Summary

Prospective cohort outcome data with follow up of 5 year pain and Flex-SF data for rotator cuff repairs, in particular, analyzing the outcome data focused on surgical techniques, including acromioplasty, single versus double row, surgical approach and biceps treatment.

Abstract

Introduction

The New Zealand prospective cohort study presents the largest prospective cohort of rotator cuff repairs in the world. We present the 60-month pain and Flex-SF data for
rotator cuff repairs. In particular, analyzing the outcome data focused on surgical techniques, including acromioplasty, single versus double row, surgical approach and biceps treatment.

Methods

This study was a multi-centre, multi-surgeon prospective cohort study of rotator cuff repairs from March 2009 until December 2010. The operating surgeon collected surgical and demographic data. Follow-up was Flex SF, Pain, and general outcome data was collected at 6, 12, 24 months, and 5 years.

Results

Overall, 2603 primary rotator cuff repairs were available for analysis. Follow up was 79% at 5 years. Pain scores similarly improved until 12 months, then remained low out to 5 years. Flex SF scores significantly increased from baseline to 24 months, and remained high at 5 years. Average improvement in Flex SF from baseline to 5 years was 16 points. Re-operation rate was 6.3%. Re-tear rate was 6.7%, risk for re-tear included three tendon tears, large and retracted tears, poor tendon quality, difficult to reduce tears.

Arthroscopic repairs were carried out in 18% of cases, mini-open 39%, open repairs 43%. There was no difference in outcome scores approaches. Infection rates were higher in open approaches (OR 1.8, p 0.07). There was no difference in outcome scores or complications between single and double row repairs. Acromioplasty was carried out in 92% of cases, and this was associated with higher Flex SF scores at 5 years (40 vs 38, p 0.01). The LHB was abnormal in 49% of patients (24% damaged/tendinopathic, 6% dislocated, 13% damaged and dislocated, 6% ruptured).

Presence of LHB pathology correlated with poorer functional and pain scores at 5 years (p < 0.01).. There was no difference in Flex SF scores between LHB tenodesis and LHB tenotomy overall (39 vs 38, p 0.5). When the tendon was dislocated LHB tenodesis had higher Flex SF scores compared to tenotomy (39 vs 36, p 0.04).

Conclusion

This study presents data from the largest rotator cuff cohort available with 79% follow up at five years. Good functional improvement is noted post rotator cuff repair, and this is maintained out to five years. Acromioplasty is associated with higher functional outcomes at five years. There was no difference in open versus arthroscopic approaches, or single versus double row repairs. Just under 50% of rotator cuff repairs had associated LHB pathology, and this is associated with poorer outcomes at 5 years. There was no difference between LHB tenotomy and tenodesis during concurrent rotator cuff repair.