These authors evaluated the results of 105 operative repairs of tears of the rotator cuff of the shoulder in eighty-nine patients at an average of five years postoperatively. They correlated the functional result with the integrity of the cuff, as determined by ultrasonography.
The size of the rotator cuff defect as seen at surgery (operative type) and as seen at followup by sonography (followup type) was classified as follows:
Type 0 - intact cuff
Type lA - thinning or a partial-thickness defect of the supraspinatus tendon.
Type lB - a full-thickness defect of the supraspinatus tendon
Type 2 - a full thickness defect involving the supraspinatus and infraspinatus tendons'
Type 3 - a full-thickness defect involving the supraspinatus ,infraspinatus ,and subscapularis tendons.
The tear size seen at surgery was related to age at the time of repair
Eighty per cent of the repairs of a tear involving only the supraspinatus tendon were intact at the time of the most recent follow-up, while more than 50 per cent of the repairs of a tear involving more than the supraspinatus tendon had a recurrent defect.
Older patients and patients in whom a larger tear had been repaired had a greater prevalence of recurrent defects.
At the time of the most recent follow-up, most of the patients were more comfortable and were satisfied with the result of the repair, even when they had sonographic evidence of a recurrent defect.
The shoulders in which the repaired cuff was intact at the time of follow-up had better function during activities of daily living and a better range of active flexion (129 +/- 20 degrees compared with 71 +/- 41 degrees) compared with the shoulders that had a large recurrent defect. Similar correlations were noted for the range of active external and internal rotation and for strength of flexion, abduction, and internal rotation.
In the shoulders in which the cuff was not intact, the degree of functional loss was related to the size of the recurrent defect.
The function of the patients who had an intact cuff after repair of a large tear was as good as that of the patients who had an intact cuff after repair of a small tear.
Comment: This study is of interest because of the detailed correlations examined among patient age, tear size, repair integrity at five years and function at five years after surgery.
It is also of interest that this study was published in 1991, bringing up the question "are current methods of cuff repair yielding results that are equal to or superior to those achieved over 25 years ago?
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