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A comparative study of functional outcome following the arthroscopic rotator cuff repair with and without subacromial decompression in type 1 acromion patients: A prospective study

Objectives: A rotator cuff tear is a common cause of pain and disability among adults. People who do repetitive lifting or overhead activities like painters, carpenters, etc., and athletes like tennis players and baseball pitchers are particularly at risk for rotator cuff tears. Though subacromial impingement is more common in patients with Type III (Hooked) acromion than Type I (Flat) acromion but our study was to evaluate any significant difference in patients treated with subacromial decompression to those who are treated without decompression in Type 1 acromion patients. Materials and methods: A prospective study of 30 patients with rotator cuff tears were divided into 2 groups i.e., Group 1 consisting of 15 patients and are treated with subacromial decompression and Group 2 consisting of another 15 patients who are treated by without subacromial decompression at SGITO, Bengaluru from November 2017 to June 2019. Clinical / Functional assessment was done using ASES, QUICK DASH and ROWE soring systems and patients was followed at regular intervals of 1, 3 & 6 months & 1-year post-op. Results: Our study showed predominant male population (60%), traumatic etiology (66.7%) and partial thickness tears (56.7%). At the end of 1 year follow up, Ases, Rowe & Quick Dash Scores was (90.33%), (92.33%) & (10.78%) respectively who are treated by acromioplasty and (90.41%), (91.67%) & (11.83%) respectively who are treated by non-acromioplasty. The mean time for improvement in symptoms in both groups are about 6 months. Conclusion: Our study concludes, that there was no significant statistical difference and clinical or functional outcome in both the study groups in terms of pain, muscle strength, range of movements except for flexion wherein statistical difference was found however there was no significant difference in functional / clinical outcome. Also, our study concludes that Age, Sex, Etiology of tear and Type of tear was not found to be a significant factor which affects the clinical/functional outcome.


Introduction
Rotator cuff tears are a common cause of shoulder pain and dysfunction encountered in the OPD. The Rotator cuff undergoes progressive degenerative changes with increasing age and may lead to partial tear to finally complete rupture of the rotator cuff. The spectrum of these disorder ranges from inflammation to massive tearing of the rotator cuff musculo-tendinous unit. A rotator cuff tear is a commonly encountered problem in orthopaedic department. After age of 40 years, approximately 30% of patients will have rotator cuff tears, and after age 60 yrs, there will be cuff tears in upto 80% of patients. A rotator cuff tear is a common cause of pain and disability among adults. People who do repetitive lifting or overhead activities like painters, carpenters, etc., and athletes like tennis players and baseball pitchers are particularly at risk for rotator cuff tears. Though subacromial impingement is more common in patients with Type III (hooked) acromion than Type I (Flat) acromion but our study was to evaluate any significant difference in patients treated with subacromial decompression to those who are treated without decompression in Type 1 acromion patients. Arthroscopic results have shown less postoperative pain, morbidity, infections and a more rapid improvement in shoulder motion.
It is essential that the merits and demerits associated with this technique should be balanced depending on the individual condition of the patient and the degree of experience gained.

Discussion
In our study of 30 patients, we assessed the functional outcome in terms of pain, range of movements and other baseline shoulder functions in those patients who are subjected to acromioplasty to those patients who are operated without acromioplasty. In our study, the mean age of the patients was 53.5yrs which was found to be almost similar as compared to other studies. 8 Patients in the age group of 20-40yrs (26.7%) out of which 4 underwent acromioplasty & another 4 operated by nonacromioplasty and 11 patients in the age group of 41-50yrs (36.7%) out of which 6 underwent acromioplasty & another 5 operated by non-acromioplasty and 7 patients in the age group of 51-60 yrs (23.3%) out of which 2 underwent acromioplasty & another 5 operated by non-acromioplasty and finally there are 4 patients in the age group of 61-70yrs (13.3%) out of which 3 underwent acromioplasty & another 1 operated by non-acromioplasty. In our study consisting of total 30 patients, 18 were males (60%) out of which 9 underwent acromioplasty remaining 9 underwent non acromioplasty and 12 females (40%) out of which 6 underwent acromioplasty remaining 6 underwent non acromioplasty. As compared to other studies, our study also has male preponderance. In our study consisting of total 30 patients, 20 were traumatic (66.7%) out of which 9 underwent acromioplasty, remaining 11 operated by non-acromioplasty procedure and rest 10 were Degenerative (33.3) out of which 6 underwent acromioplasty and remaining 4 operated by non-acromioplasty procedure.
In our study, we had 17 partial thickness tears (56.7%) out of which 9 patients underwent subacromial decompression, remaining 8 were treated by without subacromial decompression and 13 full thickness tears (43.3%) out of which 6 patients underwent subacromial decompression, remaining 7 were treated by without subacromial decompression.
There was significant improvement of flexion from 129.0 (group 1) preoperatively to 148.67 (group 1) & from 131.0 (group 2) preoperatively 154.33 (group 2) at 1yr and though there was a statistically significant difference, but in functional outcome there was no much significant difference in both the type of procedures. There was significant improvement of Abduction from 129.0 (group 1) preoperatively to 155.0 (group 1) & from 129.67 (group2) preoperatively to154.67 (group 2) at 1yr and there was no statistical significant difference in functional outcome in both the type of procedures (i.e., with and without subacromial decompression). There was significant improvement of External rotation from 49.0 (group 1) preoperatively to 76.33 (group 1) & from 50.0 (group 2) preoperatively to 76.67 (group 2) at 1yr and there was no statistical significant difference in functional outcome in both the type of procedures (i.e., with and without subacromial decompression).
There was significant improvement of Internal rotation from 41.67(group 1) preoperatively to 71.33 (group 1) & from 40.33 (group 2) preoperatively to 70.00 (group 2) at 1yr follow up and there was no statistical significant difference in functional outcome in both the type of procedures ( i.e., with and without subacromial decompression).    There were no infections, neurovascular injuries, instances of postoperative shoulder stiffness, or other complications requiring intervention.

Conclusion
Our study concludes that there is no significant statistical difference in the functional outcome following the arthroscopic rotator cuff repair with and without subacromial decompression in type I Acromion patients.