ABSTRACT
PURPOSE: Our goal in this analysis was to compare clinical outcomes and radiographic healing rates of double-row (DR) transosseous-equivalent versus single-row (SR) Mason-Allen configuration (MAC) arthroscopic repair techniques. METHODS: A prospective, nonrandomized assessment of 132 arthroscopic rotator cuff repair patients included 78 SR repair patients and 54 with DR repair. Tears measured between 1.5 and 4.5 cm. Patients were evaluated with a visual analog scale; University of California, Los Angeles score; American Shoulder and Elbow Surgeons score; active range of motion; and dynamometric strength. Scores and measurements were obtained preoperatively and at 3, 6, 12, and 24 months postoperatively. The SR repairs were performed with the arthroscopic MAC. For DR repairs, two 5.5-mm fully threaded Bio-Corkscrew anchors (Arthrex, Naples, FL), single loaded with FiberWire (Arthrex), were used for the medial row. The lateral row was secured with PushLock bioabsorbable anchors (Arthrex). Forty-four patients in the SR group and 37 patients in the DR group returned for magnetic resonance imaging (MRI) evaluation of repair integrity between 12 and 28 months postoperatively. RESULTS: DR repairs resulted in higher outcome scores, though not significantly. Patient satisfaction rates were 95% in the SR group and 92% in the DR group. MRI showed a statistically significantly improved healing rate with SR repair compared with DR repair in our entire patient population (P ≤ .017). A more homogeneous subset of patients with tears between 2.5 and 3.5 cm showed a significantly improved healing rate for the DR repair (P ≤ .03). CONCLUSIONS: Our short-term results suggest that SR MAC repair provides comparable clinical results to DR repair. Although our MRI data suggest improved healing rates in our SR repairs in the entire patient population, when similar-sized tears were compared, the DR repair group showed improved radiographic healing. LEVEL OF EVIDENCE: Level III, retrospective comparative study.
Subject(s)
Arthroscopy/methods , Lacerations/surgery , Range of Motion, Articular/physiology , Rotator Cuff/surgery , Suture Techniques , Adult , Cohort Studies , Female , Follow-Up Studies , Humans , Injury Severity Score , Magnetic Resonance Imaging , Male , Middle Aged , Pain Measurement , Plastic Surgery Procedures/instrumentation , Plastic Surgery Procedures/methods , Recovery of Function , Retrospective Studies , Rotator Cuff Injuries , Shoulder Joint/physiopathology , Shoulder Joint/surgery , Suture Anchors , Tensile Strength , Treatment OutcomeABSTRACT
PURPOSE: The purpose of this outcome analysis was to evaluate the clinical presentation of isolated posterior labral tears resulting from athletic injury and to use multiple outcome measurements to evaluate postoperative results after arthroscopic repair with respect to satisfaction, function, and return to sport. METHODS: Seventy-five consecutive patients injured during athletic activity were treated surgically during the 2-year period from 2005 to 2006 for labral pathologies. Twenty-eight patients were treated for isolated posterior labral tears. Of these, all underwent arthroscopic repair of their tears. The mechanism of injury was trauma to a previously asymptomatic shoulder during sports. The patients' mean age was 21 years, and they were evaluated with American Shoulder and Elbow Surgeons; University of California, Los Angeles; Rowe; and visual analog scale scores, as well as active motion and dynamometric strength testing. Scores and measurements were obtained preoperatively and postoperatively at 3, 6, and 12 months and yearly thereafter. RESULTS: In our athletic population undergoing surgical management for labral pathology, 37% of patients (28 of 75) were found to have purely posterior labral lesions after an athletic injury. On intraoperative examination, an element of posterior laxity was seen in only 29% of patients with these tears. At 24 months, significant improvements were observed in the American Shoulder and Elbow Surgeons; University of California, Los Angeles; Rowe; and visual analog scale scores. Increases in forward flexion and external rotation strength were also noted. Return to sport was achieved in 26 of 28 patients (93%). A 93% patient satisfaction rate was observed for arthroscopic posterior labral repairs at more than 24 months. CONCLUSIONS: Our patient-athletes presented with painful, dysfunctional shoulders that inhibited performance in their chosen sport. Arthroscopic evaluation and repair of these posterior labral lesions resulted in 26 of 28 patients (93%) returning to sport and 23 of 28 (82%) returning without any limitations. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
