title: Arthroscopic repair of large and massive rotator cuff tears using the side-to-side suture technique. Mid-term clinical and anatomic evaluation.
abstract: PREAMBLE: Arthroscopic repair is our treatment of choice for massive rotator cuff tears. In order to reduce tension, we perform a side-to-side suture technique. The purpose of our work was to study the outcome of such technique by evaluating functional score and rotator cuff integrity using ultrasound at 2-year follow-up.
  
  
  OBJECTIVE
  The "side-to-side" arthroscopic repair of large and massive rotator cuff tears provides a long-term continuity of rotator cuff mechanism, enhances function and relieves pain with low morbidity.
  
  
  METHODS
  Retrospective monocenter study.
  
  
  METHODS
  We included a continuous series of 50 patients of mean age 66.6 years (46-80), operated on between January 2007 and March 2008 for full-thickness retracted tears of the supraspinatus extending or not to the infraspinatus tendon. Management consisted of arthroscopic subacromial bursectomy, acromioplasty and side-to-side repair of the rotator cuff tendons with secure anchor fixation to the tuberosity. The relative Constant score was used for clinical evaluation preoperatively and at a minimum of 24 months after surgery. The continuity of rotator cuff mechanism was evaluated using ultrasound.
  
  
  RESULTS
  The mean relative Constant score improved significantly (p<0.05) from 40% (18-67) preoperatively to 91.7% (40-107) postoperatively. Fifty-six percent of the rotator cuffs from this series demonstrated continuity with a postoperative relative Constant score of 98.4% (74-121) and an increase in the shoulder strength score of 3.6 kg (1-6). Forty-four percent of the rotator cuffs had recurrent tear with an overall relative Constant score of 83.6% (4-126) and we did not observe any improvement in the strength score in this sub-group. Eighty-eight percent of the patients were satisfied or very satisfied with their outcome.
  
  
  CONCLUSIONS
  At a minimum 24-month follow-up, the side-to-side suturing technique reported excellent functional results with a very high satisfaction rate. For these large and massive rotator cuff tears sometimes considered as irreparable, ultrasound confirmed the continuity of the repair in 56% of the cases. Unhealed patients were not disadvantaged since they experienced pain relief and functional improvement. However, in this sub-group of patients, recovery of shoulder strength was poor.
  
  
  METHODS
  Level IV.
authors.affiliation: Department of orthopaedic and trauma surgery, Rouen University Hospital, 1, rue de Germont 76031 Rouen cedex, France. thomas.rousseau@ymail.com
authors.forename: T
authors.initials: T
authors.lastname: Rousseau
authors.forename: X
authors.initials: X
authors.lastname: Roussignol
authors.forename: S
authors.initials: S
authors.lastname: Bertiaux
authors.forename: F
authors.initials: F
authors.lastname: Duparc
authors.forename: F
authors.initials: F
authors.lastname: Dujardin
authors.forename: O
authors.initials: O
authors.lastname: Courage
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D018709:Statistics, Nonparametric; D013536:Suture Techniques; D016896:Treatment Outcome; D014945:Wound Healing