2015 ISAKOS Biennial Congress ePoster #2426

Arthroscopic Transosseous Rotator Cuff Repair is Cost Effective Compared to Anchored Technique

Uma Srikumaran, MD, Columbia, MD UNITED STATES
Lucas Romine, MD, Lutherville, MD UNITED STATES
Catherine Hannan, BS, Columbia, MD UNITED STATES
Meera Chappidi, BA, Baltimore, MD UNITED STATES
Kelly Kilcoyne, MD, El Paso, TX UNITED STATES
Steve Peterson, MD, Baltimore, MD UNITED STATES
Edward G. McFarland, Lutherville, MD UNITED STATES
Bashir Zikria, MD, Bethesda, MD UNITED STATES

Johns Hopkins University, Baltimore, Maryland, USA

FDA Status Cleared

Summary: This case-control analysis demonstrates arthroscopic anchorless, transosseous rotator cuff repair is clinically equivalent and cost effective compared to traditional anchored rotator cuff repair.

Rate:

Abstract:

Introduction

Current trends in arthroscopic rotator cuff repair have focused on restoration of and compression across the natural anatomic footprint, which historically reflects the repair obtained with the traditional, open transosseous technique. Recent advancements in instrumentation have accommodated an arthroscopic, anchorless transosseous repair, which reproduces the gold standard of open transosseous repair. Currently, no published literature exists directly comparing arthroscopic, anchorless, transosseous repair to standard arthroscopic anchored techniques.

Methods

We conducted a retrospective case-control analysis of 90 arthroscopic rotator cuff repairs performed by a single surgeon with minimum 1 year follow up. The control group included patients who underwent arthroscopic anchored repair including both single and double row constructs. The experimental group included patients who underwent arthroscopic anchorless, transosseous repair. We excluded patients with isolated partial thickness tears, revision cuff repair, and isolated repairs of the subscapularis. Baseline demographic data included age, sex, and shoulder dominance. Intraoperative data on the tear size, number of tendons involved and degree of retraction was recorded prospectively. All patients had full thickness tears of the supraspinatus and/or infraspinatus tendons. We collected visual analog pain (VAS), subjective shoulder value (SSV), and American Shoulder and Elbow Surgeons (ASES) scores. We recorded range of motion and postoperative complications. Statistical and cost analysis was performed.

Results

There were 45 patients in the control group and 45 patients in the experimental group who met all inclusion criteria and completed a minimum 1 year follow up. Baseline demographic data for age (p=0.07) and sex (p=0.87) did not differ between groups, although there was a trend toward older patients in the anchorless, transosseous group. Compared to the anchored group, the anchorless, transosseous group was found to have significantly larger tear size (p<0.001). At minimum 1 year follow up, there was significant (p<.001) postoperative improvement in both groups with respect to SSV, VAS, and ASES scores compared to preoperative scores. There was no difference between the two groups with respect to SSV (p = 0.89), pain score (p = 0.88), ASES score (p=0.46) or range of motion in abduction, forward elevation, and external rotation (p=0.99, 0.96, 0.78 respectively). There were no infections, nerve injuries, or returns to the operating room in either group. Cost analysis suggested 30-80% implant savings per case for the anchorless, transosseous group depending on tear size.

Discussion And Conclusion

Arthroscopic transosseous rotator cuff repair achieves similar clinical and patient reported outcomes with 30-81% reduction in implant costs, compared to traditional anchored techniques.

REFERENCES:
1. Cole, BJ, ElAttrache NS, et. al. Arthroscopic Rotator Cuff Repairs: An Anatomic and Biomechanical Rationale for Different Suture-Anchor Repair Configurations. Arthroscopy. 2007; 23:662-669.
2. Kuroda S. et al. Advantages of Arthroscopic Transosseous Suture Repair of the Rotator Cuff without the Use of Anchors. Clin Orthop Relat Res (2013) 471:3514–3522.
3. Garofalo R. et.al. Arthroscopic transosseus (anchorless) rotator cuff repair. Knee Surgery, Sports Traumatology, Arthroscopy. June 2012, Volume 20, Issue 6, pp 1031-1035.