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Open Rotator Cuff Repair without Acromioplasty
Wren V. McCallister, MD1; I. Moby Parsons, MD2; Robert M. Titelman, MD3; Frederick A. MatsenIII, MD1
1 Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 N.E. Pacific Street, Box 356500, Seattle, WA 98195. E-mail address for F.A. Matsen III: matsen@u.washington.edu
2 Seacoast Orthopaedics and Sports Medicine, 237 Route 108, Suite 205, Somersworth, NH 03878
3 Resurgens Orthopaedics, 1285 Hembree Road, Suite 200-A, Roswell, GA 30076
View Disclosures and Other Information
Investigation performed at the Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, Washington

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Jun 01;87(6):1278-1283. doi: 10.2106/JBJS.D.02432
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Background: In most clinical reports on rotator cuff repair, acromioplasty was done as part of the procedure. In this prospective study, we evaluated the hypothesis that rotator cuff repair without acromioplasty would result in a substantial improvement in shoulder comfort and function.

Methods: Ninety-six consecutive primary repairs of full-thickness tears of the rotator cuff were performed through a deltoid-muscle-splitting incision that preserved the integrity of the coracoacromial arch and the deltoid insertion. All patients were invited to participate in a prospective study involving periodic self-assessment of shoulder function with the Simple Shoulder Test and general health status with the Short Form-36 (SF-36) questionnaire, both of which are validated instruments. Sixty-one patients provided follow-up information for at least two years postoperatively, and the average duration of follow-up was five years. Thirty-four of the tears involved the supraspinatus tendon alone; sixteen involved the supraspinatus and infraspinatus tendons; and eleven involved the supraspinatus, infraspinatus, and subscapularis tendons.

Results: The percentage of shoulders that could be used to perform each of the twelve functions on the Simple Shoulder Test was significantly increased postoperatively (p < 0.002). Men and women had different degrees of function preoperatively (p < 0.00000001) and postoperatively (p < 0.001), but the improvement in function was essentially identical for the two genders. The mean improvement in the number of shoulder tests that could be performed was best for the patients with one-tendon tears (4.9 tests), next best for those with two-tendon tears (3.6 tests), and worst for those with three-tendon tears (3.3 tests). SF-36 scores for physical role (p < 0.003) and comfort (p < 0.0001) were significantly improved postoperatively.

Conclusions: Significant improvement in self-assessed shoulder comfort and in each of the twelve shoulder functions was observed after rotator cuff repairs performed without acromioplasty. The technique that we used is very similar to that described by Codman almost seventy years ago.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Frederick A. Matsen, MD
    Posted on October 08, 2008
    An Apology and Clarification by Dr. Matsen
    University of Washington, Seattle, WA

    EDITOR'S NOTE: It has come to the attention of the Editorial Office that there was a substantial amount of redundancy and duplication in an article published in this Journal in 2005 and an article published in

    Clinical Orthopaedics and Related Research

    in 2001. The two articles had a common author, FA Matsen, III, MD. This concern was brought to the attention of Dr. Matsen, and his response is provided:

    To the Editor:

    I am writing with regard to similarities in two articles: McCallister, Parsons, Titelman and Matsen. "Open Rotator Cuff repair without Acromioplasty" JBJS (A) 2005:87:1278-1283 and Goldberg, Lippitt; and Matsen. "Improvement in Comfort and Function after Cuff Repair Without Acromioplasty." Clinical Orthopaedics and Related Research 2001 390:142-150.

    The authors of the paper published in 2005 in this Journal failed to indicate that this was an update of a previous publication from our group in Clinical Orthopaedics and Related Research in 2001. Secondly, we did not cite the article in Clinical Orthopaedics and Related Research in the references of the paper listed in JBJS. Also, we used much of the same wording in the two papers. For these errors, we apologize to JBJS and its readership.

    The more recent paper, however, does contain important information, presented below, not contained in the first article:

    1. the highly significant differences in the results for men and women.

    2. the highly significant relationship between the result and the number of tendons torn.

    3. the comparison of the rationale and technique we use to those published by Codman over 70 years ago.

    4. the findings in over twice as many shoulders.

    We believe that this additional information will be of benefit to the orthopaedic community, and justifies the publication of the more recent manuscript.

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