Arthroscopic Rotator Cuff Repair - Audit of Practice
Authors: Stephen Crotty, Matthew Smith, Lennard Funk
OBJECTIVE: To assess the outcomes of arthroscopic rotator cuff repairs in a single surgeon practice using single row repair techniques.
BACKGROUND DATA: Studies have shown that the results gained from arthroscopic rotator cuff repair (83-91% good/excellent) are at least equal to results gained from open surgery (51-84%). A standard of 90% good/excellent was set for our patient cohort, with a retear rate on ultrasound scanning of less than 25%.
METHODS: A Constant score of 65 or more and an Oxford score of 33 or less constitute a good/excellent operative result. A retrospective search of the senior author's database from 01/04/04 to 01/04/07 identified 111 cases of arthroscopic rotator cuff repair. Each patient was invited to attend a clinic to complete an Oxford score, Constant score and have their shoulders examined and assessed by ultrasound. Patients unable or unwilling to attend the clinic were interviewed by telephone using the Oxford score assessment.
RESULTS: Follow-up by Constant score was available for 51 cases (45.9%) and by Oxford score for 86 cases (77.5%). Both the mean Constant score and Oxford score improved following surgical intervention. Pre-operatively 14.3% of our patient cohort had good/excellent Constant scores and 46% had good/excellent Oxford scores. Post-operatively, this had risen to 78.4% using Constant scoring and 90.7% with Oxford scoring. The full thickness retear rate on ultrasound scanning was 8.5% at review.
CONCLUSION: The Oxford scoring system was our most powerful outcome measure. With 91.6% of our patient cohort reporting good/excellent results from and a retear rate of 8.5% we feel that we do not need to alter our current practice for most standard tears, however predictors for retears were identified which might be addressed by newer fixation techniques and orthobiologics.