Arthroscopic Treatment of Massive Posterosuperior Rotator Cuff Tears A Critical Analysis Review
After their review of the available data, these authors concluded that
(1) Massive rotator cuff tears that are treated nonoperatively demonstrate increases in tear size, fatty infiltration, muscular atrophy, and arthritis.
(2) The pooled retear rate following complete repair of massive rotator cuff tears is 79%.
(3) Absorbable and nonabsorbable graft augmentation following rotator cuff repair can reduce the retear rate and improve functional outcomes.
(4) Irreparable tears can be predicted preoperatively by evaluating the degree of fatty infiltration, muscular atrophy, and tendon length.
(5) Latissimus dorsi transfer, lower trapezius transfer, and superior capsular reconstruction provide improvements in terms of pain, range of motion, and function in patients with irreparable tears.
Comment: This is an impressively comprehensive article. The authors carefully differentiate options for treating a reparable massive tear:
After their review of the available data, these authors concluded that
(1) Massive rotator cuff tears that are treated nonoperatively demonstrate increases in tear size, fatty infiltration, muscular atrophy, and arthritis.
(2) The pooled retear rate following complete repair of massive rotator cuff tears is 79%.
(3) Absorbable and nonabsorbable graft augmentation following rotator cuff repair can reduce the retear rate and improve functional outcomes.
(4) Irreparable tears can be predicted preoperatively by evaluating the degree of fatty infiltration, muscular atrophy, and tendon length.
(5) Latissimus dorsi transfer, lower trapezius transfer, and superior capsular reconstruction provide improvements in terms of pain, range of motion, and function in patients with irreparable tears.
Comment: This is an impressively comprehensive article. The authors carefully differentiate options for treating a reparable massive tear:
from the options for treating a massive irreparable cuff tear:
They point out that nonoperative treatment of a massive rotator cuff tear can be effective for patients who present with pain and preserved range of motion with an emphasis on strengthening the remaining rotator cuff, deltoid, and periscapular muscles. While tear progression has been observed in association with the nonoperative treatment, its not clear whether the clinical outcomes of operative management of these tears is superior to that of non-operative management. The bottom line, of course, is that these tears are degenerative so that all methods of treatment (non-operative and operative) are destined to suffer from progressive deterioration with time of the tissue surrounding the humeral head (see chart above).
Thus it seems important to focus on the symptoms of the patient at present because it is unclear whether we can change the natural history of this disease.
Finally we need to recall that selected patients with massive irreparable cuff tears can be successfully treated by methods that do not attempt to restore the integrity of the rotator cuff, such as rehabilitation (see this link), the smooth and move procedure (see link, link, link), the CTA athroplasty (see this link) and the reverse total shoulder (see this link).
Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link
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How you can support progress in shoulder surgery
You may be interested in some of our most visited web pages arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
How you can support progress in shoulder surgery
You may be interested in some of our most visited web pages arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
