Repair integrity and clinical outcome after arthroscopic rotator cuff repair under low repair tension

Abstract

Background

Excessively high repair tension negatively affects clinical outcomes after rotator cuff repair. This study was performed to examine the clinical outcomes and repair integrity of the rotator cuff in patients treated by arthroscopic rotator cuff repair (ARCR) under low repair tension (<10 N) (ie, low-tension ARCR).

Methods

The study involved patients who underwent low-tension ARCR between January 2020 and December 2021. The single-row or triple-row technique was used for low-tension ARCR. We excluded 10 patients who underwent other procedures, other types of repair, or partial repair, as well as 4 patients who underwent an ultrasound evaluation of cuff integrity. Clinical evaluations included the visual analog scale (VAS) for pain, range of motion (ROM), and clinical scores (Japanese Orthopaedic Association [JOA] shoulder score, University of California at Los Angeles [UCLA] shoulder score, and simple shoulder test [SST]), assessed preoperatively and 2 years postoperatively. Structural repair integrity was evaluated by magnetic resonance imaging at 12 months postoperatively. Statistical analyses were performed using Statistics Package for Social Science software (version 29.0.0; IBM Corp., Armonk, NY, USA). The Wilcoxon signed-rank test was performed to compare continuous and continuously ranked data (VAS score, ROM, JOA shoulder score, UCLA score, and SST score). A P value of < .05 was considered statistically significant.

Results

This retrospective case series involved 77 patients with a mean age of 65.9 ± 9.5 years (range, 42-85 years) and a mean follow-up period of 25.3 ± 3.3 months (range, 24-38 months). All patients had a full-thickness rotator cuff tear, classified as small in 5 patients, medium in 47, large in 25, and massive in 0. The mean tear size was 506.0 ± 332.5 mm². All patients underwent low-tension ARCR (single-row, n = 48; triple-row, n = 29). Repair tension was measured using a digital tensiometer. The VAS score at rest (48.6-1.1, P < .001), in motion (75.2-5.4, P < .001), and at night (62.0-1.5, P < .001); ROM with forward flexion (124°-167°, P < .001), abduction (109°-167°, P < .001), external rotation (56.0°-68.6°, P < .001), and internal rotation (14.1°-9.0°, P < .001); JOA shoulder score (66.5-98.1, P < .001); UCLA shoulder score (15.9-34.2, P < .001); and SST score (4.5-10.7, P < .001) were significantly better at the 2-year follow-up than before surgery. Two patients developed a retear (2.6%).

Conclusion

Low-tension ARCR resulted in a low retear rate and good clinical outcomes.