Technique for Margin Convergence in Rotator Cuff Repair

Michael K. Shindle, MD
Summit Medical Group

Shane J. Nho, MD
Department of Orthopedic Surgery, Hospital for Special Surgery

Denis Nam, MD
Department of Orthopedic Surgery, Hospital for Special Surgery

John D. MacGillivray, MD
John D. MacGillivray, MD
Associate Attending Orthopedic Surgeon, Hospital for Special Surgery
Associate Professor of Clinical Orthopedic Surgery, Weill Cornell Medical College
Frank A. Cordasco, MD, MS
Frank A. Cordasco, MD, MS
Attending Orthopedic Surgeon, Hospital for Special Surgery
Professor of Orthopedic Surgery, Weill Cornell Medical College
David W. Altchek, MD
David W. Altchek, MD
Attending Orthopedic Surgeon, Hospital for Special Surgery
Co-Chief Emeritus, Sports Medicine, Hospital for Special Surgery
Russell F. Warren, MD
Russell F. Warren, MD
Attending Orthopedic Surgeon, Hospital for Special Surgery
Professor of Orthopedic Surgery, Weill Cornell Medical College

Abstract

The purpose of the present study is to describe the technique of margin convergence for U-shaped rotator cuff tears and report the clinical outcomes and ultrasonography with a minimum of 2 years follow-up. Three hundred eleven patients with a rotator cuff tear were prospectively enrolled in a registry at one institution. Inclusion criteria included any patient undergoing arthroscopic margin convergence for a rotator cuff tear. Exclusion criteria included open or mini-open rotator cuff repairs or suture anchor fixation to the cuff insertion without margin convergence. The outcome measurements included physical examination, manual muscle testing, the American Shoulder and Elbow Surgeons (ASES) score, and ultrasonography. Nineteen patients met the study criteria and 13 were available for 2-year follow-up (68.4%). The mean age of this cohort was 62.2 ± 7.5 years with a mean pre-operative rotator cuff tear size of 4.0 ± 1.6 cm. The ASES score increased significantly from 50.0 ± 17.7 before surgery to 83.3 ± 19.5 at 2 years (P = 0.01). The active forward elevation also improved from 156.2 ± 11.9° before surgery to 168.0 ± 12.1 at 2 years (P = 0.03). The active external rotation 54.4 ± 14.5 at baseline and improved to 57.1 ± 19.1 at 2 years (P = 0.04). The strength also increased significantly from 6.7 ± 6.4 to 10.6 ± 4.9 lb at 1 year (P = 0.048). The post-operative ultrasound demonstrated that 46.2% of rotator cuff tears were healed at 2 years. In conclusion, margin convergence is a useful technique for U-shaped tears that are difficult to mobilize.

This article appears in HSS Journal: Volume 7, Number 3.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports
 

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