Comparison of the Functional Outcomes of Arthroscopic Debridement and Repair of Bursal-side Partial-thickness Rotator Cuff Tears

Öz

Background: To compare the clinical and functional scores of arthroscopic debridement and repair (conversion to full thickness) surgeries in patients with bursal-side partial-thickness rotator cuff tears (BPTRCT). Materials and Methods: A single-center retrospective study was conducted to compare the arthroscopic debride-ment and arthroscopic repair for BPTRCT performed between March 2017 and September 2021. Arthroscopic debridement patients were grouped as Group 1 and the repair group as Group 2. A total of 98 patients with an average age of 57.5 years (range 29-83 years), including 41 male and 57 female patients, met the inclusion criteria. VAS (Visual Analogue Scale) and UCLA (University of California Los Angeles) shoulder scores applied in the preopera-tive period and in the 12th month of the postoperative clinical follow-ups were evaluated. In addition to the pre-operative and postoperative comparison of both scores, their improvement of these scores was also compared. Results: The mean age of the repair group and the debridement group was 64.4 ±11.02 and 52.6 ±11.24, respective-ly. No significant difference between the two groups was observed in terms of demographic characteristics (p˃0.05). The mean operation time was 91.46 ±16.44 min in the repair group and 49.82 ±13.46 min in the debridement group. The VAS score dramatically improved, from preoperative 5.10±1.23 to postoperative 3.68±1.33 points in the deb-ridement group and from preoperative 5.17±1.35 to postoperative 3.58±1.16 points in the repair group. The two groups had no statistically significant difference in postoperative VAS scores (p=0.991). Preoperative and postopera-tive VAS score improvement was also compared between the groups, however, there was also no statistically signifi-cant difference in terms of VAS score changes (p=0.132). The UCLA scores also dramatically improved, from pre-operative 17.14±4.19 to postoperative 24.57±5.04 points in the debridement group and from preoperative 17.46±5.05 to postoperative 25.48±5.61 points in the repair group. No statistically significant difference was ob-served between the two groups in terms of postoperative UCLA scores (p=0.361). In the postoperative first-year follow-up, no re-tears were observed either in the debridement or in the repair group. Conclusions: Both arthroscopic debridement and arthroscopic repair surgeries provide clinically comparable suc-cessful results and high satisfaction for patients with bursal-side rotator cuff tears. No statistically significant differ-ence was observed between these two methods. Easier early postoperative rehabilitation seems to be the main advantage of the debridement method.

Anahtar Kelimeler

• Bursal-side
• partial-thickness rotator cuff tear
• arthroscopy
• repair

Bursal Yüz Kısmi Kalınlıkta Rotator Manşet Yırtıklarının Artroskopik Debridman ve Tamirinin Fonksiyonel Karşılaştırılması

Öz

Amaç: Bursal yüz kısmi kalınlıkta rotator manşet yırtığı (BPTRCT) olan hastalarda artroskopik debridman ve tamir (tam kata dönüştürerek) ameliyatlarının klinik ve fonksiyonel sonuçlarını karşılaştırmak. Materyal ve Metod: Mart 2017-Eylül 2021 tarihleri arasında opere edilen BPTRCT'de artroskopik debridman ve artroskopik tamiri karşılaştırmak için tek merkezli retrospektif bir çalışma yapıldı. Artroskopik debridman hastaları Grup 1, tamir grubu Grup 2 olarak adlandırıldı. Toplam 98 hasta (41 erkek ve 57 kadın) çalışmaya dahil edildi. Hastala-rın ortalama yaşı 57,5 (29-83 yıl) idi. Ameliyat öncesi ve postoperatif 12. ay VAS (Visual Analog Scale) ve UCLA (Uni-versity of California Los Angeles) omuz skorları değerlendirildi. Her iki skorun preoperatif ve postoperatif karşılaştır-masına ek olarak, bu skorlardaki değişimler de karşılaştırıldı. Bulgular: Tamir grubunun ve debridman grubunun yaş ortalaması sırasıyla 64,4 ±11,02 ve 52,6 ±11,24 idi. Demografik özellikler açısından iki grup arasında anlamlı bir fark gözlenmedi (p˃0.05). Ortalama operasyon süresi tamir grubunda 91,46 ±16,44 dk, debridman grubunda 49,82 ±13,46 dk idi. VAS skoru, debridman grubunda preoperatif 5.10±1.23'ten postoperatif 3.68±1.33 puana ve tamir grubunda preoperatif 5.17±1.35'ten postoperatif 3.58±1.16 puana ilerleme kaydetti. Postoperatif 12. ay VAS skorlarında iki grup arasında istatistiksel olarak anlamlı fark yoktu (p=0,991). Gruplar arasında preoperatif ve postoperatif VAS skorlarındaki iyileşme de karşılaştırıldı ancak VAS skorla-rındaki değişimler açısından istatistiksel olarak anlamlı bir fark bulunamadı (p=0,132). UCLA skorları da debridman grubunda ameliyat öncesi 17.14±4.19'dan ameliyat sonrası 24.57±5.04 puana ve tamir grubunda ameliyat öncesi 17.46±5.05'ten ameliyat sonrası 25.48±5.61 puana dramatik bir şekilde iyileşti. Ameliyat sonrası UCLA skorları açısın-dan iki grup arasında istatistiksel olarak anlamlı bir fark gözlenmedi (p=0,361). Postoperatif birinci yıl takibinde deb-ridman ve onarım grubunda tekrar yırtık görülmedi. Sonuç: Bursal yüz rotator manşet yırtıklarının cerrahi tedavisinde hem artroskopik debridman hem de artroskopik onarım klinik olarak karşılaştırılabilir başarılı sonuçlar vermekte olup hastalar açısından oldukça tatmin edici sonuçlar elde edilebilmektedir. Çalışmamızda bu iki yöntem arasında klinik skorlamalar açısından istatistiksel olarak anlamlı bir fark gözlenmedi. Ameliyat sonrası dönemde daha kolay ve erken rehabilitasyon, debridman yönteminin ana avantajı olarak görünmektedir.

Anahtar Kelimeler

• Bursal-yüz
• kısmi-kalınlıkta rotator manşet yırtıkları
• artroskopi
• tamir

Kaynakça

1. 1. Matthewson G, Beach CJ, Nelson AA, Woodmass JM, Ono Y, Boorman RS, et al. Partial Thickness Rotator Cuff Tears: Current Concepts. Advances in orthopedics. 2015;2015:458786.
2. 2. Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB. Ab-normal findings on magnetic resonance images of asymp-tomatic shoulders. The Journal of bone and joint surgery American volume. 1995;77(1):10-5.
3. 3. Strauss EJ, Salata MJ, Kercher J, Barker JU, McGill K, Bach BR, Jr., et al. Multimedia article. The arthroscopic manage-ment of partial-thickness rotator cuff tears: a systematic re-view of the literature. Arthroscopy : the journal of arthro-scopic & related surgery : official publication of the Arthros-copy Association of North America and the International Ar-throscopy Association. 2011;27(4):568-80.
4. 4. McConville OR, Iannotti JP. Partial-thickness tears of the rotator cuff: evaluation and management. The Journal of the American Academy of Orthopaedic Surgeons. 1999;7(1):32-43.
5. 5. Finnan RP, Crosby LA. Partial-thickness rotator cuff tears. Journal of shoulder and elbow surgery. 2010;19(4):609-16.
6. 6. Fukuda H. The management of partial-thickness tears of the rotator cuff. The Journal of bone and joint surgery Brit-ish volume. 2003;85(1):3-11.
7. 7. Yang S, Park HS, Flores S, Levin SD, Makhsous M, Lin F, et al. Biomechanical analysis of bursal-sided partial thickness ro-tator cuff tears. Journal of shoulder and elbow surgery. 2009;18(3):379-85.
8. 8. Xiao J, Cui G. Clinical and structural results of arthroscopic repair of bursal-side partial-thickness rotator cuff tears. Journal of shoulder and elbow surgery. 2015;24(2):e41-6.

9. 9. Prodromos CC, Finkle S, Prodromos A, Chen JL, Schwartz A, Wathen L. Treatment of Rotator Cuff Tears with platelet rich plasma: a prospective study with 2 year follow-up. BMC musculoskeletal disorders. 2021;22(1):499.
10. 10. Mall NA, Kim HM, Keener JD, Steger-May K, Teefey SA, Middleton WD, et al. Symptomatic progression of asymp-tomatic rotator cuff tears: a prospective study of clinical and sonographic variables. The Journal of bone and joint sur-gery American volume. 2010;92(16):2623-33.
11. 11. Maman E, Harris C, White L, Tomlinson G, Shashank M, Boynton E. Outcome of nonoperative treatment of symp-tomatic rotator cuff tears monitored by magnetic reso-nance imaging. The Journal of bone and joint surgery Amer-ican volume. 2009;91(8):1898-906.
12. 12. Zhang Y, Zhai S, Qi C, Chen J, Li H, Zhao X, et al. A compara-tive study of arthroscopic débridement versus repair for Ellman grade II bursal-side partial-thickness rotator cuff tears. Journal of shoulder and elbow surgery. 2020;29(10):2072-9.
13. 13. Wang T, Ren Z, Zhang Y, Zhao X, Liu X, Yu T, et al. Compari-son of Arthroscopic Debridement and Repair in the Treat-ment of Ellman Grade II Bursal-side Partial-thickness Rota-tor Cuff Tears: A Prospective Randomized Controlled Trial. Orthopaedic surgery. 2021;13(7):2070-80.
14. 14. Ashir A, Lombardi A, Jerban S, Ma Y, Du J, Chang EY. Mag-netic resonance imaging of the shoulder. Polish journal of radiology. 2020;85:e420-e39.
15. 15. Uchiyama Y, Hamada K, Khruekarnchana P, Handa A, Nakajima T, Shimpuku E, et al. Surgical treatment of con-firmed intratendinous rotator cuff tears: retrospective analysis after an average of eight years of follow-up. Jour-nal of shoulder and elbow surgery. 2010;19(6):837-46.
16. 16. Sugaya H, Maeda K, Matsuki K, Moriishi J. Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation. Arthrosco-py : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North Ameri-ca and the International Arthroscopy Association. 2005;21(11):1307-16.
17. 17. Ogata S, Uhthoff HK. Acromial enthesopathy and rotator cuff tear. A radiologic and histologic postmortem investiga-tion of the coracoacromial arch. Clinical orthopaedics and related research. 1990(254):39-48.
18. 18. Andarawis-Puri N, Ricchetti ET, Soslowsky LJ. Rotator cuff tendon strain correlates with tear propagation. Journal of biomechanics. 2009;42(2):158-63.
19. 19. Park JY, Yoo MJ, Kim MH. Comparison of surgical outcome between bursal and articular partial thickness rotator cuff tears. Orthopedics. 2003;26(4):387-90; discussion 90.
20. 20. Liem D, Alci S, Dedy N, Steinbeck J, Marquardt B, Möl-lenhoff G. Clinical and structural results of partial suprasp-inatus tears treated by subacromial decompression without repair. Knee surgery, sports traumatology, arthroscopy : of-ficial journal of the ESSKA. 2008;16(10):967-72.
21. 21. Beard DJ, Rees JL, Cook JA, Rombach I, Cooper C, Merritt N, et al. Arthroscopic subacromial decompression for sub-acromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, random-ised surgical trial. Lancet (London, England). 2018;391(10118):329-38.