It is common for patients and physicians to prefer the arthroscopic rotator cuff repair over the mini open repair. There is no doubt that arthroscopic surgery is the treatment of choice when the rotator cuff tear is small and involves one tendon. In an era of "small incision" and "high tech" surgery it is difficult to educate patients about outcomes and cost effectiveness. The operating time difference between the mini open repair that respects the fibers of the deltoid (without deltoid detachment) and arthroscopic rotator cuff repair is significant when there is a massive rotator cuff tear. A 3 or 4 hour anesthesia for a repair of a massive rotator cuff tear imposes dangers to the patient without a doubt. When a mini open rotator cuff tear for the same size tear takes 60 minutes to complete then the mini open repair is superior in terms of safety and cost effectiveness. We perform both mini open and arthroscopic surgery for rotator cuff tears and with the three cases demonstrated below the readers of this blog will see that there is no difference in the outcomes at one year after the surgery. This conclusion can be drawn due to the large number of studies demonstrating the equality of the two techniques.
CASE No 1: The first case is 40 year old male who had a traumatic tear as a result of an injury at work. He is a truck driver. He presented in the office with weakness in his forward elevation of the shoulder and active forward flexion of 50 degrees. Because of a retained metallic implant in his body it was not possible to evaluate his rotator cuff with an MRI after his injury. Instead a CT arthrogram was obtained which does demonstrate the retraction and severity of the rotator cuff tear that he had at the time of evaluation.
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| CT arthrogram showing the torn tendon. CLICK ON IMAGE FOR LARGE VERSIO |
For the mini open approach an incision measuring 6-8 cm in length was made on shoulder just inferior to the acromion parallel to the skin Langer's lines for better cosmetic result.
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Intra-operatively we found a retracted supraspinatus tendon tear as demonstrated in the pictures below.
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A mini open rotator cuff tear repair was performed achieving full coverage of the footprint of the rotator cuff. We always aim for a tension free repair.
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Intra-operative video of the repaired rotator cuff.
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His rehab protocol consisted of passive and assisted ROM to the shoulder for 3 months, then a subsequent 3 month period of progressive strengthening.
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At one year postoperatively, he had active forward elevation to 170 degrees as demonstrated in the picture below.
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CASE No 2: The second case is a 50 year old female who presented in the office with shoulder pain and a retracted rotator cuff tear as demonstrated on MRI.
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Her active forward elevation was to 70 degrees prior to surgery and had weakness in shoulder abduction. She underwent an arthroscopic rotator cuff repair for a retracted tear of the rotator cuff.
Arthroscopic pictures are demonstrated below.
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| View anterolateral arthroscopy portal. CLICK ON IMAGE FOR LARGE VERSION |
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| Posterior intra-articular viewing portal |
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| Traction sutures aim the reduction of the tendon to the footprint |
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| Final repair |
At one year after surgery her active forward elevation was to 170 degrees as demonstrated above.
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