Abstract
Objectives:
Treatment for partial-thickness (PT) supraspinatus tears are largely based on surgeon intuition since little is known regarding the outcomes of specific treatment methods. Therefore, the purpose of this study was to evaluate the outcomes following arthroscopic management of partial-thickness supraspinatus tears.
Methods:
Institutional Review Board approval was obtained prior to initiation of this study. All data were prospectively collected and retrospectively analyzed. Between March 2006 and April 2011, 61 shoulders underwent arthroscopic treatment for PT supraspinatus tears. Inclusion criteria were: age >18 years, primary arthroscopic treatment for a PT supraspinatus tear, and were 2 years removed from the index surgery. Treatments included debridement (< 50% thickness), side-to-side repair with sutures and repair (> 50% thickness) using either single- (50-75%) or double-row (>75%) suture anchor constructs. Concomitant treatments were recorded. Demographic data were collected pre- and postoperatively along with ASES, SF-12 PCS, QuickDASH, SANE and satisfaction after minimum two-year follow-up. Data regarding intraoperative findings, treatments, complications and revision surgeries were collected. Treatment failure was defined as subsequent surgery on the supraspinatus tendon. Outcomes data were compared with preoperative baselines along with various demographic and surgical variables. Statistical significance was set at p<0.05.
Results:
69 shoulders (38 men, 29 women, 2 bilateral) with a mean age of 52 years (range, 20-74) underwent arthroscopic treatment for PT supraspinatus tears. There were 2 complications (2.9%): 1 shoulder developed axillary nerve symptoms and 1 developed a superficial wound infection. 8 of the 69 shoulders (11.6%) underwent subsequent surgery on the index shoulder unrelated to the rotator cuff before final follow-up and were omitted from the outcomes analysis. 24/61 shoulders had bursal-sided tears (39.3%) and 37/61 had articular-sided tears (60.7%). 31 shoulders (50.8%) had a tear involving <25% of the tendon thickness. 35 tears (57.4%) were repaired whereas 26 tears (42.6%) underwent debridement alone. 28 shoulders also had proximal biceps tendon lesions (45.9%), 28 had SLAP tears (45.9%) and 18 had other pathologies. Treatment failure occurred in 4 shoulders (6.6%) and they were subsequently removed from outcomes analysis. 57 shoulders had a mean follow-up of 41.3 months (range, 24.0-74.2 months). All postoperative outcomes scores and pain scores improved significantly over preoperative baselines (p<0.05) (Table 1). ASES scores returned to levels of age-matched normals. Tears that underwent debridement only demonstrated significantly worse QuickDASH scores compared to the rest of the cohort (mean 12.0 [SE 4.3] versus mean 7.8 [SE 2.1]; p<0.05) whereas shoulders that underwent acromioplasty demonstrated significantly improved QuickDASH scores compared to the rest of the cohort (mean 6.8 [SE 2.1] versus mean 13.6 [SE 3.5]; p=0.026).
Conclusion:
Arthroscopic treatment for PT supraspinatus tears provides excellent outcomes and satisfaction in the majority of patients. There were no differences in outcomes between articular- versus bursal-sided supraspinatus tears; however, QuickDASH scores were affected negatively by debridement and positively by acromioplasty.