Arthroscopic repair of massive rotator cuff tears: a prospective cohort with 2- to 4-year follow-up.

PURPOSE The goal of this study is to report on the complete arthroscopic repair of massive rotator cuff tears. TYPE OF STUDY Prospective cohort study. METHODS Between 1997 and 1999, 37 patients underwent complete arthroscopic repair of massive rotator cuff tears. The preoperative and postoperative outcomes of these 37 patients were analyzed using the constant score, American Shoulder and Elbow Society (ASES) index, visual analog pain scale (VAS), a single question of percent function compared with the opposite unaffected extremity, and a single question reflecting satisfaction (Would you undergo the surgery and the postoperative rehabilitation to achieve the result you have today?). The null hypothesis that was tested was that there was no difference between the preoperative and postoperative outcomes. The 37 patients were divided, by cohort design, into 2 groups; massive anterosuperior (AS; subscapularis, supraspinatus, and infraspinatus with or without the teres minor) and massive posterosuperior (PS; supraspinatus and infraspinatus, with or without the teres minor) tears. Additionally, the null hypothesis that there was no difference between outcomes for massive AS and massive PS subgroups was tested. RESULTS There was no statistically significant difference between either subset of massive rotator cuff tears with respect to preoperative and postoperative outcomes. The null hypothesis was supported for between groups. All but 2 patients said that they would undergo surgery again to achieve the postoperative state. CONCLUSIONS The arthroscopic repair of massive rotator cuff tears is effective for decreasing pain and improving the functional status of the shoulder for most patients. Complete coverage was achieved in 78% of the patients at the time of surgery. A subset of patients who did not have complete coverage or coverage at a second setting showed similar outcomes as those with full coverage. The patient satisfaction rate was 95%.

[1]  W. F. Bennett.  Arthroscopic repair of full-thickness supraspinatus tears (small-to-medium): A prospective study with 2- to 4-year follow-up. , 2003, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[2]  William F Bennett,et al.  Arthroscopic repair of isolated subscapularis tears: A prospective cohort with 2- to 4-year follow-up. , 2003, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[3]  Stephen S Burkhart,et al.  Arthroscopic subscapularis tendon repair: Technique and preliminary results. , 2002, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[4]  F. Wilson,et al.  Arthroscopic repair of full-thickness tears of the rotator cuff: 2- to 14-year follow-up. , 2002, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[5]  S S Burkhart,et al.  Arthroscopic rotator cuff repair: Analysis of results by tear size and by repair technique-margin convergence versus direct tendon-to-bone repair. , 2001, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[6]  S. Burkhart.  Arthroscopic Treatment of Massive Rotator Cuff Tears , 2001, Clinical orthopaedics and related research.

[7]  G. Gartsman.  Arthroscopic Rotator Cuff Repair , 2001, Clinical orthopaedics and related research.

[8]  W. F. Bennett.  Subscapularis, medial, and lateral head coracohumeral ligament insertion anatomy. Arthroscopic appearance and incidence of "hidden" rotator interval lesions. , 2001, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[9]  J. Warner.  Management of massive irreparable rotator cuff tears: the role of tendon transfer. , 2000, Instructional course lectures.

[10]  J. Warner,et al.  Diagnosis and treatment of anterosuperior rotator cuff tears. , 2001, Journal of shoulder and elbow surgery.

[11]  S S Burkhart,et al.  A stepwise approach to arthroscopic rotator cuff repair based on biomechanical principles. , 2000, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[12]  B. Fuchs,et al.  Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. , 1999, Journal of shoulder and elbow surgery.

[13]  J. Tauro.  Arthroscopic "interval slide" in the repair of large rotator cuff tears. , 1999, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[14]  G. Walch,et al.  The 'dropping' and 'hornblower's' signs in evaluation of rotator-cuff tears. , 1998, The Journal of bone and joint surgery. British volume.

[15]  G. Gartsman,et al.  Arthroscopic Repair of Full-Thickness Tears of the Rotator Cuff* , 1998, The Journal of bone and joint surgery. American volume.

[16]  M. Brinker,et al.  Early Effectiveness of Arthroscopic Repair for Full-Thickness Tears of the Rotator Cuff. An Outcome Analysis* , 1998, The Journal of bone and joint surgery. American volume.

[17]  J C Tauro,et al.  Arthroscopic rotator cuff repair: analysis of technique and results at 2- and 3-year follow-up. , 1998, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[18]  L. Bigliani,et al.  The rotator cuff. Large and massive tears. Technique of open repair. , 1997, The Orthopedic cllinics of North America.

[19]  S. Snyder,et al.  Technique of arthroscopic rotator cuff repair using implantable 4-mm Revo suture anchors, suture Shuttle Relays, and no. 2 nonabsorbable mattress sutures. , 1997, The Orthopedic clinics of North America.

[20]  G. Gartsman,et al.  Full-thickness tears: arthroscopic repair. , 1997, The Orthopedic clinics of North America.

[21]  S. Burkhart.  Partial repair of massive rotator cuff tears: the evolution of a concept. , 1997, The Orthopedic clinics of North America.

[22]  C. Gerber,et al.  Complex and Revision Problems in Shoulder Surgery , 1997 .

[23]  K. An,et al.  Activation of the Rotator Cuff in Generating Isometric Shoulder Rotation Torque , 1996, The American journal of sports medicine.

[24]  K. Athanasiou,et al.  Margin convergence: a method of reducing strain in massive rotator cuff tears. , 1996, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[25]  D. Ogilvie-Harris,et al.  Partial repair of irreparable rotator cuff tears. , 1994, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[26]  D Goutallier,et al.  Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. , 1994, Clinical orthopaedics and related research.

[27]  S. Burkhart.  Reconciling the paradox of rotator cuff repair versus debridement: a unified biomechanical rationale for the treatment of rotator cuff tears. , 1994, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[28]  S. Burkhart,et al.  The rotator crescent and rotator cable: an anatomic description of the shoulder's "suspension bridge". , 1993, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[29]  L. Bigliani,et al.  Operative repair of massive rotator cuff tears: Long-term results. , 1992, Journal of shoulder and elbow surgery.

[30]  H Ikeda,et al.  Rotator interval lesion. , 1986, Clinical orthopaedics and related research.

[31]  C. Constant,et al.  A clinical method of functional assessment of the shoulder. , 1987, Clinical orthopaedics and related research.

[32]  M Post,et al.  Rotator cuff tear. Diagnosis and treatment. , 1983, Clinical orthopaedics and related research.

[33]  R. Neviaser.  Tears of the rotator cuff. , 1980, The Orthopedic clinics of North America.