Top

Journal of Orthopaedics and Traumatology

Published in:

Open Access 01-03-2010 | Original Article

Massive rotator cuff tears: functional outcome after debridement or arthroscopic partial repair

Authors: Alexander Berth, Wolfram Neumann, Friedemann Awiszus, Géza Pap

Published in: Journal of Orthopaedics and Traumatology | Issue 1/2010

Abstract

Background

The surgical treatment of massive rotator cuff tears (RCT) is still controversial and can be based on a variety of different surgical repair methods. This study investigated the effectiveness of arthroscopic debridement or arthroscopic partial repair in patients with massive RCT.

Materials and methods

This prospective, randomized study involved forty-two patients with massive RCT (fatty infiltration stage 3 or 4) treated with either arthroscopic partial repair or arthroscopic debridement were selected to detect possible differences in functional outcome. Both groups were matched according to age and gender. Patients were examined before, and 16 ± 3 and 24 ± 2 months after surgery. The status of the rotator cuff repair was determined using ultrasonographic evaluation.

Results

Regardless of the treatment group, postoperative results demonstrated highly significant improvements compared with preoperative values in most parameters. The overall Constant score in the partial repair group was superior to the outcome in the debridement group (P < 0.01, F = 8.561), according to better results in abduction (P < 0.01, F = 13.249), activity (P < 0.01, F = 21.391) and motion (P < 0.01, F = 4.967). All treatment groups had similar pain relief (P = 0.172, F = 1.802) and satisfaction, reflected in equal values of disabilities of the arm, shoulder and hand (DASH) score (P = 0.948, F = 0.004). Ultrasonography revealed structural failure of the partial rotator cuff repair in 52% at final follow-up.

Conclusions

During the follow-up period all patients in our series had good or satisfactory outcome after rotator cuff surgery. Regardless of high rates of structural failure of the partial rotator cuff repair, the results of arthroscopic partial rotator cuff repair demonstrated slightly better functional outcome than debridement.

Norwood LA, Barrack R, Jacobson KE (1989) Clinical presentation of complete tears of the rotator cuff. J Bone Joint Surg Am 71:499–505PubMed

Murrell GA, Walton JR (2001) Diagnosis of rotator cuff tears. Lancet 357:769–770PubMedCrossRef

Ainsworth R, Lewis JS (2007) Exercise therapy for the conservative management of full thickness tears of the rotator cuff: a systematic review. Br J Sports Med 41:200–210PubMedCentralPubMedCrossRef

Alvarez CM, Litchfield R, Jackowski D et al (2005) A prospective, double-blind, randomized clinical trial comparing subacromial injection of betamethasone and xylocaine to xylocaine alone in chronic rotator cuff tendinosis. Am J Sports Med 33:255–262PubMedCrossRef

Wolf BR, Dunn WR, Wright RW (2007) Indications for repair of full-thickness rotator cuff tears. Am J Sports Med 35:1007–1016PubMedCrossRef

Gohlke F, Rolf O, Bohm D (2007) Open reconstruction of the rotator cuff. Orthopade 36:834–847PubMedCrossRef

Habermeyer P, Lehmann L, Lichtenberg S (2000) Rotator cuff tears: diagnosis and therapy. Orthopade 29:196–208PubMed

Dietz SO, Habermeyer P, Magosch P (2002) Current concepts in treatment of rotator cuff tears. Zentralbl Chir 127:194–202PubMedCrossRef

Loew M (2000) Traumatic development of rotator cuff lesion. Scientific principles and consequences for expert assessment. Orthopade 29:881–887CrossRef

10.

DeFranco MJ, Bershadsky B, Ciccone J et al (2007) Functional outcome of arthroscopic rotator cuff repairs: a correlation of anatomic and clinical results. J Shoulder Elbow Surg 16:759–765PubMedCrossRef

11.

Goutallier D, Postel JM, Bernageau J et al (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 78–83

12.

Matthews TJ, Hand GC, Rees JL et al (2006) Pathology of the torn rotator cuff tendon. Reduction in potential for repair as tear size increases. J Bone Joint Surg Br 88:489–495

13.

Galatz LM, Griggs S, Cameron BD, Iannotti JP (2001) Prospective longitudinal analysis of postoperative shoulder function: a ten-year follow-up study of full-thickness rotator cuff tears. J Bone Joint Surg Am 83-A:1052–1056PubMed

14.

Gerber C, Fuchs B, Hodler J (2000) The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am 82:505–515PubMed

15.

Burkhart SS (2001) Arthroscopic treatment of massive rotator cuff tears. Clin Orthop Relat Res 107–18

16.

Burkhart SS, Nottage WM, Ogilvie-Harris DJ et al (1994) Partial repair of irreparable rotator cuff tears. Arthroscopy 10:363–370PubMedCrossRef

17.

Ogilvie-Harris DJ, Demaziere A (1993) Arthroscopic debridement versus open repair for rotator cuff tears. A prospective cohort study. J Bone Joint Surg Br 75:416–420PubMed

18.

Melillo AS, Savoie FH III, Field LD (1997) Massive rotator cuff tears: debridement versus repair. Orthop Clin North Am 28:117–124PubMedCrossRef

19.

Gartsman GM (1997) Massive, irreparable tears of the rotator cuff. Results of operative debridement and subacromial decompression. J Bone Joint Surg Am 79:715–721

20.

Moser M, Jablonski MV, Horodyski M, Wright TW (2007) Functional outcome of surgically treated massive rotator cuff tears: a comparison of complete repair, partial repair, and debridement. Orthopedics 30:479–482PubMed

21.

Patte D (1990) Classification of Rotator Cuff Lesions. Clin Orthop Relat Res 81–86

22.

Bateman JE (1963) The diagnosis and treatment of ruptures of the rotator cuff. Surg Clin North Am 43:1523–1530PubMed

23.

Prickett WD, Teefey SA, Galatz LM et al (2003) Accuracy of ultrasound imaging of the rotator cuff in shoulders that are painful postoperatively. J Bone Joint Surg Am 85-A:1084–1089PubMed

24.

Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 160-4

25.

Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29:602–608

26.

Duralde XA, Bair B (2005) Massive rotator cuff tears: the result of partial rotator cuff repair. J Shoulder Elbow Surg 14:121–127PubMedCrossRef

27.

de Jesus JO, Parker L, Frangos AJ, Nazarian LN (2009) Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. AJR Am J Roentgenol 192:1701–1707PubMedCrossRef

28.

Verma NN, Dunn W, Adler RS et al (2006) All-arthroscopic versus mini-open rotator cuff repair: a retrospective review with minimum 2-year follow-up. Arthroscopy 22:587–594PubMedCrossRef

29.

Sugaya H, Maeda K, Matsuki K, Moriishi J (2007) Repair integrity and functional outcome after arthroscopic double-row rotator cuff repair. A prospective outcome study. J Bone Joint Surg Am 89:953–960PubMedCrossRef

30.

Costouros JG, Porramatikul M, Lie DT, Warner JJ (2007) Reversal of suprascapular neuropathy following arthroscopic repair of massive supraspinatus and infraspinatus rotator cuff tears. Arthroscopy 23:1152–1161PubMedCrossRef

31.

Mallon WJ, Wilson RJ, Basamania CJ (2006) The association of suprascapular neuropathy with massive rotator cuff tears: a preliminary report. J Shoulder Elbow Surg 15:395–398PubMedCrossRef

32.

Itoi E, Minagawa H, Sato T et al (1997) Isokinetic strength after tears of the supraspinatus tendon. J Bone Joint Surg Br 79:77–82PubMedCrossRef

33.

Hata Y, Saitoh S, Murakami N et al (2004) Atrophy of the deltoid muscle following rotator cuff surgery. J Bone Joint Surg Am 86-A:1414–1419PubMed

34.

Gumina S, Di GG, Perugia D, Postacchini F (2008) Deltoid detachment consequent to open surgical repair of massive rotator cuff tears. Int Orthop 32:81–84PubMedCentralPubMedCrossRef

35.

Pearsall AW, Ibrahim KA, Madanagopal SG (2007) The results of arthroscopic versus mini-open repair for rotator cuff tears at mid-term follow-up. J Orthop Surg Res 2:24PubMedCentralPubMedCrossRef

36.

Kang L, Henn RF, Tashjian RZ, Green A (2007) Early outcome of arthroscopic rotator cuff repair: a matched comparison with mini-open rotator cuff repair. Arthroscopy 23:573–582PubMedCrossRef

37.

Zvijac JE, Levy HJ, Lemak LJ (1994) Arthroscopic subacromial decompression in the treatment of full thickness rotator cuff tears: a 3- to 6-year follow-up. Arthroscopy 10:518–523PubMedCrossRef

Title: Massive rotator cuff tears: functional outcome after debridement or arthroscopic partial repair
Authors: Alexander Berth
Wolfram Neumann
Friedemann Awiszus
Géza Pap
Publication date: 01-03-2010
Publisher: Springer International Publishing
Published in: Journal of Orthopaedics and Traumatology / Issue 1/2010
Print ISSN: 1590-9921
Electronic ISSN: 1590-9999
DOI: https://doi.org/10.1007/s10195-010-0084-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Massive rotator cuff tears: functional outcome after debridement or arthroscopic partial repair

Abstract

Background

Materials and methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2010

Periprosthetic fractures of the femur: the stability of the implant dictates the type of treatment

Decolonization of orthopedic surgical team S. aureus carriers: impact on surgical-site infections

A prospective randomised radiostereometric analysis trial of SmartSet HV and Palacos R bone cements in primary total hip arthroplasty

Subcutaneous tissue flaps for hallux covering

The effect of zoledronate during bone healing

Key factors in determining surgical timing of total knee arthroplasty in osteoarthritic patients: age, radiographic severity, and symptomatic severity