title: Alterations of the Deltoid Muscle After Open Versus Arthroscopic Rotator Cuff Repair.
abstract: BACKGROUND
  Open repair can be more useful than arthroscopic repair for immobile and severely retracted, large to massive rotator cuff tears. However, it is not known whether the deltoid muscle is altered after open repair or to what extent the deltoid origin remains detached after surgery.
  
  
  OBJECTIVE
  To compare postoperative alterations of the deltoid muscle in open versus arthroscopic repair for severely retracted, large to massive rotator cuff tears.
  
  
  METHODS
  Case-control study; Level of evidence, 3.
  
  
  METHODS
  Enrolled in this study were 135 patients who underwent surgical repair for severely retracted, large to massive rotator cuff tears and who had routine follow-up MRIs at least 6 months after surgery. Open repairs were performed in 56 cases and arthroscopic repairs in 79 cases. The detachment and thickness of the deltoid muscle at its proximal origin were recorded in 5 zones on MRI. The alterations of the deltoid muscle and postoperative integrity of the repaired rotator cuff were evaluated.
  
  
  RESULTS
  Partial detachment of the deltoid occurred in 1 patient (1.8%) in the open group and in 2 patients (2.5%) in the arthroscopic group (P = .80). All the partial detachments occurred in zones 2 and 3. Attenuation of the proximal origin of the deltoid was found in 3 patients (5.4%) in the open group and in 4 patients (5.1%) in the arthroscopic group (P = .87). Atrophy of the deltoid muscle was shown in 3 patients (5.4%) in the open group and 4 patients (5.1%) in the arthroscopic group (P = .61). The retear rate of the repaired cuff was 30.4% (17/56) in the open group and 38.0% (30/79) in the arthroscopic group (P = .74).
  
  
  CONCLUSIONS
  Between open and arthroscopic repair for severely retracted, large to massive rotator cuff tears, there was no significant difference in detachment of the deltoid origin and alterations of the deltoid muscle after repair. Postoperative alterations of the deltoid occurred in arthroscopic surgery as well as in open surgery. For immobile massive rotator cuff tear, open repair is an acceptable technique as long as the deltoid muscle is meticulously reattached after surgery.
authors.affiliation: Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: Nam Su
authors.initials: NS
authors.lastname: Cho
authors.affiliation: Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Cha
authors.affiliation: Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea shoulderrhee@hanmail.net.
authors.forename: Yong Girl
authors.initials: YG
authors.lastname: Rhee
mesh_terms: D000328:Adult; D001178:Arthroplasty / Q000379:methods; D001182:Arthroscopy / Q000379:methods; D016022:Case-Control Studies; D057645:Deltoid Muscle / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D017006:Rotator Cuff / Q000473:pathology / Q000601:surgery*; D013710:Tendons / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult
keywords: arthroscopic; deltoid detachment; open; repair; rotator cuff tear; shoulder