HSS Journal

, 7:208 | Cite as

Technique for Margin Convergence in Rotator Cuff Repair

  • Michael K. Shindle
  • Shane J. Nho
  • Denis Nam
  • John D. MacGillivray
  • Frank A. Cordasco
  • Ronald S. Adler
  • David W. Altchek
  • Russell F. Warren
Original Article

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.

Keywords

margin convergence rotator cuff shoulder arthroscopy 

References

  1. 1.
    Bretzke CA, Crass JR, Craig EV, Feinberg SB, Ultrasonography of the rotator cuff. Normal and pathologic anatomy. Invest Radiol. 1985;20:311–5.PubMedCrossRefGoogle Scholar
  2. 2.
    Burkhart SS, Athanasiou KA, Wirth MA, Margin convergence: a method of reducing strain in massive rotator cuff tears. Arthroscopy. 1996;12:335–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Burkhart SS, Danaceau SM, Pearce CE, Arthroscopic rotator cuff repair: analysis of results by tear size and by repair technique-margin convergence versus direct tendon-to-bone repair. Arthroscopy. 2001;17:905–12.PubMedCrossRefGoogle Scholar
  4. 4.
    Calvert PT, Packer NP, Stoker DJ, Bayley JI, Kessel L, Arthrography of the shoulder after operative repair of the torn rotator cuff. J Bone Joint Surg Br. 1986; 68:147–50.PubMedGoogle Scholar
  5. 5.
    Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K, The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am. 2004;86:219–24.PubMedGoogle Scholar
  6. 6.
    Gerber C, Fuchs B, Hodler J, The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am. 2000;82:505–15.PubMedGoogle Scholar
  7. 7.
    Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC, Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res, 1994;304:78–83.PubMedGoogle Scholar
  8. 8.
    Harryman DT, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA, Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am. 1991; 73:982–9.PubMedGoogle Scholar
  9. 9.
    Hodler J, Fretz CJ, Terrier F, Gerber C, Rotator cuff tears: correlation of sonographic and surgical findings. Radiology. 1988;169:791–4.PubMedGoogle Scholar
  10. 10.
    Huijsmans PE, Pritchard MP, Berghs BM, van Rooyen KS, Wallace AL, de Beer JF, Arthroscopic rotator cuff repair with double-row fixation. J Bone Joint Surg Am. 2007;89:1248–57.PubMedCrossRefGoogle Scholar
  11. 11.
    Klepps S, Biship J, Lin J, Cahlon O, Strauss A, Hayes P, Flatow EL, Prospective evaluation of the effect of rotator cuff integrity on the outcome of open rotator cuff repairs. Am J Sports Med. 2004;32:1716–22.PubMedCrossRefGoogle Scholar
  12. 12.
    Liu SH, Baker CL, Arthroscopically assisted rotator cuff repair: correlation of functional results with integrity of the cuff. Arthroscopy. 1994;10:54–60.PubMedCrossRefGoogle Scholar
  13. 13.
    Mack LA, Nyberg DA, Matsen FA, 3rd, Sonographic evaluation of the rotator cuff. Radiol Clin North Am. 1988;26:161–77.PubMedGoogle Scholar
  14. 14.
    Michener LA, McClure PW, Sennett BJ, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg, 2002;11:587–94.PubMedCrossRefGoogle Scholar
  15. 15.
    Middleton WD, Reinus WR, Totty WG, Melson CL, Murphy WA, Ultrasonographic evaluation of the rotator cuff and biceps tendon. J Bone Joint Surg Am. 1986;68:440–50.PubMedGoogle Scholar
  16. 16.
    Nho, S, Shindle MK, Adler RS, Warren RF, Altchek DW, MacGillivray JD. Prospective analysis of arthroscopic rotator cuff repair: subgroup analysis. J Shoulder Elbow Surg. 2009;18:697–704.PubMedCrossRefGoogle Scholar
  17. 17.
    Packer NP, Calvert PT, Bayley JI, Kessel L, Operative treatment of chronic ruptures of the rotator cuff of the shoulder. J Bone Joint Surg Br. 1983;65:171–5.PubMedGoogle Scholar
  18. 18.
    Thomazeau H, Boukobza E, Morcet N, Chaperon J, Langlais F, Prediction of rotator cuff repair results by magnetic resonance imaging. Clin Orthop Relat Res. 1997;344:275–83.PubMedCrossRefGoogle Scholar
  19. 19.
    Wilson FV, Hinov V, Adams G, Arthroscopic repair of full-thickness tears of the rotator cuff: 2- to 14-year follow-up. Arthroscopy. 2002;18:136–44.PubMedCrossRefGoogle Scholar

Copyright information

© Hospital for Special Surgery 2011

Authors and Affiliations

  • Michael K. Shindle
    • 1
    • 3
  • Shane J. Nho
    • 1
  • Denis Nam
    • 1
  • John D. MacGillivray
    • 1
  • Frank A. Cordasco
    • 1
  • Ronald S. Adler
    • 2
  • David W. Altchek
    • 1
  • Russell F. Warren
    • 1
  1. 1.Department of Orthopedic SurgeryHospital for Special SurgeryNew YorkUSA
  2. 2.Department of Radiology and ImagingHospital for Special SurgeryNew YorkUSA
  3. 3.Summit Medical Group MorristownUSA

Personalised recommendations