These authors reviewed 26 patients who underwent arthroscopic debridement for an irreparable rotator cuff tear with a median follow-up of 98 months (range, 58-115 months). The rotator cuff was deemed irreparable intraoperatively by the treating surgeon based on inability to mobilize the tendon to the medial footprint without excessive tension, or poor-quality tissue that could not be secured with suture and anchor fixation. All patients underwent a subacromial bursectomy. A tuberoplasty or acromioplasty was performed at the surgeon’s discretion. Management of the biceps was dependent on the operating surgeon’s assessment of biceps disease.
The average age at the time of surgery was 60±11 years. Six patients (23%) had a reoperation at a median 11 months (range, 1-91 months), with 5 of those being revised to reverse shoulder arthroplasty. Median ASES and visual analog scale pain scores improved significantly from preoperatively to postoperatively (P <.01). Lower preoperative forward elevation was associated with worse postoperative ASES scores (P <.004) and revision to reverse shoulder arthroplasty. The authors found no associations between preoperative radiographic variables and reoperation or lower outcome scores.
Median ASES scores improved significantly from preoperatively to postoperatively from 38 (IQR, 29-49; range, 17-73) to 74 (IQR, 54-87; range, 25-95) (P <.007). Patients with <90 degrees of preoperative active forward elevation (FE) had worse median postoperative ASES scores (54, IQR, 39-73; range, 25-77) compared with those who had >90 degrees of preoperative FE (82, IQR, 63-88; range, 43-95). Also, 5 of 11 (45%) patients with <90 degrees of preoperative FE had a revision to RSA compared with 0 of 15 (0%) (P <.007) with >90 of preoperative FE. Patients with prior surgery had lower median ASES scores as well (48, IQR, 34-74; range, 25-87 vs. 81, IQR, 63-88; range, 43-95), but this only trended to significance (P =.06).
Comment: This study is important because it shows that patients with preserved active elevation above 90 degrees can benefit from surgical smoothing of the humeroscapular motion interface, irrespective of the preoperative MRI findings. Cost-effectiveness of more expensive procedures such as superior capsular reconstruction, subacromial balloon spacers or reverse total shoulder should be considered in the context of these successful results.
This study should be considered along with a paper reporting a larger series:Treatment of irreparable cuff tears with smoothing of the humeroscapular motion interface without acromioplasty, the abstract of which is posted below.
PURPOSE:
These authors sought to determine whether shoulders with irreparable rotator cuff tears and retained active elevation can be durably improved using a conservative surgical procedure that smoothes the interface between the proximal humeral convexity and the concave undersurface of the coracoacromial arch followed by immediate range of motion exercises.
METHODS:
They reviewed 151 patients with a mean age of 63.4 (range 40-90) years at a mean of 7.3 (range 2-19) years after this surgery.
RESULTS:
In 77 shoulders with previously unrepaired irreparable tears, simple shoulder test (SST) scores improved from an average of 4.6 (range 0-12) to 8.5 (range 1-12) (p < 0.001). Fifty-four patients (70%) improved by at least the minimally clinically important difference (MCID) of 2 SST points. For 74 shoulders with irreparable failed prior repairs, SST scores improved from 4.0 (range 0-11) to 7.5 (range 0-12) (p < 0.001). Fifty-four patients (73%) improved by the MCID of 2 SST points.
CONCLUSION:
Smoothing of the humeroscapular interface can improve symptomatic shoulders with irreparable cuff tears and retained active elevation. This conservative procedure offers an alternative to more complex procedures in the management of irreparable rotator cuff tears.
The technique of the smooth and move procedure is shown in this link.
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