Open Rotator Cuff Repair: The Gold Standard
Abstract & Commentary
Synopsis: Long-term follow-up confirms that open rotator cuff repairs are successful, and this should be the gold standard to compare arthroscopic cuff repair.
Source: Cofield RH. Surgical repair of chronic rotator cuff tears. A prospective long-term study. J Bone Joint Surg Am. 2001;83-A:71-77.
As arthroscopic rotator cuff repair becomes more popular, it is important to have a standard with which to compare results. This paper provides that standard. Cofield and colleagues report long-term (average, 13.4-year follow-up) results on 105 patients who underwent open rotator cuff repair and were followed prospectively. No patients in the cohort were lost to follow-up, although 16 died for unrelated causes during the study period. The majority of the repairs were tendon-to-bone and included an acromioplasty in all patients and distal clavicle resection in just more than half of the patients. There were 16 small tears, 40 medium tears, 38 large tears, and 11 massive tears. Cofield et al report satisfactory pain relief in 96 shoulders, and significant improvement in motion and strength. Not surprisingly, less successful results were reported with larger tears. Cofield et al report an 80% excellent or satisfactory outcome at an average of more than 13 years after open rotator cuff surgery.
Comment by Mark D. Miller, MD
Although initial reports of arthroscopic rotator cuff repairs are encouraging, it is important to recognize how high of a standard this paper presents. Note that this is a prospective, long-term study with a preponderance of large chronic tears. Many of the repairs that are done arthroscopically are self-selected to be smaller, more acute tears in younger patients. Note also that the early reports of arthroscopic cuff repairs are short-term, retrospective studies. My personal concern with arthroscopic repairs are based upon the fact that good grasping sutures in the cuff (such as with the modified Mason-Allen stitch) are simply not possible with arthroscopically placed sutures and arthroscopic knot tying. Newer devices that use tacks or other anchoring devices in lieu of suture anchors introduce another possibility for arthroscopic cuff repair that presents additional advantages and disadvantages that need to be thoroughly investigated before they can be recommended. Unfortunately, as in other areas of sports medicine, technical "advances" outpace our ability to adequately test these devices and techniques. However, as this paper clearly points out, it is important to be well versed in classic procedures that have a proven track record before discarding all of the ten-blades in your surgicenter!
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