Background: The clinical outcomes of open rotator cuff repair are
well established, but the structural results and their effect on clinical
outcome are poorly known. We assessed the structural changes in the
musculotendinous units after open rotator cuff repair and correlated these
findings with the clinical outcome to establish a benchmark for future
series.
Methods: Thirty-two consecutive standardized open repairs of a
single tendon tear of the rotator cuff were analyzed in twenty-one men and
eleven women with an average age of 59.0 years. The supraspinatus tendon was
involved in twenty-two patients and the subscapularis tendon, in ten. The
clinical outcome, including the Constant score, was assessed prospectively for
all patients at an average of thirty-eight months postoperatively. The
structural outcome was assessed on standardized magnetic resonance imaging
scans.
Results: The mean overall subjective shoulder value was 82.8% of the
value for a normal shoulder. On the average, the age and gender-adjusted
Constant score increased from 63.9% preoperatively to 94.5% postoperatively (p
< 0.0001); the score for pain, from 6.8 points to 13.2 points (p <
0.0001); and the score for activities of daily living, from 11.2 points to
17.9 points (p < 0.0001). The overall rerupture rate was 13% (four of the
thirty-two shoulders). All reruptures were distinctly smaller than the
original tear. Muscular atrophy or fatty infiltration did not significantly
decrease after the tendon repair. In fact, fatty infiltration in the
supraspinatus (p < 0.0053) and infraspinatus (p < 0.003) muscles
increased significantly.
Conclusions: Direct open repair of a complete, isolated tear of one
tendon of the rotator cuff resulted in significant subjective and objective
improvement and very high patient satisfaction. Successful direct repair was
not associated with a decrease in preoperative muscular atrophy and was
associated with increased fatty infiltration of the muscle.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.