Background: The treatment of rotator cuff tears has evolved from
open surgical repairs to complete arthroscopic repairs over the past two
decades. In this study, we reviewed the results of arthroscopic rotator cuff
repairs with the so-called double-row, or footprint, reconstruction
Methods: Between 1998 and 2002, 264 patients underwent an
arthroscopic rotator cuff repair with double-row fixation. The average age at
the time of the operation was fifty-nine years. Two hundred and thirty-eight
patients (242 shoulders) were available for follow-up; 210 were evaluated with
a full clinical examination and thirty-two, with a questionnaire only.
Preoperative and postoperative examinations consisted of determination of a
Constant score and a visual analogue score for pain as well as a full physical
examination of the shoulder. Ultrasonography was done at a minimum of twelve
months postoperatively to assess the integrity of the cuff.
Results: The average score for pain improved from 7.4 points (range,
3 to 10 points) preoperatively to 0.7 point (range, 0 to 3 points)
postoperatively. The subjective outcome was excellent or good in 220 (90.9%)
of the 242 shoulders. The average increase in the Constant score after the
operation was 25.4 points (range, 0 to 57 points). Ultrasonography
demonstrated an intact rotator cuff in 83% (174) of the shoulders overall, 47%
(fifteen) of the thirty-two with a repair of a massive tear, 78% (thirty-two)
of the forty-one with a repair of a large tear, 93% (113) of the 121 with a
repair of a medium tear, and 88% (fourteen) of the sixteen with a repair of a
small tear. Strength and active elevation increased significantly more in the
group with an intact repair at the time of follow-up than in the group with a
failed repair; however, there was no difference in the pain scores.
Conclusions: Arthroscopic rotator cuff repair with double-row
fixation can achieve a high percentage of excellent subjective and objective
results. Integrity of the repair can be expected in the majority of shoulders
treated for a large, medium, or small tear, and the strength and range of
motion provided by an intact repair are significantly better than those
following a failed repair.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.