Skip to main content

Advertisement

SpringerLink
Log in

No Difference in Postoperative Pain After Arthroscopic versus Open Rotator Cuff Repair

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Rotator cuff repair is a successful treatment in terms of patient satisfaction and pain relief regardless of the repair method. Although arthroscopic repair is commonly thought to be less painful than open or miniopen repair, studies disagree on this point.

Questions/purposes

We wished to compare the results of patient-reported postoperative pain after open versus arthroscopic rotator cuff repair and to identify any predictors of various pain outcomes in these groups.

Methods

One-hundred two patients (52 with open repair, 50 with arthroscopic repair) participated. Preoperatively, patients reported pain levels and self-perceived pain tolerance, and they underwent a test for an objective measurement of pain tolerance. Intraoperative variables included surgery duration and size of the tear. Postoperatively, patients maintained a pain log for 6 weeks, reporting daily pain (VAS) and narcotic consumption. Outcome variables included days to zero pain, the presence of residual pain, weekly pain levels, and cumulative 6-week pain level. Age, sex, tear size, pain tolerance, surgery duration, and self-reported preoperative pain were analyzed as possible predictors of postoperative pain. This study was powered (β = 0.2 and α = 0.05) to detect a difference of 10% in the VAS and postoperative analgesic use with a requirement of 50 patients in each arm.

Results

Days to zero pain (mean, 28.8 days, 95% CI, 24.8–32.8 days versus 27.6 days, 95% CI, 23.3–31.9 days for open versus arthroscopic, respectively; p = 0.69) were not different between the open and arthroscopic repair groups. There were differences of questionable clinical relevance and borderline statistical significance favoring arthroscopic intervention in the second postoperative week (2.3 versus 3.2 of 10 on the VAS; p = 0.045). Otherwise, no differences were seen between the two groups in terms of residual pain, cumulative pain, or medication use. Consistent predictors of postoperative pain affecting multiple outcome measures included severe preoperative pain, smaller tear size, and female sex.

Conclusions

There were no differences of clinically relevant size between arthroscopic and open rotator cuff surgery in this comparative series. Therefore, the choice of arthroscopic rotator cuff repair should not be based on decreased postoperative pain.

Level of Evidence

Level II, therapeutic study. See the Instructions or Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Baker CL, Whaley AL, Baker M. Arthroscopic rotator cuff tear repair. J Surg Orthop Adv. 2003;12:175–190.

    PubMed  Google Scholar 

  2. Bishop J, Klepps S, Lo IK, Bird J, Gladstone JN, Flatow EL. Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study. J Shoulder Elbow Surg. 2006;15:290–299.

    Article  PubMed  Google Scholar 

  3. Buess E, Steuber KU, Waibl B. Open versus arthroscopic rotator cuff repair: a comparative view of 96 cases. Arthroscopy. 2005;21:597–604.

    Article  PubMed  Google Scholar 

  4. Demirhan M, Esenyel CZ. [All arthroscopic treatment of rotator cuff tears][in Turkish]. Acta Orthop Traumatol Turc. 2003;37(suppl 1):93–104.

    PubMed  Google Scholar 

  5. Faucett J, Gordon N, Levine J. Differences in postoperative pain severity among four ethnic groups. J Pain Symptom Manage. 1994;9:383–389.

    Article  CAS  PubMed  Google Scholar 

  6. Forsythe ME, Dunbar MJ, Hennigar AW, Sullivan MJL, Gross M. Prospective relation between catastrophizing and residual pain following knee arthroplasty: two-year follow-up. Pain Res Manag. 2008;13:335–341.

    PubMed Central  PubMed  Google Scholar 

  7. 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;86:219–224.

    PubMed  Google Scholar 

  8. Gartsman GM. Arthroscopic acromioplasty for lesions of the rotator cuff. J Bone Joint Surg Am. 1990;72:169–180.

    CAS  PubMed  Google Scholar 

  9. Gartsman GM. All arthroscopic rotator cuff repairs. Orthop Clin North Am. 2001;32:501–510, x.

  10. Gramke HF, de Rijke JM, van Kleef M, Kessels AG, Peters ML, Sommer M, Marcus MA. Predictive factors of postoperative pain after day-case surgery. Clin J Pain. 2009;25:455–460.

    Article  PubMed  Google Scholar 

  11. Ip HY, Abrishami A, Peng PW, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology. 2009;111:657–677.

    Article  PubMed  Google Scholar 

  12. Itoi E, Tabata S. Incomplete rotator cuff tears: results of operative treatment. Clin Orthop Relat Res. 1992;284:128–135.

    PubMed  Google Scholar 

  13. Kang L, Henn RF, Tashjian RZ, Green A. Early outcome of arthroscopic rotator cuff repair: a matched comparison with mini-open rotator cuff repair. Arthroscopy. 2007;23:573–582, 582.e1–2.

  14. Kasten P, Keil C, Grieser T, Raiss P, Streich N, Loew M. Prospective randomised comparison of arthroscopic versus mini-open rotator cuff repair of the supraspinatus tendon. Int Orthop. 2011;35:1663–1670.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Kelly AM. Does the clinically significant difference in visual analog scale pain scores vary with gender, age, or cause of pain? Acad Emerg Med. 1998;5:1086–1090.

    Article  CAS  PubMed  Google Scholar 

  16. Kelly AM. The minimum clinically significant difference in visual analogue scale pain score does not differ with severity of pain. Emerg Med J. 2001;18:205–207.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Köse KC, Tezen E, Cebesoy O, Karadeniz E, Guner D, Adiyaman S, Demirtas M. Mini-open versus all-arthroscopic rotator cuff repair: comparison of the operative costs and the clinical outcomes. Adv Ther. 2008;25:249–259.

    Article  PubMed  Google Scholar 

  18. Levy HJ, Uribe JW, Delaney LG. Arthroscopic assisted rotator cuff repair: preliminary results. Arthroscopy. 1990;6:55–60.

    Article  CAS  PubMed  Google Scholar 

  19. Lindley K, Jones GL. Outcomes of arthroscopic versus open rotator cuff repair: a systematic review of the literature. Am J Orthop (Belle Mead, NJ). 2010;39:592–600.

    PubMed  Google Scholar 

  20. Millar NL, Wu X, Tantau R, Silverstone E, Murrell GA. Open versus two forms of arthroscopic rotator cuff repair. Clin Orthop Relat Res. 2009;467:966–978.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Mobilio N, Gremigni P, Pramstraller M, Vecchiatini R, Calura G, Catapano S. Explaining pain after lower third molar extraction by preoperative pain assessment. J Oral Maxillofac Surg. 2011;69:2731–2738.

    Article  PubMed  Google Scholar 

  22. Morse K, Davis AD, Afra R, Kaye EK, Schepsis A, Voloshin I. Arthroscopic versus mini-open rotator cuff repair: a comprehensive review and meta-analysis. Am J Sports Med. 2008;36:1824–1828.

    Article  PubMed  Google Scholar 

  23. Norberg FB, Field LD, Savoie FH 3rd. Repair of the rotator cuff: mini-open and arthroscopic repairs. Clin Sports Med. 2000;19:77–99.

    Article  CAS  PubMed  Google Scholar 

  24. Ochroch EA, Gottschalk A, Troxel AB, Farrar JT. Women suffer more short and long-term pain than men after major thoracotomy. Clin J Pain. 2006;22:491–498.

    Article  PubMed  Google Scholar 

  25. Osti L, Papalia R, Paganelli M, Denaro E, Maffulli N. Arthroscopic vs mini-open rotator cuff repair: a quality of life impairment study. Int Orthop. 2010;34:389–394.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Pearsall AW 4th, Ibrahim KA, Madanagopal SG. The results of arthroscopic versus mini-open repair for rotator cuff tears at mid-term follow-up. J Orthop Surg Res. 2007;2:24.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Rosseland LA, Stubhaug A. Gender is a confounding factor in pain trials: women report more pain than men after arthroscopic surgery. Pain. 2004;112:248–253.

    Article  PubMed  Google Scholar 

  28. Strommen JA, Daube JR. Determinants of pain in needle electromyography. Clin Neurophysiol. 2001;112:1414–1418.

    Article  CAS  PubMed  Google Scholar 

  29. Svendsen K, Borchgrevink P, Fredheim O, Hamunen K, Mellbye A, Dale O. Choosing the unit of measurement counts: the use of oral morphine equivalents in studies of opioid consumption is a useful addition to defined daily doses. Palliat Med. 2011;25:725–732.

    Article  CAS  PubMed  Google Scholar 

  30. Tashjian RZ, Deloach J, Porucznik CA, Powell AP. Minimal clinically important differences (MCID) and patient acceptable symptomatic state (PASS) for visual analog scales (VAS) measuring pain in patients treated for rotator cuff disease. J Shoulder Elbow Surg. 2009;18:927–932.

    Article  PubMed  Google Scholar 

  31. Todd KH. Clinical versus statistical significance in the assessment of pain relief. Ann Emerg Med. 1996;27:439–441.

    Article  CAS  PubMed  Google Scholar 

  32. Warner JJ, Tétreault P, Lehtinen J, Zurakowski D. Arthroscopic versus mini-open rotator cuff repair: a cohort comparison study. Arthroscopy. 2005;21:328–332.

    Article  PubMed  Google Scholar 

  33. Wiesenfeld-Hallin Z. Sex differences in pain perception. Gend Med. 2005;2:137–145.

    Article  PubMed  Google Scholar 

  34. Yamaguchi K, Ball CM, Galatz LM. Arthroscopic rotator cuff repair: transition from mini-open to all-arthroscopic. Clin Orthop Relat Res. 2001;390:83–94.

    Article  PubMed  Google Scholar 

  35. Yamaguchi K, Levine WN, Marra G, Galatz LM, Klepps S, Flatow EL. Transitioning to arthroscopic rotator cuff repair: the pros and cons. Instr Course Lect. 2003;52:81–92.

    PubMed  Google Scholar 

  36. Yu J, Higgins LD, Moorman CT 3rd. Technique for arthroscopic rotator cuff repair. J Surg Orthop Adv. 2006;15:154–159.

    PubMed  Google Scholar 

  37. Zumstein MA, Jost B, Hempel J, Hodler J, Gerber C. The clinical and structural long-term results of open repair of massive tears of the rotator cuff. J Bone Joint Surg Am. 2008;90:2423–2431.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Rothman Institute, 125 S 9th St, Ste 1000, Philadelphia, PA, 19107, USA

    Gerald Williams Jr MD, Matthew J. Kraeutler BS, Benjamin Zmistowski BS & John M. Fenlin Jr MD

Authors
  1. Gerald Williams Jr MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthew J. Kraeutler BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Benjamin Zmistowski BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John M. Fenlin Jr MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Benjamin Zmistowski BS.

Additional information

Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Williams, G., Kraeutler, M.J., Zmistowski, B. et al. No Difference in Postoperative Pain After Arthroscopic versus Open Rotator Cuff Repair. Clin Orthop Relat Res 472, 2759–2765 (2014). https://doi.org/10.1007/s11999-014-3715-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-014-3715-6

Keywords

Search

Navigation