From the Guidelines
The mini-open rotator cuff repair technique is a viable option for treating full-thickness rotator cuff tears, offering the advantage of direct visualization of the tear while minimizing deltoid damage compared to traditional open approaches. When considering the significance of mini-open rotator cuff repair, it is essential to weigh the available evidence. A study by 1 found that there is no conclusive recommendation for or against a specific technique, including mini-open repair, due to the limited number of comparative studies. However, a more recent study by 1 compared different surgical techniques, including mini-open and arthroscopic approaches, and found that the arthroscopic approach had lower pain scores on postoperative day 1 compared to the mini-incision approach. Some key points to consider when performing a mini-open rotator cuff repair include:
- Patient positioning in either beach chair or lateral decubitus position under general anesthesia with regional nerve block
- A small 3-5 cm incision made over the anterolateral acromion
- The deltoid muscle is split rather than detached to access the subacromial space
- An acromioplasty may be performed to remove bone spurs and create space for the repaired tendon
- Suture anchors are placed into the bone, and sutures are passed through the tendon in a configuration that provides strong fixation while restoring normal anatomy. It is crucial to prioritize the most recent and highest-quality study, which in this case is 1, when making a definitive recommendation. Based on the available evidence, the mini-open rotator cuff repair technique is a suitable option for treating full-thickness rotator cuff tears, but it may not offer the same level of pain reduction as arthroscopic approaches. In terms of postoperative care, patients typically require a sling for 4-6 weeks with progressive rehabilitation starting with passive motion, advancing to active motion, and finally strengthening exercises over 3-6 months. Ultimately, the choice of surgical technique depends on various factors, including the patient's specific condition, the surgeon's expertise, and the available resources. However, based on the current evidence, the mini-open rotator cuff repair technique is a viable option that can provide effective treatment for full-thickness rotator cuff tears.
From the Research
Significance of Mini-Open Rotator Cuff Repair
The mini-open rotator cuff (RC) repair is a surgical technique that has been used to treat rotator cuff tears, offering several advantages over traditional open repair. Some of the key benefits of mini-open RC repair include:
- Relative deltoid preservation 2
- Ability to assess and treat coexisting intra-articular pathology 2
- Shorter hospitalization 2
- Reduced early morbidity 2
- Easier and quicker rehabilitation 2
- Smaller scar 2
Comparison with Other Techniques
Mini-open RC repair has been compared to other techniques, such as open and all-arthroscopic repair. The results of these comparisons suggest that:
- Mini-open repair can produce excellent results in patients with small, moderate, and large rotator cuff tears 3
- There is no statistically significant difference in outcome between mini-open repair and other techniques for patients with different tear sizes 3
- All-arthroscopic repair offers several advantages, including smaller incisions, easy access to the glenohumeral joint, and less soft tissue dissection 4
Indications and Outcomes
The indications for mini-open RC repair include:
- Small- to medium-sized full-thickness tears of the rotator cuff 2
- Patients who have failed a preoperative course of physical therapy and nonoperative management 3 The outcomes of mini-open RC repair have been reported to be excellent, with:
- High patient satisfaction rates (92.6%) 3
- High return to preinjury activity rates (83%) 3
- Improved shoulder function and reduced pain 5, 6