Clinical and Radiologic Outcomes of Arthroscopic Rotator Cuff Repair in Medial Bursal-Side Fosbury Flop Tears Compared With Tendinous Avulsion Lesions

Sean W L Ho; Tiago Martinho; Arash Amiri; Jeanni Zbinden; Xue Ling Chong; Hugo Bothorel; Philippe Collin; Alexandre Lädermann

doi:10.1016/j.asmr.2023.100879

Clinical and Radiologic Outcomes of Arthroscopic Rotator Cuff Repair in Medial Bursal-Side Fosbury Flop Tears Compared With Tendinous Avulsion Lesions

Arthrosc Sports Med Rehabil. 2024 Feb 9;6(2):100879. doi: 10.1016/j.asmr.2023.100879. eCollection 2024 Apr.

Authors

Sean W L Ho¹, Tiago Martinho², Arash Amiri², Jeanni Zbinden², Xue Ling Chong³, Hugo Bothorel⁴, Philippe Collin⁵, Alexandre Lädermann^{6

7}

Affiliations

¹ Department of Orthopedic Surgery, Tan Tock Seng Hospital, Singapore.
² Division of Orthopaedics and Trauma Surgery, Hôpital de La Tour, Meyrin, Switzerland.
³ Royal Square Medical Centre, Singapore.
⁴ Research Department, Hôpital de La Tour, Meyrin, Switzerland.
⁵ American Hospital of Paris, Neuilly-sur-Seine, France.
⁶ Faculty of Medicine, University of Geneva, Geneva, Switzerland.
⁷ Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.

Abstract

Purpose: To determine the clinical and radiologic outcomes after surgical repair of medial bursal-side Fosbury flop rotator cuff tears compared with traditional avulsion of tendinous attachments lesions.

Methods: A retrospective cohort study was performed. All patients who had undergone arthroscopic posterosuperior repair were recruited. Patients with previous shoulder rotator cuff surgery were excluded. Recruited patients were divided into 2 groups: one presenting Fosbury flop tears and the other presenting with standard avulsion lesions. Preoperative demographics such as age, gender, and arm dominance were recorded. Range of motion (ROM), visual analog scale (VAS) for pain and satisfaction, Constant score, Single Alpha-Numeric Evaluation score, and American Shoulder and Elbow Surgeons score were evaluated at 3 points in time: preoperatively, and at 6 months and minimum 1-year postoperatively. The healing of repaired cuffs was evaluated by ultrasound at 6 months.

Results: Two hundred thirty-six patients were recruited, with 27 (11.4%) Fosbury flop tears and 209 (88.6%) tendon avulsions. Although there was no significant difference in gender or arm dominance between the groups, Fosbury flop tears had significantly older patients (P < .05) with a mean age 61.6 years (standard deviation 9.0), compared with tendon avulsions with a mean age of 56.1 years (standard deviation 9.1). There was no significant difference in tendon retraction between the groups. Both groups demonstrated significant improvement in ROM, visual analog scale, American Shoulder and Elbow Surgeons, Single Alpha-Numeric Evaluation, and Constant score postoperatively at 6 months and minimum 1 year. The groups demonstrated no significant difference in the ROM and clinical scores. There was a nonsignificant difference in re-tear rate of 7.4% (2/27) in Fosbury flop tears compared with 2.8% (6/209) in tendon avulsions (P = .361).

Conclusions: Arthroscopic rotator cuff repair of medial bursal side Fosbury Flop rotator cuff tears results in favorable clinical and radiologic outcomes at 4 years after surgery. These outcomes are comparable with surgically repaired avulsion lesions, with an acceptable retear rate after arthroscopic repair.

Level of evidence: Level III, retrospective comparative prognostic trial.