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Published on: January 23, 2018
Comparative study between arthroscopic repair vs. débridement of Ellman grade II PASTA lesions
Dimitrios V Papadopoulos1, Athanasios Kontogiannis1, James R Mullen2
1Second Department of Orthopaedic Surgery, School of Medicine, Konstantopouleio General Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Background:
Although débridement is typically recommended for the treatment of medium-sized 3-6 mm (Ellman grade II) partial-thickness articular-sided supraspinatus tendon avulsion (PASTA) lesions, this approach is associated with mixed results. The purpose of this study is to compare the postoperative outcomes between arthroscopic débridement vs. repair in Ellman grade II PASTA lesions.
Methods:
A retrospective study was performed in which 17 patients with a grade II PASTA lesion underwent arthroscopic débridement compared to 18 patients in whom conversion to full-thickness tear and repair was performed. Patients were evaluated preoperatively, at 6 months, 12 months and 24 months postoperatively. Shoulder range of motion and residual pain using the visual analog scale score were assessed. Constant-Murley and American Shoulder and Elbow Surgeons (ASES) scores were also calculated.
Results:
The visual analog scale score was lower in patients who underwent repair compared to those who underwent débridement (medians: 0.5 vs. 2, P < .001) at 24 months postoperatively. However, the range of motion was similar between the two study groups. The postoperative Constant-Murley and ASES scores were higher in the repair group (medians: 81.5 vs. 68, P < .001 and medians: 89 vs. 75, P < .001, respectively). Multiple linear regression analysis further confirmed repair was associated with improved Constant-Murley (coefficient = 13.1, 95% confidence interval: 11.1-15.0, P < .001) and ASES (coefficient = 13.2, 95% confidence interval: 10.3-16.0, P < .001) scores.
Conclusions:
The results of this study indicate that repair of grade II PASTA lesions are associated with improved outcomes when compared to débridement. However, future studies with a larger sample size are needed to validate the results of this study to determine whether a change in the "commonly accepted" practice of débridement alone for grade II PASTA lesions should be considered.
