Comparison of the clinical outcomes after in situ transtendinous and "all-inside" repair technique for partial-thickness articular-sided rotator cuff tears

Objective - To compare the functional results of the arthroscopic transtendinous repair and «All-inside» technique in patients with partial-thickness articular-sided rotator cuff tears, with a depth of 50-90% of the tendon thickness. Material and methods. The study with the formation of two compared groups containing 91 patients older than 55 years with symptomatic partial atraumatic rupture of the articular surface of the supraspinatus tendon, with a depth of 50-90% of the tendon thickness. After subacromial decompression, 49 patients of group I underwent transtendon repair. 42 patients of group II had a suture according to the «all-inside» technique. Each group contained two subgroups of patients with retraction articular portion of the cuff (38 observations) and patients without retraction (53 observations). The clinical outcomes was assessed using the Constant score before treatment, as well as after 24 months. During the entire study period, 91 patients were monitored, among whom were 20 women and 71 men, the average age was 65±8,9 years. There were no statistically significant differences in the overall structure of patients in the study groups. In a comparative assessment of treatment efficacy, t-tests were used for dependent and independent samples with a confidence interval of 95%. Results. The summary functional results of patients without retraction of the articular layer rotator cuff, did not differ significantly (p = 0.178) when using a transtendon suture (78.5 ± 11.2) and the «all-inside» repair technique (81.3 ± 10.4), however, the pain syndrome and the range of motion in the shoulder joint were better (p = 0.015 and 0.029, respectively) after «all-inside» suture. In patients with retraction of the articular portion of rotator cuff, the functional results were significantly better (p = 0.023) after the «all-inside» technique with an summary Constant score, and persistent contracture due to postoperative adhesive capsulitis was observed only after transtendon fixation of the cuff (3 observations, 13,6%). In cases where there was no retraction of the articular layer of the cuff, both during the summary assessment on the Constant score and on the subscores, there were no significant differences between the compared techniques of arthroscopic suture. Conclusion. To choice the method of surgical fixation of the tendons of the rotator cuff of the shoulder, partially torn from the articular side, it is necessary to take into account the stratification of the damaged tendon and the retraction of the articular joint layer, in addition to determining the depth and location of the damage. In the presence of retraction, it is more efficient to perform the «all-inside» repair technique.