Whether a rotator cuff tear is articular-sided or bursal-sided doesn’t affect the outcomes of arthroscopic tear completion and repair, according to a new study.
Location of Rotator Cuff Tear Doesn’t Affect Surgery Outcomes
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The researchers of “No Difference in Outcome Between Articular-Sided and Bursal-Sided Tears: Comparative Study With Minimum 2-Year Follow-Up of Arthroscopic Repairs in 104 Patients in a Single-Surgeon Series,” published in the May 01, 2021 issue of Arthroscopy, sought to compare functional outcomes after surgery based on which side the tear was located.
They conducted a retrospective analysis of 104 patients who had symptomatic partial-thickness rotator cuff tear repair at a single institution between 2010 and 2015. Data was collected on range of motion, pain score measured on the Numeric Pain Rating Scale, and outcome scores (Constant-Murley score, University of California, Los Angeles shoulder score and Oxford Shoulder Score) preoperatively and again at 1 year and 2 years post-surgery.
All the rotator cuff tears involved the supraspinatus tendon and were no larger than 2cm. Sixty-five of the patients had an articular-sided tear and 38 had a bursal-sided tear. The mean age of the patients in the articular-sided group was 53.4 years and 55.8 years in the bursal-sided group.
Before the surgery, there were no significant differences in age, sex, or measured outcome parameters between the two groups. And postoperatively, the patients in both groups achieved significant improvement in pain relief and functional outcomes at the 2-year follow-up.
Overall, there was no difference between the two groups in range of motion in forward flexion (p = .781) or abduction (p =.348), pain score (p = .187), Constant-Murley score (p = .186), University of California, Los Angeles shoulder score (p = .911) and Oxford Shoulder Score (p = .186) at 2 years.
The researchers wrote, “Partial-thickness rotator cuff tears treated with arthroscopic tear completion and subsequent repair achieved good outcomes in terms of Range of Motion, functional outcomes, and pain relief at 2 years. There was no difference in outcomes regardless of whether the location of the tear was articular-sided or bursal-sided.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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