Surgical management of large rotator cuff tears combined with instability in elite rugby football players

Abstract

Large rotator cuff tears are extremely uncommon in young people and when they occur they may be associated with shoulder instability. This paper reports on a series of six elite rugby union and rugby league footballers who presented with shoulder instability and large rotator cuff tears. They were treated with a two stage procedure: an open rotator cuff repair followed by an open shoulder stabilisation some 10 weeks later. All had successful outcomes. The paper also highlights the risk of tearing the rotator cuff when a patient continues to play contact sport with an untreated unstable shoulder.

Rotator Cuff Tear and Glenohumeral Instability

“…The authors concluded that persistent pain and weakness after primary dislocation in this age group are indications for further evaluation. Similar presentations were noted by Goldberg et al [8] in a series of elite young rugby players. Five of the six participants had symptoms before a catastrophic injury, including difficulty with abduction and a sensation of a ''dead arm'' with forceful overhead muscular activity.…”

“…In two of the studies, the absence of a capsulolabral lesion was specifically noted in all patients [3,27]. Four of the studies specifically included patients with a capsulolabral lesion and rotator cuff tear who underwent both an anterior stabilization and rotator cuff repair [8,11,32,42]. Mean outcomes (pain relief, Rowe shoulder scores, or American Shoulder and Elbow Society scores) improved in all studies, and redislocation was reported in only one study where two patients had irreparable cuff tears [32].…”

“…These patients had restored stability after subscapularis repair to the lesser tuberosity. The surgeries were performed in a staged fashion in a study by Goldberg et al [8]; open anterior stabilization was performed at a mean of 9.5 weeks after the open rotator cuff repair in all patients. Imhoff et al [17] presented a subgroup of 15 patients with anterior capsulolabral injury and rotator cuff tears; 11 patients underwent only arthroscopic capsulorraphy and four patients underwent anterior stabilization and miniopen rotator cuff repair.…”

“…After applying these inclusion and exclusion criteria, ultimately 11 studies were included in the systematic review [3,8,10,11,17,27,29,32,37,38,42] (Table 1). Five of the studies were Level III evidence [10,17,37,38,42], and the remainder represented Level IV evidence [3,8,11,27,29,32]. Three of the studies [3,8,27] reported entirely on patients with combined cuff pathology and shoulder instability, and the remainder included subgroups with combined pathology.…”

“…Five of the studies were Level III evidence [10,17,37,38,42], and the remainder represented Level IV evidence [3,8,11,27,29,32]. Three of the studies [3,8,27] reported entirely on patients with combined cuff pathology and shoulder instability, and the remainder included subgroups with combined pathology. Six of the studies specifically reported on patients older than 40 years [10,27,29,32,37,38].…”