These authors evaluated the clinical and structural outcome 20 years after repair of isolated
supraspinatus tendon tears. The average age at surgery for these patients was 52 years. 137 patients were recalled for a clinical and imaging assessment. Six patients (4.3%) had died from unrelated causes, 52 (38.0%) were lost to follow-up, and 13 (9.5%) had undergone reoperations leaving 66 patients for clinical evaluation. Radiographs and magnetic resonance imaging were additionally performed for 45 patients.
The Constant Score (CS) improved from an average of 51.5 points preoperatively to 71 points. At followup, the average Simple Shoulder Test score was 9.5 out of 12.
Failure of the repair (Sugaya IV-V) was present in 19 of 45 patients (42 %),.
Failure of the repair (Sugaya IV-V) was present in 19 of 45 patients (42 %),.
There was advanced fatty infiltration (Goutallier III-IV) of the supraspinatus in 12 (27%) and of the infraspinatus muscle in 16 (35%).
Supraspinatus atrophy was present in 12 patients (28%), advanced arthritis in 6, and cuff tear arthropathy in 12 (30%).
Clinical outcomes were significantly inferior for shoulders with fatty infiltration.
Comment: This is an important study in that it shows
(1) that only 58% of repairs of isolated supraspinatus tears remain intact at 20 years and only 8.9% of the tendons were “normal” (Sugaya type I). i.e. rotator cuff degeneration often progresses as patients age from 52 to 72 and
(2) patients with failed cuff repairs had good shoulder function, specifically a Simple Shoulder Test score of 8 out of 12 i.e. an intact supraspinatus is not essential to a functional shoulder.
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