Mid-Term Clinical Results after Open Rotator Cuff Reconstruction in Double-Row Technique with Titanium Anchor Screws

Background: The double-row rotator cuff repair is discussed controversially. Despite improved biomechanical properties, reduced re-tear rates and higher costs, no significant difference compared to single-row fixation in the clinical results is found. Mid-term results of an open double-row fixation with titanium anchor screws are presented. Material and Methods: 237 patients (m=142, f=95, median age: 56.3 years) were operated in 2007 with this technique by the senior author (M.G.). Preoperatively, 2 years and 4,5 years postoperatively a subjective shoulder score (SSG) with follow-up rates of 86, 87 and 83%, was evaluated. 5.1 years postoperatively an objective evaluation of 131 patients using the Constant-Murley scores (CS), the simple shoulder tests (SST), Gerbers shoulder value and the evaluation with school grades followed. The integrity of the cuff was checked with ultrasound. The absolute (re-tears and partial re-tears) and the relative (re-tears, partial re-tears, thinning and thickening of the cuff) re-tear rates were evaluated. Results: In SSG a highly significant improvement from 51 to 83 points was found (p<0.001). In CS80 points (min.: 18; max.: 100), and in SST 11 points (min.: 2; max.: 12) were achieved. The shoulder value of Gerber increased significantly from preoperative 28.1 to 84.5% 5.1 years postoperative (p<0.001).The absolute re-tear rate, evaluated in ultrasound was 7.6%, the relative re-tear rate 17.6%. For primary rotator cuff reconstructions a higher CS with 82 points and a lower relative re-tear rate with 10.5% were found. The patients age had no significant influence on the clinical outcome. The rupture size showed a significant impact on the re-tear rate and the scores (p<0.05). Between the operated and healthy shoulder neither strength nor mobility were found to be significantly different. Men reached a highly significant better strength than women (p<0.001) which also resulted in a significantly better outcome in the CS (p<0.01). The costs for open titanium transfixation technique with 330Euro per case are markedly less than for arthroscopic suture bridge technique with 600 to 1000Euro per case. Conclusion: Open double-row cuff repair with titanium screws is a safe and cost effective technique with a low re-tear rate with comparable clinical results regarding open and arthroscopic procedures.