Objectives

This study evaluated the mechanical performance, under low-load cyclic loading, of two different knotless suture anchor designs: sutures completely internal to the anchor body (SpeedScrew) and sutures external to the anchor body and adjacent to bone (MultiFIX P).

Purpose: A major issue in the Canadian health care system are the extensive wait times for consultation with an orthopaedic surgeon. We identified that a high percentage of patients referred to shoulder surgery sub-specialists for chronic full thickness rotator cuff tears had not undergone appropriate non-operative treatment prior to being referred, and ultimately did not require surgery. In an effort to improve the referral process and to optimize patient care, we sought to identify clinical predictors for outcome of non-operative treatment of chronic full-thickness rotator cuff tears. This would allow general practitioners to clearly identify patients who are most likely to fail non-operative treatment and actually require surgical consultation. The primary purpose of this study was to determine if the outcome of non-operative treatment in chronic, symptomatic, full-thickness rotator cuff tears could be predicted based upon presenting clinical characteristics, including: age, dominant extremity involvement, gender, duration of symptoms, onset (acute or chronic), forward elevation range of motion, external rotation strength, size of tear, smoking status, and the Rotator Cuff Quality of Life Questionnaire score (RCQOL).

Method: Fifty patients, between the ages of 40 and 85 years, with a documented full-thickness tear on ultrasound or magnetic resonance imaging (MRI), were recruited prospectively. They underwent a three month home-based program of non-operative treatment under the supervision of an experienced physiotherapist and sport medicine physician. At the conclusion of the three month program, patients were evaluated by an orthopaedic surgeon and were defined as having been successful or as having failed non-operative treatment. Successful patients declined surgical treatment after consulting with the surgeon, whereas failed patients elected to undergo surgery, or, if avoiding surgery for other health or “life” reasons, had not experienced adequate improvement with the non-operative program to have been considered successful. The patient’s baseline clinical characteristics were analyzed using logistic regression to determine which characteristics were predictive of outcome.

Results: Thirty-eight of 50 (76%) of patients were successful with the non-operative program. Univariate analysis showed that a patient’s Rotator Cuff Quality of Life questionnaire score was a significant predictor of outcome of non-operative treatment (p = 0.017). Patients who were successful with non-operative treatment had a mean baseline RCQOL score of 49/100, whereas patients who failed non-operative treatment had a mean baseline RCQOL score of 31/100. The two factors of patient age and dominant extremity involvement also trended toward significance.

Conclusion: Baseline RCQOL score can predict which patients will be successful with non-operative treatment and which patients will fail non-operative treatment for a chronic, full-thickness rotator cuff tear.

Purpose: Arthroscopic repair of type II SLAP lesions can lead to improved clinical outcomes. However, the structural integrity of arthroscopically repaired type II SLAP lesions is unknown. The purpose of this study was to evaluate the clinical outcome of arthroscopically repaired type II SLAP lesions, and to evaluate the appearance of the repair on MRI arthrogram performed at least 1 year post-operatively.

Method: Between March 2003 and June 2006, the senior author performed isolated repairs of 25 type II SLAP lesions in 25 patients (18 male, 7 female) with a mean age of 40 +/− 12 years. The mean duration of symptoms was 32 months. None of the patients had undergone previous surgery on the affected shoulder. All tears were repaired using standard arthroscopic suture anchor repair to bone. All patients were reviewed using a standardized clinical examination by a blinded, independent observer, and using the ASES shoulder index and the simple shoulder test (SST). Paired and unpaired t-tests were used to determine significant differences between pre-operative and post-operative scores and re-torn and intact SLAP repairs, respectively. A p< 0.05 was considered statistically significant. In addition, 20 of the 25 patients were evaluated by MRI arthrography at least 1 year post-operatively which was interpreted by a musculoskeletal trained radiologist who was blinded to the patient’s clinical outcome.

Results: Follow-up was an average of 24.9 months. The mean ASES scores improved from 51.7 pre-operatively to 86.3 Follow-up was an average of 24.9 months. The mean ASES scores improved from 51.7 pre-operatively to 86.3 post-operatively (p< 0.0001) and the SST scores from 7.76 to 10.76 (p< 0.001). Twenty-two out of the 25 patients stated that they would have surgery again and there was a mean patient satistifaction of 8.7+/− 1.4 out of 10. Of the 20 patients who had post-operative MRI arthrograms, no patient had an obvious recurrent type II SLAP lesion, 8 patients had equivocal MRI arthrograms with a small amount of Gadolium insinuiating between labum and bone, and 12 patient had a completely intact superior labrum. There was no significant difference in ASES, SST and patient satisfication scores between patients with equivocal or competely intact repairs (ASES= 87.7 versus 85.4; p = 0.71; SST = 10.8 versus 10.8; p = 0.97; Pt satistifaction = 8.2 versus 8.8; p = 0.40). However, of the three patients who were not satisfied with the procedure (i.e. would not have the surgery again) two had postoperative MRI arthograms and both had equivocal SLAP repairs.

Conclusion: Clinical outcomes following arthroscopic repair of type II SLAP lesions showed statistically significant improvement in shoulder scores from pre to post-operative. MRI arthrogram results do not necessarily correlate with clinical outcome.