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September 2007

Arthroscopic Rotator Cuff Repair
Bernard F. Hearon, M.D.

The rotator cuff consists of four muscle-tendon units which envelop the shoulder joint, in front, on top and in back.  The cuff tendons attach to the bony prominences of the proximal humerus.  They function as internal or external rotators of the shoulder joint and promote shoulder stability when the arm is held overhead.

Rotator cuff tendon tears are extremely common in the adult population.  Tears may be traumatic, occurring from sports injuries, work-related lifting injuries or slip-and-fall injuries.  Atraumatic rotator cuff tears are also possible, resulting from age-related wear-and-tear phenomenon around the shoulder.  Patients with rotator cuff tears will often complain of shoulder pain aggravated by overhead activities and shoulder pain at night.

Neglected or untreated rotator cuff tendon tears will often propagate over time.  Mild tears enlarge to become moderate-size tears, moderate tears progress to large tears and large tears may become massive tears.  Patients with massive rotator cuff tears are at risk to develop so called “rotator cuff arthropathy,” ie., shoulder arthritis resulting from rotator cuff deficiency.

Treatment of choice for rotator cuff tear is surgical repair.  Open repair, done through incisions 2 inches or more in length, has been the accepted method of treatment for many years.  In the 1990’s, arthroscopic rotator cuff repair, done through small stab incisions, was popularized.  However, in some studies, the results of arthroscopic repairs using single-row suture technique did not appear to be as good as the results obtained by means of the open incision technique.

Recently, arthroscopic rotator cuff repair with double-row suture technique was introduced.  This technique allows for more precise restoration of the rotator cuff attachment over a broad bony surface area.  Early clinical results are remarkably good.  Huijsmans et al. (South Africa) reported 91% excellent or good subjective results in 242 patients with cuff tears treated by double-row suture method.  Lafosse et al. (France) reported only 11% of 105 patients failed to heal rotator cuff repairs similarly treated.  Favorable reports from US orthopaedists are expected in the near future.

The message for patients with rotator cuff tears is clear.  Your orthopaedic surgeon should be an experienced shoulder arthroscopist who is familiar with the double-row suture anchor repair technique.  In our practice, more than 95% of rotator cuff repairs are done arthroscopically.  Large or massive tears are repaired by means of the double-row suture anchor technique.  Since we have adopted this method of repair, our clinical results have also improved and are consistent with the recent literature.

Want more information online?  Go to www.orthosupersite.com.  Click on “Shoulder/Elbow” to find article by Dr. Levine on arthroscopic rotator cuff repair by double-row suture bridge method. 

References

1. Huijsmans PE, Pritchard MP, Berghs BM, van Rooyen KS, Wallace AL, de Beer JF.  Arthroscopic rotator cuff repair with double-row fixation.  J Bone Joint Surg, 89-A(6): 1248-57, June 2007.

2. Levine WN.  My approach to rotator cuff repair in 2007: Arthroscopic double-row suture bridge method offers restoration of the anatomic footprint.  Orthopedics Today, 27: 24-27, July 2007.

3. Lafosse L, Brozska R, Toussaint B, Gobezie R.  The outcome and structural integrity of arthroscopic rotator cuff repair with the use of double-row suture anchor technique.  J Bone Joint Surg, 89-A(7): 1533-41, July 2007.