Relationship between clinical and surgical findings and reparability of large and massive rotator cuff tears: a longitudinal study

Abstract

BackgroundThe literature has shown good results with partial repairs of large and massive tears of rotator cuff but the role of factors that affect reparability is less clear. The purpose of this study was twofold, 1) to examine clinical outcomes following complete or partial repair of large or massive full-thickness rotator cuff tear, and 2) to explore the value of clinical and surgical factors in predicting reparability.MethodsThis was a secondary data analysis of consecutive patients with large or massive rotator cuff tear who required surgical treatment (arthroscopic complete or partial repair) and were followed up for two years. Disability measures included the American Shoulder and Elbow Surgeons (ASES), the relative Constant-Murley score (CMS) and the shortened version of the Western Ontario Rotator Cuff Index (ShortWORC). The relationship between predictors and reparability was examined through logistic regressions and chi-square statistics as appropriate. Within group change over time and between group differences in disability outcomes, range of motion and strength were examined by student’s T-tests and non-parametric statistics.ResultsOne hundred and twenty two patients (41 women, 81 men, mean age 64, SD = 9) were included in the analysis. There were 86 large (39 fully reparable, 47 partially reparable) and 36 (10 fully reparable, 26 partially reparable) massive tears. Reparability was not associated with age, sex, or pre-operative active flexion or abduction (p > 0.05) but the fully reparable tear group showed a better pre-operative ASES score (p = 0.01) and better active external rotation in neutral (p = 0.01). Reparability was associated with tear shape (p < 0.0001), size (p = 0.002), and tendon quality (p < 0.0001).ConclusionsReparability of large or massive tears is affected by a number of clinical and surgical factors. Patients whose tears could not be fully repaired showed a statistically significant improvement in range of motion, strength and disability at 2 years, although they had slightly inferior results compared to those with complete repairs.

Massive rotator cuff tears: pathomechanics, current treatment options, and clinical outcomes

“…57 In these cases, partial repairs of the tendons have been used successfully. Burkhart introduced the concept of partial repair on the basis of restoring biomechanical force couples and increasing acromiohumeral distances, therefore improving function and pain.…”

“…57 High subjective disability, limited active external rotation, poor tendon quality, larger tear size, and U-shaped tears could often be repaired only partially. In the cohort, both partial and complete repair groups demonstrated improved function and level of disability.…”

Reverse Shoulder Arthroplasty for Massive Rotator Cuff Tears

“…CTA is a clear and well accepted indication of RSA because with other treatments, medical, conventional shoulder prosthesis [105] , repair [106] , results are disappointing [2,5,14,15,18,25,35,47,51,106] . The advent of RSA was revolutionary in the treatment of this condition [2,63,66,70,[107][108][109] .…”

“…However, surgical treatment remains a challenge due to technical difficulties and unpredictability of the results of the repair [41,42] , which led orthopedic surgeons to look for alternative options to treat MCT Many palliative interventions have been proposed, including, tendon transfers [17,37,38] , long head of the biceps tenotomy or tenodesis [43] , subacromial decompression [44] , subacromial balloons, partial rotator cuff repair [45][46][47] , superior capsular reconstruction [51][52][53][54] , hemiarthroplasty or total shoulder prosthesis constrained or not [55][56][57][58][59][60][61][62] and reverse shoulder arthroplasty [63][64][65][66][67][68][69] .…”

Resultado clínico do reparo parcial nas roturas irreparáveis do manguito rotador

“…For the UCLA score, Burkhart et al6 demonstrated an increase from 9.8 to 27.6, whereas Franceschi et al16 reported an increase from 8.6 to 28.8. and Iagulli et al17 from 12.1 to 29.5. Authors using the Constant score reported preoperative values ranging from 36.3 to 45.9, and postoperative values ranging from 69.9 to 75.3 15,[18][19][20][21].…”