ARTHROSCOPIC REINSERTION OF THE SUPRASPINATOUS: EVALUATION OF HEALING WITH THE ARTHROSCAN

Abstract

Purpose: Arthroscopic reinsinsertion of rotator cuff tears is an alternative to surgical treatment, but there is some question as to the reliability of this technique. The purpose of this work was to assess healing with arthroscan, MRI or ultrasonography after arthroscopic reinsertion of the supraspinatus.

Material: There were 48 supraspinatus resections in 47 patients (27 men and 20 women), mean age 56 years (range 34–76 years). Thirty patients were active workers (109 manual labourers), seven were sedentary workers, and ten were retired. Mean initial Constant score was 40.56 (range 13–67). Arthroscan or MRI identified 48 full thickness tears of the supraspinatus (41 distal and seven intermediate tears, associated with twenty cleavages of the subspinatus, six cases of biceps tendonitis, and four lesions involving the upper third of the subscapularis.

Methods: All patients underwent totally arthroscopic reinsertion of the supraspinatus. One tenotomy of the long biceps and three reinsertions of the upper third of the subscapularis were also performed. All patients were immobilised for six weeks. Passive rehabilitation was started immediately and active work was allowed after six weeks.

Results: For this consecutive series of 48 supraspinatus reinsertions with a minimum 12 months follow-up, the Constant score at last follow-up was 76.77 (range 39–99). Arthroscan (n=40), ultrasonography (n=3) and MRI (n=1) were performed at six months to search for leakage and assess healing at the trochiter and cartilage level, aspect of the inferior aspect of the tendon and muscle degeneration. No leakage was observed in 37 cases, the tendon had a normal aspect in 15, with fringes in four cases, and in 12 cases there was a point leakage. Full thickness tear was found in seven cases. Clinical outcome was not correlated with operative technique or preoperative imaging.

Discussion: These results in a preliminary series suggest that arthroscopic reinsertion of suprasinatus tears with little retraction is a reliable alternative to surgical reinsertion. The deltoid insertions are not disrupted and adherence phenomena and morbidity are reduced. Arthroscopy also allows complete exploration of the glenohumeral joint. Longer follow-up will be needed to determine the long-term outcome.