Use of Magnetic Resonance Arthrography to Compare Clinical Features and Structural Integrity After Arthroscopic Repair of Bursal Versus Articular Side Partial-Thickness Rotator Cuff Tears

Abstract

BACKGROUND: There has been no study using magnetic resonance arthrography (MRA) to compare clinical features and structural integrity after arthroscopic repair of bursal and articular side partial-thickness rotator cuff tears (PTRCTs).

HYPOTHESIS: The 2 groups studied, which consisted of patients who underwent arthroscopic repair for either the articular side or the bursal side, would show significant improvement in overall outcomes after surgery, even though clinical outcomes and structural integrity would not be significantly different. It was thought that the incidence of preoperative positive impingement signs and protruded spurs on the acromion undersurface would be higher in patients with a bursal side tear.

STUDY DESIGN: Case-control study; Level of evidence, 3.

METHODS: The current study consisted of 83 patients who underwent arthroscopic repair for either articular side (group A; n = 29) or bursal side (group B; n = 54) PTRCT and who were available at the 2-year follow-up. Clinical outcomes were compared by use of the Neer impingement sign, visual analog scale for pain, Simple Shoulder Test, University of California Los Angeles score, and American Shoulder and Elbow Surgeons score. At 6 months after surgery, MRA was used to assess structural integrity.

RESULTS: At 2-year follow-up, both groups showed significant improvement in pain and shoulder function scores, even though there was no significant difference between groups. The retear rate on follow-up MRA was not significantly different between group A (8%) and B (11%). Patients in group B, compared with group A, showed a higher incidence of the preoperative impingement sign (89% vs 52%, respectively; P = .004), protruded spur on the acromion undersurface (69% vs 0%, respectively; P < .001), and concomitant acromioplasty (93% vs 24%, respectively; P < .001).

CONCLUSION: Both articular and bursal side PTRCTs showed significant functional improvements after arthroscopic repair. The bursal side tears had a higher incidence of impingement sign at preoperative examination and more often had a protruded spur on the acromion undersurface.