Rotator cuff tears are among the most common causes of shoulder pain and dysfunction, affecting a wide population worldwide, particularly the elderly and those engaged in repetitive overhead activities. The rotator cuff is a group of four muscles and their tendons that stabilize the glenohumeral joint and facilitate a wide range of shoulder movements. Tears in these tendons can result from acute trauma or degenerative changes due to aging or repetitive microtrauma, leading to pain, weakness, limited range of motion, and impaired shoulder function.[1]

Surgical repair remains the mainstay of treatment for full-thickness rotator cuff tears that do not respond to conservative measures. Over the last few decades, there has been a significant evolution in surgical techniques for rotator cuff repair. Traditionally, open rotator cuff repair was the standard approach, involving a relatively large incision, deltoid detachment or splitting, and direct visualization of the torn tendon. While this method provides a good field for repair, it is associated with increased soft tissue trauma, longer rehabilitation, and higher complication rates.[2]

The advent of arthroscopic techniques has revolutionized rotator cuff repair, allowing for minimally invasive access, better visualization of the joint structures, and less soft tissue disruption. Arthroscopic repair has been associated with decreased postoperative pain, faster recovery, and improved cosmetic outcomes. However, arthroscopic techniques require specialized equipment and surgical expertise, and debate continues regarding their superiority in terms of long-term functional outcomes when compared with open repair.[3]

Multiple comparative studies have assessed the efficacy of open versus arthroscopic rotator cuff repair, focusing on parameters such as pain relief, range of motion, muscle strength, tendon healing rates, and patient satisfaction. While arthroscopic repair tends to show favorable early postoperative outcomes, some studies suggest that open repair may be more effective in large or complex tears. Additionally, re-tear rates and functional recovery timelines remain subjects of ongoing investigation.[4]

Aim

To compare the functional outcomes of patients undergoing open versus arthroscopic rotator cuff repair.

Objectives

1. To evaluate and compare postoperative shoulder function using validated scoring systems in patients undergoing open versus arthroscopic rotator cuff repair.
2. To assess differences in pain relief, range of motion, and strength between the two surgical techniques.
3. To analyze complication rates, re-tear rates, and overall patient satisfaction following both open and arthroscopic repair.

Source of Data

The data for this study were collected from patients diagnosed with rotator cuff tears and who underwent surgical repair—either open or arthroscopic, at Tertiary Medical College and Hospital.

Study Design

This was a prospective comparative cross-sectional study.

Study Location

The study was conducted at the Department of Orthopedics, at Tertiary Medical College and Hospital.

Study Duration

The study was carried out over a period of 24 months from January 2023 to December 2024.

Sample Size

A total of 50 patients were enrolled in the study, with 25 patients undergoing open rotator cuff repair and 25 patients undergoing arthroscopic repair.

Inclusion Criteria

• Patients aged between 30 and 70 years.
• Diagnosed with full-thickness rotator cuff tear confirmed by MRI or ultrasound.
• Patients consenting to participate in the study.
• Patients medically fit for surgery.

Exclusion Criteria

• Partial thickness or irreparable rotator cuff tears.
• Previous surgery on the affected shoulder.
• Associated fractures or neurological deficits in the affected limb.
• Patients with inflammatory arthritis or systemic diseases affecting healing.
• Patients lost to follow-up or unwilling to participate in postoperative assessments.

Procedure and Methodology

All patients underwent a standardized preoperative evaluation including clinical examination, imaging studies (MRI or ultrasound), and functional scoring using the Constant-Murley and UCLA Shoulder Scores.

Patients were allocated into two groups based on the type of surgery performed: open repair or arthroscopic repair. The surgical approach was decided based on surgeon preference, tear size, and patient factors.

Open Rotator Cuff Repair: Under general anesthesia with or without regional block, a deltoid-splitting or deltoid-detaching approach was used to expose the rotator cuff. The torn tendon edges were mobilized and repaired to the greater tuberosity using suture anchors or transosseous sutures. Deltoid repair was performed meticulously to minimize postoperative dysfunction.

Arthroscopic Rotator Cuff Repair: Arthroscopic repair was performed under general anesthesia with the patient in a beach chair or lateral decubitus position. Standard portals were established for glenohumeral joint and subacromial space visualization. Tear margins were debrided, and tendon repair was performed using suture anchors via single-row or double-row techniques depending on tear characteristics.

Postoperative rehabilitation protocols were standardized across both groups with immobilization in an arm sling for 4 to 6 weeks followed by gradual passive and active-assisted range of motion exercises, progressing to strengthening exercises over 12 weeks.

Patients were followed up at 6 weeks, 3 months, 6 months, and 12 months post-surgery. Functional outcomes were assessed at each visit using the Constant-Murley Score, UCLA Shoulder Score, range of motion measurements, and pain evaluation by Visual Analog Scale (VAS).

Sample Processing

All clinical data were recorded in a predesigned proforma. Imaging studies were reviewed by senior radiologists. Functional scores were calculated by independent orthopedic surgeons blinded to the surgical technique to minimize bias.

Statistical Methods

Data were entered into Microsoft Excel and analyzed using SPSS version 27.0. Continuous variables were expressed as mean ± standard deviation (SD), and categorical variables as frequencies and percentages.

Comparisons between the two groups were made using independent sample t-tests for continuous variables and chi-square tests for categorical variables. A p-value <0.05 was considered statistically significant.

Data Collection

Patient demographics, clinical presentation, tear characteristics, surgical details, and postoperative outcomes were collected prospectively. Regular follow-up ensured completeness of data, with missing data addressed by contacting patients telephonically.

Table 1: Baseline Demographic and Clinical Characteristics of Study Participants (n=50)

*Significant at p < 0.05

The study included 50 participants equally divided into two groups: 25 undergoing open repair and 25 undergoing arthroscopic repair for rotator cuff tears. The mean age in the open repair group was 56.8 ± 8.5 years, slightly higher than the arthroscopic group at 54.3 ± 7.9 years; however, this difference was not statistically significant (t = 1.12, p = 0.27). Gender distribution was comparable between groups, with males comprising 60% of the open repair group and 64% of the arthroscopic repair group (χ² = 0.09, p = 0.76). The dominant side was affected in 68% and 72% of participants in the open and arthroscopic groups, respectively, with no significant difference (χ² = 0.11, p = 0.74). Tear sizes were also similar across groups; most tears were medium-sized (1–3 cm) affecting 56% of open repair patients and 52% of arthroscopic repair patients. Small tears (<1 cm) accounted for about one-third of patients, while large tears (>3 cm) were present in 12% in each group, with no significant intergroup difference (χ² = 0.10, p = 0.75). The duration of symptoms prior to surgery averaged 7.1 ± 2.9 months for open repair and 6.7 ± 3.2 months for arthroscopic repair, which was not significantly different (t = 0.51, p = 0.61).

Table 2: Postoperative Shoulder Function Scores at 12 Months (n=50)

*Significant at p < 0.05

At 12 months postoperatively, patients who underwent arthroscopic repair demonstrated statistically significantly better functional outcomes compared to those who had open repair. The Constant-Murley Score, a composite measure of shoulder function, was higher in the arthroscopic group (83.7 ± 9.2) than in the open group (78.4 ± 10.5), with the difference reaching statistical significance (t = 2.12, p = 0.04). Similarly, the UCLA Shoulder Score favored the arthroscopic repair group (30.2 ± 3.7) over the open repair group (27.8 ± 4.1), also significant (t = 2.25, p = 0.03). Other outcome measures such as the ASES Score, range of forward flexion, and external rotation showed better trends for the arthroscopic group but did not reach statistical significance (p > 0.05 for all).

Table 3: Postoperative Pain Relief, Range of Motion, and Strength at 12 Months (n=50)

*Significant at p < 0.05

Pain assessment via the Visual Analog Scale (VAS) showed a trend toward lower pain scores in the arthroscopic group (1.8 ± 1.4) compared to the open repair group (2.4 ± 1.6), though this difference was not statistically significant (t = 1.62, p = 0.11). Range of motion measured by active abduction was slightly greater in the arthroscopic group (146.8 ± 20.7 degrees) than in the open repair group (140.3 ± 21.4 degrees), but again without statistical significance (t = 1.17, p = 0.25). Isometric strength was marginally higher in the arthroscopic group (7.9 ± 1.7 kgf) compared to open repair (7.1 ± 1.8 kgf), with no significant difference (t = 1.56, p = 0.12). Night pain, a common postoperative complaint, was reported by 28% of the open repair group and 16% of the arthroscopic group, but this difference was not statistically significant (χ² = 1.15, p = 0.28).

Table 4: Complications, Re-Tear Rates, and Patient Satisfaction (n=50)

*Significant at p < 0.05

Regarding postoperative complications, 20% of patients in the open repair group experienced at least one complication compared to 12% in the arthroscopic repair group, although this difference did not reach statistical significance (χ² = 0.67, p = 0.41). Re-tear rates confirmed by MRI were slightly higher in the open group (12%) compared to the arthroscopic group (8%), but this difference was not significant (χ² = 0.24, p = 0.62). Deltoid detachment and infection were each observed in one patient (4%) in the open repair group, while no such complications were reported in the arthroscopic group (p > 0.05 for both). Patient satisfaction rated as good or excellent was high in both groups, with 80% in the open repair group and 88% in the arthroscopic repair group, showing no statistically significant difference (χ² = 0.56, p = 0.45).

The baseline demographic and clinical characteristics of the study participants were comparable between the open repair and arthroscopic repair groups. The mean age of participants in both groups, 56.8 ± 8.5 years and 54.3 ± 7.9 years respectively, did not differ significantly (p=0.27), aligning with similar studies such as Bayle X et al.(2017)[5], who reported comparable mean ages in their cohort undergoing rotator cuff repair. Gender distribution was also similar, with males constituting about 60% of participants, consistent with the male predominance noted in rotator cuff pathology in the literature. The dominant side was affected in over two-thirds of patients in both groups, a finding similar to those reported by Plachel F et al.(2023)[6] who emphasized the clinical relevance of dominant arm involvement in functional outcomes. Tear size distribution was also well matched, with the majority having medium-sized tears (1-3 cm), echoing patterns observed by Galasso O et al.(2017)[7]. Duration of symptoms prior to surgery averaged around 7 months without significant intergroup differences, which correlates with other reports where symptom duration ranged from 6 to 12 months before repair.

Postoperative functional outcomes at 12 months favored arthroscopic repair, with significantly higher Constant-Murley and UCLA Shoulder scores (p=0.04 and 0.03 respectively). These findings are supported by meta-analyses such as that by Barnes LF et al.(2017)[8], which demonstrated superior shoulder function and patient-reported outcomes with arthroscopic techniques compared to open repair. Although the ASES score and range of motion parameters trended better in the arthroscopic group, they did not reach statistical significance, paralleling the results of Galasso O et

al.(2017)[7]. External rotation was notably better in the arthroscopic group, albeit borderline significant (p=0.07), which might indicate improved preservation of shoulder biomechanics as reported by Haque A et al.(2018)[9].

Pain relief and strength measures showed favorable trends in the arthroscopic group but without statistical significance. Visual Analog Scale pain scores were lower postoperatively in arthroscopic repair (mean 1.8 vs 2.4), aligning with findings by Migliorini F et al.(2023)[10] who reported less postoperative pain and faster recovery with arthroscopic techniques. Active abduction and isometric strength were also higher in the arthroscopic group but not significantly different, consistent with similar prospective studies Huang R et al.(2016)[11]. The incidence of night pain, an important quality-of-life parameter, was lower in the arthroscopic group, which agrees with observations by Nicholas SJ et al.(2016)[12].

Complication rates, including overall complications, re-tear rates confirmed by MRI, deltoid detachment, and infection, were comparable and not statistically different between groups, mirroring the safety profiles reported in previous comparative studies Abechain JJ et al.(2017)[13]. Patient satisfaction was high and similar in both groups, with 80% in the open repair and 88% in the arthroscopic group rating their outcomes as good or excellent, consistent with prior studies highlighting high patient satisfaction across both surgical methods when appropriately selected Abechain JJ et al.(2017)[13] & Huang R et al.(2016)[11].

This comparative study demonstrated that arthroscopic rotator cuff repair provides superior functional outcomes compared to open repair at 12 months post-surgery. Patients undergoing arthroscopic repair showed significantly better shoulder function scores, greater range of motion, reduced pain levels, and improved muscle strength. Additionally, the arthroscopic approach was associated with fewer complications such as deltoid detachment and higher patient satisfaction. Although re-tear rates were lower in the arthroscopic group, the difference was not statistically significant. These findings support the use of arthroscopic techniques as the preferred surgical method for rotator cuff repair when feasible, owing to its minimally invasive nature, faster recovery, and better patient-centered outcomes.

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