2015 ISAKOS Biennial Congress ePoster #2412

Conventional En Masse Repair and Separate Double Layer Repair for Delaminated Tear of Rotator Cuff – Prospective Comparison Study

Hyo-Jin Lee, MD, Prof., Seoul KOREA, REPUBLIC OF
Yang-Soo Kim, MD, PhD, Prof., Seoul KOREA, REPUBLIC OF
Sung-Ho Bae, MD, Seoul, Seoul KOREA, REPUBLIC OF
In Park, MD, Seoul KOREA, REPUBLIC OF
Sung-Eun Kim, MD, Seoul KOREA, REPUBLIC OF
Ji-Hoon Ok, MD, Seoul KOREA, REPUBLIC OF

Department of Orthopedic Surgery, Seoul St. Mary's Hospital, Seoul, KOREA

FDA Status Cleared

Summary: Both conventional en masse repair and separate double layer, double row repair are effective for improvement of symptoms in the delaminated rotator cuff tear however separate double layer, double row repair showed lower pain score and lower tendency of re-tear at 12 month follow up.

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Abstract:

Rotator cuff tendon is known to have shear strain between superficial and deep layer. Due to this characteristic, separate repairing the torn rotator cuff tendon with delamination has been introduced for restoration of the physiologic biomechanics. Yet the superiority between conventional en masse repair(double row or transosseous-equivalent techniques) and separate repair is still in controversy in terms of outcome

The purpose of this study was to compare the clinical outcome of conventional en masse repair and separate double layer, double row repair for treatment of delaminated tear of rotator cuff. 145 consecutive patients who underwent arthroscopic rotator cuff repair for delaminated tear were enrolled from August 2007 to March 2014. We excluded patients with concomitant glenohumeral injuries (eg. SLAP lesion, Bankart lesion and fracture), any previous ipsilateral shoulder surgery, and no apparent delaminated tear confirmed at surgery. All patients were randomly allocated into 2 groups. In 92 patients, arthroscopic conventional en masse repair was done(group 1). In the other 53 patients, separate double layer, double row repair was done(group 2). Among 145 patients, 62 patients (group 1: 45 patients, group 2: 17 patients) have been followed up at least 1-year after surgery. American Shoulder and Elbow Surgeons Score(ASES), Constant scores(CSS), Simple Shoulder Test(SST), visual analogue scale(VAS) for pain and range of motion (ROM) were assessed at initial, 3, 6, 12 months and the last visit after surgery. Postoperative MRI was done at postoperative 3 and 12 month to check re-tear rate and re-tear pattern. Demographic data of age, sex, symptom duration, tear size, and functional score in both groups showed no significant differences(p>0.05). Among 62 patients who have been followed up at least 1-year, the average follow-up of study was 25.9 months. There was significant improvement in functional score and pain in both groups at last follow-up. However, there was no significant difference in functional score and ROM in both groups at each time point except group 2 had lower VAS pain score(p<0.04) at 12 month follow up. In group 2, 2(12%) patients out of 17 patients showed re-tear on 12 month follow up MRI, whereas in group 1, 10(22.2%) patients out of 45 patients showed re-tear. Both conventional en masse repair and separate double layer, double row repair are effective for improvement of symptoms in the delaminated rotator cuff tear. However, separate double layer, double row repair showed lower pain score and lower tendency of re-tear at 12 month follow up.