Clinical Outcomes Of Three Different Shoulder Arthroscopic Surgical Techniques For The Treatment Of Ellman Type Ⅲ PASTA Lesions

Purpose:To evaluate the clinical outcomes of three different shoulder arthroscopic surgical techniques(tear completion and repair,in situ transtendon repair,and all-inside repair)for the treatment of Ellman type Ⅲ PASTA(Partial Articular-sided Supraspinatus Tendon Avulsion)lesions.Methods:A retrospective case-control study was conducted to analyze the clinical data of 72 patients with Ellman type Ⅲ PASTA lesions admitted to our hospital between January 2017 and June 2020.There were 22 male patients and 50 female patients,26 left shoulders,and 46 right shoulders;24 of them underwent tear completion and repair,24 underwent transtendon repair,and 24 underwent all-inside repair.Visual analogue scale(VAS),American Shoulder and Elbow Surgery(ASES)score,Constant-Murley Shoulder(CMS)Score and The University of California Los Angeles(UCLA)score,as well as shoulder flexion,external rotation and internal rotation were compared before surgery,1 month,3 months,6 months after surgery and the last follow-up to assess the patients’ pain and clinical functional recovery.MRI reexamined 3-12 months after surgery was collected to assess tendon healing in patients.Results:The average follow-up time of the three groups was 27.56±5.75(1637)months,and none had postoperative complications like joint adhesion,infection,or nerve injury.After two-way repeated measures analysis of variance,there was no significant difference in each score and range of shoulder flexion,external rotation motion,and internal rotation among the three groups before surgery(P>0.05),the baseline remained consistent.At 1 and 3 months after surgery,compared with the other two groups,patients in the all-inside repair group had lower VAS scores,more significant improvement in ASES and CMS scores,compared with the transtendon repair group,the range of motion of shoulder flexion and external rotation were more significantly improved in the other two groups,the differences were statistically significant(P<0.05).At 6 months after surgery and the last follow-up,each shoulder score and range of shoulder motion in the three groups were significantly improved(P<0.05),but there was no significant difference among the three groups(P>0.05).Postoperative MRI follow-up showed that there were two patients(8.3%)had retears in the tear completion and repair group,and one patient(4.2%)in the transtendon repair group and the all-inside repair group respectively.Retear rate on the three groups was no significant difference.Conclusion:Tear completion and repair,transtendon repair,and all-inside repair all have good clinical outcomes for the treatment of Ellman type III PASTA lesions.The tendons healed well after repair by three surgical techniques,and retear rate on the three groups was no significant difference.Compared with the tear completion and repair group and the transtendinous repair group,pain relief and functional recovery were faster after all-inside repair group,but there was no significant difference in long-term clinical outcomes among the three surgical techniques.