Tratamiento mediante hilera única versus transóseo doble hilera en las roturas del manguito de los rotadores de tamaño pequeño y medio. Estudio prospectivo y aleatorizado

Abstract

Introduction

The best technique for arthroscopic repair of rotator cuff tears is still not clear. Several studies point to an improvement, in biomechanical terms, of repairs in double row. However, few studies have demonstrated clinical superiority of repair in double row, and these have been mainly on large ruptures.

Objective

The objective of this study was to evaluate the clinical differences using the Constant score between two arthroscopic techniques for small and medium-sized tears of the supraspinatus, and to assess the costs and benefits of both techniques.

Material and methods

Prospective, randomised, study involving 114 patients with tears of up to 3 cm of the supraspinatus tendon, diagnosed by magnetic resonance imaging, with failure of up to three months conservative treatment. Patients were randomised into two different surgical techniques: Classic single row technique with one or two anchors in 5.5 mm PEEK, with 3-wire and transosseous-equivalent (TOE) with two anchors 5.5 mm PEEK, 3-wire, medial, and two knotless lateral anchors. All patients were operated on by the same surgeon. All patients underwent the same rehabilitation program.

Patients were evaluated before and at 12 months after the operation by an independent evaluator and using the Constant score.

Results

Results were obtained on 108 patients, after excluding three post-operative complications unrelated to the surgical technique, and loss of follow up of three other patients. The characteristics of both groups, in terms of demographics, rupture dimension and pre-surgical Constant score were analysed, with no significant differences being found. The mean post-surgical Constant score for the single row group was 79, and the TOE group of 78, not having a statistically significant difference. As regards the difference between the pre and post-surgery scores, the mean difference in the single row group was 50, and in the TOE group it was 55, also without significant statistical difference. In patients with abnormally low results (4 cases), a post-operative MRI was performed, with two cases of re-rupture identified for each technique.

Conclusion

In our sample, with the techniques described, no differences in clinical outcome between the two techniques were identified. No differences were observed in the rate of re-rupture between the two techniques. Based on our results, the cost benefit ratio is unfavourable for the TOE technique.