Friday, April 5, 2013

Failed Repairs of Large or Massive Rotator Cuff Tears

Clinical and Radiographic Outcomes of Failed Repairs of Large or Massive Rotator Cuff Tears: Minimum Ten-Year Follow-up - E. Scott Paxton, MD; Sharlene A. Teefey, MD; Nirvikar Dahiya, MD; Jay D. Keener, MD; Ken Yamaguchi, MD; Leesa M. Galatz, MD
J Bone Joint Surg Am, 2013 Apr 3;95(7):627-632.

This is a long term followup of fifteen of eighteen patients average age 61 years having had attempted arthroscopic repair of massive rotator cuff tears (at least two tendons torn) at a minimum of 10 years. The rotator cuff repair was attempted with use of a single-row construct with 5-mm bioabsorbable corkscrew anchors. Two to five anchors were used, depending on tear size and configuration.  After surgery the arm was immobilized in a sling.The rehabilitation protocol began on the first postoperative day with passive shoulder range-of-motion exercises. Active-assisted motion was initiated at six weeks. A return to recreational activity with heavy demands on the shoulder or to manual labor was delayed for six months.

The functional results as measured by the ASES score are shown here

The average SST score was 9.2 out of 12 points (range, 6 to 12 points). Of these patients with structurally failed repairs, all but one had radiographic signs of proximal humeral migration or cuff tear arthropathy. Ultrasound confirmed the persistence of all tears that had been seen at two years.

The authors concluded that clinical improvements and pain relief after a failed attempt at arthroscopic rotator cuff repair of large and massive tears are durable at the time of long-term (ten-year) follow-up in spite of a high rate of progression of radiographic signs associated with large rotator cuff tears.

These results showing durable clinical improvement after failed attempts to achieve arthroscopic integrity of the rotator cuff once again cause us to question what it was about the surgery and postoperative rehabilitation that led to this improvement, in that it obviously was not the reestablishment of cuff integrity.  Did these patients achieve any value from the placement of 2 to 5 suture anchors? Might it be true that 60+ year olds with chronic massive cuff tears might be equally well treated without attempting to repair cuff tendons lacking in quantity and quality?

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