by Elizabeth Hofheinz, M.Ed., M.P.H.
Dr. Adam M. Johannsen from the Steadman Philippon Research Institute in Vail, Colorado was recently presented with the Robert H. Cofield, M.D., Award from the American Shoulder and Elbow Surgeons (ASES). The award, presented during the 2020 ASES Fellows meeting, honored Dr. Johannsen and his seasoned team of orthopaedic researchers for their work on the long-term results of arthroscopic double-row transosseous- equivalent (TOE) rotator cuff repair (RCR).
In addition to Dr. Johannsen, the research team included Justin W. Arner, M.D., Bryant Elrick, M.Sc., Philip-C Nolte, M.D., Marilee P. Horan, M.P.H., and Peter J. Millett, M.D., M.Sc. Their work was titled, “Minimum 10-Year Outcomes of Primary Arthroscopic Transosseous-Equivalent Double Row Rotator Cuff Repairs.” 
As indicated by the ASES, Dr. Cofield, a professor of orthopaedics at Mayo Clinic in Rochester, Minnesota, has dedicated his career to the “End-Result Idea,” including studies with good long-term follow-up, which can impact clinicians’ daily decisions.
Providing insight on the impetus for their work, Peter Millett, M.D., M.Sc., a partner and Director of Shoulder Surgery at The Steadman Clinic, told OSN, “While short- and medium-term outcomes of outcomes and survivorship of arthroscopic double-row TOE RCR have been well documented, what happens in the ensuing years has yet to be fully explored.”
“…double row rotator cuff repairs through a transosseous-equivalent technique have gained traction in the shoulder arthroscopy field,” wrote the authors. “This technique is a self-reinforcing construct which allows for compression of the tendon along the entire rotator cuff footprint through the sutures or tape from the medial row across the bursal surface of the tendon footprint to the lateral row. This increases healing and decreases the risk for re-tear.”
The researchers undertook a blinded retrospective study of prospectively collected data of Dr. Millett’s patients (91 shoulders/58 male patients). Patients who had a TOE repair for a full-thickness tear of the supraspinatus tendon with or without anterior and/or posterior tear propagation into the subscapularis or infraspinatus tendons, and were at least 10 years out from surgery were included.
The team collected preop and 2, 5, and minimum 10 year follow-up data, including patient-reported outcomes: American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numerical Evaluation (SANE) score, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, the physical component summary (PCS) of the 12-item Short Form (SF-12) questionnaire, and patient satisfaction (1-10, 10 = highly satisfied). Revision rotator cuff repair or conversion to reverse total shoulder arthroplasty was considered to be a failure.
In all, 5 patients (5%) had to undergo revision surgery (4 at under 5 years and 1 at 12 years after the primary surgeries). One patient had an infection at 38 days. Two patients experienced re-tears at 49 days and 4.1 years. Every patient achieved satisfactory outcomes following revision surgery.
“The current study demonstrates that the results of TOE ARCRC are durable with minimal changes from the 5 year to the 10-year time point,” say the authors. “Data from this study suggests that TOE rotator cuff repairs are durable at long-term follow-up. Furthermore, patient satisfaction, SANE, and QuickDASH were maintained at high levels at 5- and 10-year follow-up.”
Dr. Millett: “We were pleased by how well patients did, as well as by the durability of the procedure. I was an early developer of the TOE technique and have carefully followed my patients over time to ensure that they were doing well.”
“It is interesting to note that a number of years ago when I submitted a paper on minimum 10-years followup open rotator cuff repair one of the reviewers said, ‘This is a proven procedure. Why is it necessary to examine long-term results?’ At that time our results showed an 83% survivorship at 10 years; now at a minimum of 10 years we have increased survivorship to almost 95%. I am proud that we continued to innovate and to follow our patients as this has resulted in drastic improvements in patient outcomes. This procedure is not just getting people somewhat better…TOE ARCR is returning them to normal levels of function and it is highly durable over long periods of time.”
“Particularly meaningful is that this study is one of the first to examine long-term results with modern techniques for rotator cuff repair using stringent criteria for patient selection. In addition, this work is highly practical as it can be used during the preoperative counseling and surgical decision-making process.”