COMPARISON OF THE IMMEDIATE AND MEDIUM-TERM CLINICAL OUTCOMES OF TREATMENT OF PATIENTS WITH PARTIAL-THICKNESS ROTATOR CUFFTEARS OF VARIOUS DEPTH AND LOCALIZATION
Objective - To compare the effectiveness of conservative treatment, arthroscopic debridement and anchor fixation in patients with partial-thickness rotator cuff tears of various depth and localization.Material and methods. The study was a prospective randomized controlled one with the formation of three compared groups of 120 patients older than 55 years with MR-signs of an symptomatic isolated atraumatic partial tear of the supraspinatus tendon. Patients of group I were treated conservatively, group II - performed subacromial decompression, in group III, in addition to decompression, an anchor fixation was performed. Each group contained two subgroups of 60 patients with partial tears of the bursal (B-PTRCT) and articular surface of the tendons of the rotator cuff of the shoulder (PASTA, A-PTRCT), each of which was formed of four subgroups of 15 patients depending on the depth of the tendon tear: <20% , 20-50%, 50-90% and > 90%. The observation was carried out for 12 months, assessing the functional state of patients before treatment, as well as after 3, 6 and 12 months. using the Constant scale. Over the entire study period, 324 patients were monitored, including 96 women and 228 men, with an average age of 65 years. There were no statistically significant differences in the overall structure of patients in the study groups. The number of patients and the comparability of groups and subgroups according to general and radiological signs made it possible to compare treatment efficacy with a significance level of α = 0.05 and a statistical power of 85%. Results. The average functional results of conservative treatment, acromioplasty and cuff suture without taking into account the depth and localization of damage do not differ significantly, however, the pain syndrome and daily activity of patients were better after arthroscopic anchor fixation. In B-PTRCT, the average result depended on the treatment tactics chosen is not significant. In PASTA, the average functional result was better after the suture. The average results of the suture did not differ much in patients with B-PTRCT and PASTA, while the results of conservative treatment and arthroscopic decompression were significantly worse for PASTA. The revealed differences were most significant at a damage depth of 20-50%, partially remained in the 50-90% group and were absent at breaks of more than 90% and less than 20% of the tendon thickness. Arthroscopic suture was accompanied by significantly better results than alternative treatments with PASTA with a depth of more than 20% and with PASTA with a depth of more than 50%. Conclusion. To select a method for treating patients with partial-thickness rotator cuff tears of the shoulder, it is necessary to determine the depth and localization of the tear. The fixation of the supraspinatus tendon, partially torn from the side of the subacromial space of the tendon, is reasonable when the damage depth is more than 20% of the thickness of the tendon. When the tear is localized on the articular surface of the tendon, justification by suture is justified if the depth of damage exceeds 50%