Long-term outcome of arthroscopic debridement of massive irreparable rotator cuff tears

Abstract

Objectives To evaluate the clinical and radiographic outcome of low-demand patients with massive rotator cuff tears undergoing arthroscopic debridement in mid- and long-term follow-up, as well as the rate of conversion to reverse shoulder arthroplasty. Methods We performed a retrospective analysis of 19 patients with a mean age at surgery of 68 years (range, 55–80 years) from a previously described consecutive cohort and after a mean follow up of 47 month (FU1) and 145 month (FU2). The functional outcome was evaluated with the VAS score, the American Shoulder and Elbow Surgeons (ASES) score, and the age- and gender-adjusted Constant (aCS) score. The radiographic outcome was classified according to the Hamada classification. Non-parametric analyses were carried out with the Mann-Whitney U for independent samples and the Wilcoxon signed-rank test for related samples. Results Five patients (26%) developed symptomatic cuff tear arthropathy and underwent reverse shoulder arthroplasty after a mean time of 63 months (range, 45–97 months). These patients were excluded from further analyses. The mean VAS score of the remaining 14 patients at FU1 was significantly lower compared to preoperatively (P = .041), while there were no significant differences between the VAS score at FU1 and FU2 (P = 1.0). The ASES score of the affected shoulder at FU1 was significantly higher compared to prior to surgery (P = .028), while there were no significant differences between the scores of the affected shoulder between FU1 and FU2 (P = .878). While the ASES score of the contralateral shoulder at FU1 was significantly higher than the score of the affected shoulder (P = .038), there were no significant differences in the ASES scores of the affected and the healthy shoulder at FU2 (P = .575). The evaluation of the aCS produced similar results. A progression of the Hamada grade was documented in 6 patients. Conclusions Arthroscopic debridement is a safe and valid option for low-demand middle-age or elderly patients with symptomatic massive rotator cuff tears, leading to a significant pain relief and significantly improved functional outcome at mid- and long-term follow up. However, about a quarter of the patients in our cohort had to undergo reverse shoulder arthroplasty due to symptomatic cuff tear arthropathy. Furthermore, some of the remaining patients continued to undergo radiographic progression. This might be due to the natural history of their disease and/or the surgical procedure, and the clinical relevance of this finding should be evaluated in further studies.

Outcomes of Isolated Biceps Tenodesis/Tenotomy or Partial Rotator Cuff Repair Associated with Biceps Tenodesis/Tenotomy for Massive Irreparable Tears: A Systematic Review

“…A total of 6 primary studies for BT (cases series = 2, case–control = 2, randomized control trial = 1, prospective cohort study = 1) [ 15 , 22 , 35 , 36 , 37 , 38 ] involving 441 shoulders demonstrated significant improvements in the CMS at the final follow-up (range, 10.8,28) ( Figure 3 ). The minimum preoperative and maximum postoperative CMS were, respectively, 29.9 and 67.6.…”

“…The minimum preoperative and maximum postoperative CMS were, respectively, 29.9 and 67.6. For BT, 2 studies (cases series = 1, case–control = 1) [ 37 , 39 ] involving 50 shoulders demonstrated significant improvements in the ASES at the final follow-up (range, 30, 45.8).…”

Management of Irreparable Posterosuperior Rotator Cuff Tears—A Current Concepts Review and Proposed Treatment Algorithm by the AGA Shoulder Committee

“…Irreparable RCT may also be treated by an arthroscopic debridement of the remaining rotator cuff in combination with a (reversed) subacromial decompression (SAD) and a tenotomy or tenodesis of the LHBT ( Table 2 ) [ 21 , 22 , 23 ]. While lesions of the LHBT have been identified as a source of persistent pain that can be resolved with LHBT tenotomy, the purpose of arthroscopic SAD is to create a smooth, non-impinging acromiohumeral articulation by creating space, removing osteophytes and bony irregularities.…”

“…Low physical demand, sufficient residual shoulder function, older patient age and pain as the chief complaint are the main indications for arthroscopic debridement combined with (reverse) SAD and LHBT tenotomy/tenodesis. As such, a contemporary study in 19 patients (mean age 68 years) with symptomatic massive RCT reports significant improvements in functional outcomes, with an improvement in ASES Score of more than 30 points and a significant pain relief after arthroscopic debridement with SAD and the tenotomy of the LHBT after a minimum 10-year follow-up [ 23 ]. However, in this cohort 26% of patients failed and underwent RTSA during follow-up, emphasizing the importance of careful patient selection and preoperative counseling [ 23 ].…”

A method for the treatment of patients with massive tears of the rotator cuff: a clinical case

“…Разрывы вращательной манжеты с ретракцией сухожилий более 5 см или вовлечение двух или более сухожилий являются массивными повреждениями. Такие повреждения составляют до 10-40% [1].…”