Outcomes After Limited or Extensive Bursectomy During Rotator Cuff Repair: Randomized Controlled Trial

Purpose: To evaluate the effects of extensive bursectomy (EB) and limited bursectomy (LB) during arthroscopic rotator cuff repair. Methods: In the EB group (n = 39), subacromial bursae were thoroughly removed from anterior to posterior and lateral to medial. In the LB group (n = 39), bursectomy was minimized to allow torn cuff visualization and tendon repair. Visual analog scale pain scores, passive forward flexion, external rotation at the side (ER), and internal rotation at the back were measured at 5 weeks and 3, 6, and 12 months after surgery. At each time point, bursal thickness was measured and repair integrity was assessed by sonography or magnetic resonance imaging. Results: The analysis included 36 patients in the LB group and 35 in the EB group. Group visual analog scale pain scores were not significantly different at any time (P >.05 for all). Forward flexion and internal rotation at the back showed no intergroup difference during follow-up. However, ER was significantly better in the LB group at 6 months and 1 year postoperatively (31 degrees +/- 15 degrees vs 22 degrees +/- 16 degrees [P = .020] and 40 degrees +/- 19 degrees vs 27 degrees +/- 20 degrees [P = .009], respectively). Integrity failures were not significantly different at 5 weeks and at 3, 6, and 12 months (P >.05 for all). Marked bursal thickening (> 2 mm) was more frequently observed in the EB group (18 of 32 in the LB group and 27 of 32 in the EB group) at 6 months (P = .014). Conclusions: EB during arthroscopic rotator cuff repair appears to have no benefit in terms of reducing pain. More adhesions in the subacromial space after EB may result in slower motion recovery, especially in terms of ER. The extent of bursectomy did not affect tendon integrity. However, marked bursal thickening was more frequently observed in the EB group.