% based on postoperative imaging.
– The reoperation rate was 2.9%. The most common reason was glenohumeral arthritis.
– The mean Coleman score was 58/100 indicating overall low to moderate quality of studies.
– All studies had high risk of performance bias and most had risk of selection or detection bias.
Discussion
– The review concluded that arthroscopic partial repair may be a safe and effective option when complete repair is not possible. However, high re-tear rates are concerning.
– Clinical improvements were seen despite high failure rates, suggesting that debridement and decompression may contribute more to outcomes than cuff integrity.
– Only one RCT was included; most evidence was level III/IV. Longer term studies are needed to evaluate progression of osteoarthritis.
– A 2015 RCT comparing partial repair, complete repair and debridement for massive tears found no difference in Constant scores between partial and complete repair groups at 2 years follow-up.
– A 2018 meta-analysis showed partial repairs have higher re-tear rates but similar improvements in pain and function compared to complete repair.
– Clinical improvements were seen despite high failure rates, suggesting that debridement and decompression may contribute more to outcomes than cuff integrity.
– Only one RCT was included; most evidence was level III/IV. Longer term studies are needed to evaluate progression of osteoarthritis.
– A 2015 RCT comparing partial repair, complete repair and debridement for massive tears found no difference in Constant scores between partial and complete repair groups at 2 years follow-up.
– A 2018 meta-analysis showed partial repairs have higher re-tear rates but similar improvements in pain and function compared to complete repair.
Conclusion
– Arthroscopic partial repair may provide short-term improvement in pain and function for irreparable massive cuff tears when complete repair is not possible.
– However, high re-tear rates suggest repair integrity is limited. Higher quality studies with long-term follow-up are required to determine outcomes and impact on glenohumeral arthritis progression.
– However, high re-tear rates suggest repair integrity is limited. Higher quality studies with long-term follow-up are required to determine outcomes and impact on glenohumeral arthritis progression.
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