Outcomes and Tendon Integrity After Arthroscopic Treatment for Articular-Sided Partial-Thickness Tears of the Supraspinatus Tendon: Results at Minimum 2-Year Follow-Up

Matthias Brockmeyer; Alexander Haupert; Anna-Lena Lausch; Gudrun Wagenpfeil; Jonas Stroeder; Guenther Schneider; Dieter Kohn; Olaf Lorbach

doi:10.1177/2325967120985106

Outcomes and Tendon Integrity After Arthroscopic Treatment for Articular-Sided Partial-Thickness Tears of the Supraspinatus Tendon: Results at Minimum 2-Year Follow-Up

Orthop J Sports Med. 2021 Feb 26;9(2):2325967120985106. doi: 10.1177/2325967120985106. eCollection 2021 Feb.

Authors

Matthias Brockmeyer¹, Alexander Haupert¹, Anna-Lena Lausch¹, Gudrun Wagenpfeil², Jonas Stroeder³, Guenther Schneider³, Dieter Kohn¹, Olaf Lorbach⁴

Affiliations

¹ Department of Orthopaedics and Orthopaedic Surgery, Saarland University Medical Center, Homburg/Saar, Germany.
² Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg/Saar, Germany.
³ Department of Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany.
⁴ Department of Shoulder Surgery and Sports Traumatology, Schön Klinik Lorsch, Lorsch, Germany.

Abstract

Background: The best surgical treatment option for symptomatic moderate- to high-grade articular-sided partial-thickness rotator cuff tears (PTRCTs) is still controversial.

Purpose/hypothesis: The purpose of this study was to evaluate patient-reported and clinical outcomes and tendon integrity after arthroscopic debridement or repair for PTRCTs at a minimum of 2 years postoperatively. We hypothesized that the overall outcomes would be positive, showing pain relief, good shoulder function, and high tendon integrity.

Study design: Cohort study; Level of evidence, 3.

Methods: We evaluated 30 patients (16 men, 14 women; mean age, 51 years) who underwent arthroscopic treatment for symptomatic PTRCTs (Ellman grades 2 and 3). Debridement was performed in 15 patients, and arthroscopic tendon repair was performed in the remaining 15 patients. Patients completed the Constant score; American Shoulder and Elbow Surgeons (ASES) shoulder score; Western Ontario Rotator Cuff Index; Simple Shoulder Test; and visual analog scale (VAS) for pain, function, and satisfaction. In addition, patients were examined clinically (range of motion, impingement tests, rotator cuff tests, and tests for the long head of the biceps tendon), and morphologic assessment of rotator cuff integrity was performed using direct magnetic resonance arthrography and was classified according to Sugaya.

Results: The mean follow-up period was 55 months. The patient-reported outcome measures showed high patient satisfaction, reduction in persistent pain, and good shoulder function. Linear regression analysis showed that the debridement group had significantly better results on the Constant (bias-corrected and accelerated [BCa] 95% CI, 4.20-26.30), ASES (BCa 95% CI, 5.24-39.26), and VAS (pain: BCa 95% CI, 0.13-3.62; function: BCa 95% CI, 1.04-4.84; satisfaction: BCa 95% CI, 0.14-6.28) scores than did the repair group. At follow-up, there was no significant difference between the groups in clinical testing results. Good supraspinatus tendon integrity was seen in most patients: Sugaya classification grade 1 in 13 patients, grade 2 in 11 patients, and grade 3 in 6 patients.

Conclusion: Midterm results after arthroscopic debridement and repair for PTRCTs showed high patient satisfaction, good shoulder function, and high tendon integrity for both procedures. Patients who underwent arthroscopic debridement had higher Constant, ASES, and VAS scores compared with patients who underwent tendon repair.

Keywords: PASTA repair; PTRCT; debridement; direct MR arthrography; partial-thickness tear; rotator cuff.