The Journal of Bone and Joint Surgery (American). 2006;88:309-316.
doi:10.2106/JBJS.E.00117
© 2006 The Journal of Bone and Joint Surgery, Inc.
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 Shoulder/Elbow Test 14: Spring 2006 (publication date May 15, 2006; expirat...
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Clinical and Structural Results of Open Repair of an Isolated One-Tendon Tear of the Rotator Cuff

Bruno Fuchs, MD, PhD1, Michael K. Gilbart, MD1, Juerg Hodler, MD, MBA1 and Christian Gerber, MD1

1 Department of Orthopaedics, University of Zurich, Uniklinik Balgrist, Forchstrasse 340, CH-8008 Zurich, Switzerland. E-mail address for B. Fuchs: bruno.fuchs{at}balgrist.ch

Investigation performed at the Department of Orthopaedics, University of Zurich, Zurich, Switzerland

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

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.


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