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Outcomes of Rotator Cuff Repair with Concurrent Microfracture of Focal Glenohumeral Osteoarthritis

Author

J Shoulder Elbow Surg. 2021 Apr 20;S1058-2746(21)00366-9. doi: 10.1016/j.jse.2021.04.008.Online ahead of print.

Brian W Hill 1Arjun M Singh 1Matthew Astolfi 1J Gabe Horneff 1Bradley S Schoch 2Joseph A Abboud 3

Author Information

1 Department of Orthopaedic Surgery, The Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.

2 Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, FL, USA.

3 Department of Orthopaedic Surgery, The Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA. Electronic address: joseph.abboud@rothmanortho.com.

Abstract

Background: The benefit of rotator cuff repair (RCR) in patients with concurrent osteoarthritic changes remains unclear. Rotator cuff repair has the theoretical potential to increase the compressive force across the glenohumeral joint, further exacerbating osteoarthritis pain. The purpose of this study is to investigate pain relief and patient reported outcomes of patients undergoing simultaneous RCR and microfracture of focal glenohumeral osteoarthritis.

Methods: Thirty-four patients undergoing simultaneous rotator cuff repair and microfracture were retrospectively reviewed at a minimum one-year follow-up. Patient demographics, preoperative range of motion, functional outcomes (VAS, SANE, ASES, and SST) and operative metrics were recorded. The patients were then contacted to obtain postoperative functional outcome scores (VAS, SANE, ASES and SST).

Results: Twenty-seven patients (11 male/16 female (79%)) were evaluated at a mean follow-up of 25.8 months (range, 12-46). The average age at surgery was 64.9 years (range, 56-78). Chronic tears were more common than acute tears, (57.7% vs 42.3%). The majority of patients had a full rotator cuff tear (89%) involving a mean 1.7 ± .8 tendons (range, 1-3). Eighty-eight percent of the humeral lesions were Outerbridge 4 compared with 84% on the glenoid. The mean estimated involvement between the two groups with 38.4% ± 18.4 of the humeral head involved and 34.6% ± 18.4 of the glenoid involved. PROs scores improved postoperatively with a reduction in mean VAS (6.6 to 2.0, p<0.01), SANE, (33.8 to 79.8, p<0.01), ASES (38.0 to 80.9, p<0.01) and SST (3.07 to 9.70, p<0.01). Cumulatively, only 52% (14/27) of the patients improved by the MCID for all collected PROs however.

Conclusions: Our results demonstrate modest improvements in postoperative pain and functional scores at a minimum of one year follow-up in a cohort of patients who have undergone rotator cuff repair and glenohumeral microfracture. In cases of small focal lesions of full thickness cartilage loss, RCR with microfracture is a reasonable treatment option however patients should be counseled to expectations accordingly.