Abstract
Background
To reduce the healthcare burden, the clinical results of arthroscopic rotator cuff
repair and the cost of the implants used have recently been focused upon. This study
compared implant cost, surgical time, short-term clinical results, and cuff repair
integrity 2 years postoperatively between arthroscopic transosseous rotator cuff repair
using lateral cortical augmentation (TOA) and arthroscopic transosseous-equivalent
suture bridge (TOE).
Methods
This study included 220 patients with rotator cuff repairs performed by a single surgeon
between December 2013 and December 2018. Overall, 70 TOA and 68 TOE cases met the
inclusion criteria. The same surgeon performed the procedures at two different hospitals,
and the techniques differed between the facilities. A total of 42 TOA patients were
matched with 42 TOE patients. The patients were matched using a propensity score analysis
by gender, age, and cuff tear size. The minimum follow-up period was 2 years. Implant
cost and surgical time were compared between the two methods. The range of motion,
clinical outcomes, and visual analog scale were evaluated. Magnetic resonance imaging
was performed to examine cuff repair integrity 2 years postoperatively.
Results
The follow-up rate was 81% (112/138 patients). Implant cost was significantly lower
with TOA ($1,396 vs. $2,165; p < 0.001) than with TOE. The average surgical time in
the TOA method was significantly shorter than that in the TOE method (82 vs. 109 min;
p = 0.001). At a minimum 2-year follow-up, the mean active elevation, abduction, and
clinical outcomes improved with both methods, although no improvements in external
and internal rotations were observed with either method. There were no significant
differences in the postoperative variables and retear rate (TOA, 12%; TOE, 19%; p = 0.548)
between the two methods.
Conclusions
TOA and TOE achieved comparable clinical results; however, TOA was more cost-effective
and had a shorter surgical time than TOE.
Level of evidence
Level Ⅲ, retrospective matched control study.
Keywords
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Article info
Publication history
Published online: February 21, 2023
Accepted:
February 4,
2023
Received in revised form:
January 15,
2023
Received:
November 2,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Published by Elsevier B.V. on behalf of The Japanese Orthopaedic Association.
