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Scientific Articles   |    
Repair Integrity and Functional Outcomes for Arthroscopic Margin Convergence of Rotator Cuff Tears
Kyung Cheon Kim, MD, PhD1; Hyun Dae Shin, MD, PhD1; Soo Min Cha, MD1; Joung Hun Kim, MD1
1 Department of Orthopaedic Surgery, Chungnam National University Hospital, 640 Daesa-Dong, Jung-Gu, Daejeon 301-721, South Korea. E-mail address for K.C. Kim: kckim@cnu.ac.kr
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Investigation performed at the Department of Orthopaedic Surgery, Chungnam National University Hospital, Jung-Gu, Daejeon, South Korea



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Mar 20;95(6):536-541. doi: 10.2106/JBJS.L.00397
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Abstract

Background: 

We evaluated the clinical outcomes of arthroscopic margin convergence for rotator cuff tears.

Methods: 

Twenty-four consecutive patients with full-thickness rotator cuff tears, in which the free tendon edge could not be reduced to the footprint after the release and mobilization of the rotator cuff tendon, were included. Rotator cuff repair integrity was determined by magnetic resonance imaging or ultrasonography after the operation. The mean age and follow-up period for the patients were 59.6 years (range, forty-eight to seventy-three years) and 30.6 months (range, twenty-four to sixty months), respectively. Five outcome measures were used before surgery and at the time of the final follow-up: a visual analog scale (VAS) pain score, the American Shoulder and Elbow Surgeons (ASES) score, the Shoulder Rating Scale of the University of California Los Angeles (UCLA), the Constant-Murley score, and the range of shoulder motion.

Results: 

The follow-up rate for imaging was 95.8%, and the follow-up rate for clinical evaluation was 91.7%. The mean UCLA score (and standard deviation) improved from 17.4 ± 5.5 preoperatively to 31.6 ± 4.0 at the time of the final follow-up (p < 0.001). The mean ASES score improved from 54.9 ± 23.3 to 91.3 ± 11.8, respectively (p < 0.001). The mean Constant-Murley score improved from 45.9 ± 17.6 to 79.1 ± 12.6 (p < 0.001). The mean VAS score improved from 6.5 ± 1.7 to 1.3 ± 1.5 (p < 0.001). The mean range of motion (forward flexion) improved from 117.9° ± 37.7° to 166.8° ± 16.7° (p < 0.001). The postoperative imaging examinations showed cuff integrity without a retear in 52.2% of the shoulders. However, the UCLA, ASES, and Constant-Murley scores were not significantly different between healed and unhealed groups (p = 0.800, p = 0.322, and p = 0.597, respectively).

Conclusions: 

Reducing tension by margin convergence followed by a repair of the resulting free edge to bone has reasonable short-term clinical results but a substantial retear rate (47.8%). However, the retears tended to be smaller than the original tear size. No significant difference was observed in the short-term clinical results between the groups with or without a retear.

Level of Evidence: 

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

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    References

    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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