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Knee Surgery, Sports Traumatology, Arthroscopy

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01-12-2016 | Shoulder

Arthroscopic management of massive rotator cuff tears: an evaluation of debridement, complete, and partial repair with and without force couple restoration

Authors: Philipp R. Heuberer, Roman Kölblinger, Stefan Buchleitner, Leo Pauzenberger, Brenda Laky, Alexander Auffarth, Philipp Moroder, Sylvia Salem, Bernhard Kriegleder, Werner Anderl

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2016

Abstract

Purpose

To evaluate the effectiveness of arthroscopic debridement (DB), partial (PR), and complete repair (CR) for massive rotator cuff tears (mRCT) in terms of functional and subjective parameters, and repair integrity.

Methods

For this single-centre study, 68 consecutive shoulders with mRCT involving at least three tendons and treated with arthroscopic DB (n = 23), PR (n = 22), and CR (n = 23) were included. All patients (52–81 years) were prospectively assessed before and at a mean of 45 months after surgery using functional and subjective parameters. Preoperative tendon rupture pattern and post-operative repair integrity were assessed by MRI. A coding system describing accurately rotator cuff rupture, treatment, and integrity was established.

Results

All treatment groups improved significantly from pre- to post-operative (P < 0.01), while preoperative parameters, except fatty degeneration, were not significantly different. However, post-operative comparisons revealed similar scores with DB (constant score, CS 65.8 ± 14.7, qDASH 24.1 ± 20.6) and PR (CS 67.5 ± 9.9, P = n.s.; qDASH 20.5 ± 14.4, P = n.s.), while CR were significantly better (CS 80.3 ± 8.9; qDASH 7.0 ± 8.7; P ≤ 0.001). Force couple restoration of PR did not significantly influence outcome. Re-tear rates with CR (29 %) were lower compared to PR (53 %). Intact CR compared to intact PR showed better CS (83.4 ± 7.3 vs. 68.5 ± 10.6, P = 0.009) and qDASH (5.4 ± 8.3 vs. 21.2 ± 9.5, P = 0.006). The vast majority of patients were satisfied with their arthroscopic procedure (DB 87 %; PR 86 %; CR 91 %).

Conclusion

Arthroscopic DB, PR, and CR were effective in treating mRCT involving at least three tendons. Reparability of mRCT was influenced by fatty degeneration of the muscles. However, CR showed the most favourable short-term improvements.

Level of evidence

IV.

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Anakwenze OA, Baldwin K, Milby AH, Warrender W, Shulman B, Abboud JA (2013) Arthroscopic repair of large rotator cuff tears using the double-row technique: an analysis of surgeon experience on efficiency and outcomes. J Shoulder Elbow Surg 22(1):26–31CrossRefPubMed

Berdusco R, Trantalis JN, Nelson AA, Sohmer S, More KD, Wong B, Boorman RS, Lo IK (2013) Arthroscopic repair of massive, contracted, immobile tears using interval slides: clinical and MRI structural follow-up. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-013-2683-9 PubMed

Berth A, Neumann W, Awiszus F, Pap G (2010) Massive rotator cuff tears: functional outcome after debridement or arthroscopic partial repair. J Orthop Traumatol 11(1):13–20CrossRefPubMedPubMedCentral

Burkhart SS (1994) Reconciling the paradox of rotator cuff repair versus debridement: a unified biomechanical rationale for the treatment of rotator cuff tears. Arthroscopy 10(1):4–19CrossRefPubMed

Burkhart SS, Barth JR, Richards DP, Zlatkin MB, Larsen M (2007) Arthroscopic repair of massive rotator cuff tears with stage 3 and 4 fatty degeneration. Arthroscopy 23(4):347–354CrossRefPubMed

Burkhart SS, Nottage WM, Ogilvie-Harris DJ, Kohn HS, Pachelli A (1994) Partial repair of irreparable rotator cuff tears. Arthroscopy 10(4):363–370CrossRefPubMed

Choi S, Kim MK, Kim GM, Roh YH, Hwang IK, Kang H (2014) Factors associated with clinical and structural outcomes after arthroscopic rotator cuff repair with a suture bridge technique in medium, large, and massive tears. J Shoulder Elbow Surg. doi:10.1016/j.jse.2014.02.021

Chung SW, Kim JY, Kim MH, Kim SH, Oh JH (2013) Arthroscopic repair of massive rotator cuff tears: outcome and analysis of factors associated with healing failure or poor postoperative function. Am J Sports Med 41(7):1674–1683CrossRefPubMed

Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

10.

DeOrio JK, Cofield RH (1984) Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am 66(4):563–567CrossRefPubMed

11.

Dwyer T, Razmjou H, Henry P, Gosselin-Fournier S, Holtby R (2013) Association between pre-operative magnetic resonance imaging and reparability of large and massive rotator cuff tears. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-013-2745-z

12.

Ellman H (1990) Diagnosis and treatment of incomplete rotator cuff tears. Clin Orthop Relat Res 254:64–74

13.

Franceschi F, Papalia R, Vasta S, Leonardi F, Maffulli N, Denaro V (2015) Surgical management of irreparable rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 23(2):494–501CrossRefPubMed

14.

Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 8(6):599–605CrossRefPubMed

15.

Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K (2004) The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am 86-A(2):219–224CrossRefPubMed

16.

Gerber C, Fuchs B, Hodler J (2000) The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am 82(4):505–515CrossRefPubMed

17.

Gilbart MK, Gerber C (2007) Comparison of the subjective shoulder value and the constant score. J Shoulder Elbow Surg 16(6):717–721CrossRefPubMed

18.

Goutallier D, Postel JM, Gleyze P, Leguilloux P, Van Driessche S (2003) Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg 12(6):550–554CrossRefPubMed

19.

Iagulli ND, Field LD, Hobgood ER, Ramsey JR, Savoie FH 3rd (2012) Comparison of partial versus complete arthroscopic repair of massive rotator cuff tears. Am J Sports Med 40(5):1022–1026CrossRefPubMed

20.

Kempf JF, Gleyze P, Bonnomet F, Walch G, Mole D, Frank A, Beaufils P, Levigne C, Rio B, Jaffe A (1999) A multicenter study of 210 rotator cuff tears treated by arthroscopic acromioplasty. Arthroscopy 15(1):56–66CrossRefPubMed

21.

Kim JR, Cho YS, Ryu KJ, Kim JH (2012) Clinical and radiographic outcomes after arthroscopic repair of massive rotator cuff tears using a suture bridge technique: assessment of repair integrity on magnetic resonance imaging. Am J Sports Med 40(4):786–793CrossRefPubMed

22.

Kim SJ, Lee IS, Kim SH, Lee WY, Chun YM (2012) Arthroscopic partial repair of irreparable large to massive rotator cuff tears. Arthroscopy 28(6):761–768CrossRefPubMed

23.

Kuhn JE, Dunn WR, Ma B, Wright RW, Jones G, Spencer EE, Wolf B, Safran M, Spindler KP, McCarty E, Kelly B, Holloway B (2007) Interobserver agreement in the classification of rotator cuff tears. Am J Sports Med 35(3):437–441PubMed

24.

Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R (2007) Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am 89(6):1184–1193CrossRefPubMed

25.

Liem D, Lengers N, Dedy N, Poetzl W, Steinbeck J, Marquardt B (2008) Arthroscopic debridement of massive irreparable rotator cuff tears. Arthroscopy 24(7):743–748CrossRefPubMed

26.

Lo IK, Burkhart SS (2004) The interval slide in continuity: a method of mobilizing the anterosuperior rotator cuff without disrupting the tear margins. Arthroscopy 20(4):435–441CrossRefPubMed

27.

Meyer DC, Wieser K, Farshad M, Gerber C (2012) Retraction of supraspinatus muscle and tendon as predictors of success of rotator cuff repair. Am J Sports Med 40(10):2242–2247CrossRefPubMed

28.

Mochizuki T, Sugaya H, Uomizu M, Maeda K, Matsuki K, Sekiya I, Muneta T, Akita K (2008) Humeral insertion of the supraspinatus and infraspinatus. New anatomical findings regarding the footprint of the rotator cuff. J Bone Joint Surg Am 90(5):962–969CrossRefPubMed

29.

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(6):479–482PubMed

30.

Park JY, Siti HT, Keum JS, Moon SG, Oh KS (2010) Does an arthroscopic suture bridge technique maintain repair integrity?: a serial evaluation by ultrasonography. Clin Orthop Relat Res 468(6):1578–1587CrossRefPubMed

31.

Patte D (1990) Classification of rotator cuff lesions. Clin Orthop Relat Res 254:81–86

32.

Rockwood CA Jr, Williams GR Jr, Burkhead WZ Jr (1995) Debridement of degenerative, irreparable lesions of the rotator cuff. J Bone Joint Surg Am 77(6):857–866CrossRefPubMed

33.

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(5):953–960PubMed

34.

Thomazeau H, Rolland Y, Lucas C, Duval JM, Langlais F (1996) Atrophy of the supraspinatus belly. Assessment by MRI in 55 patients with rotator cuff pathology. Acta Orthop Scand 67(3):264–268CrossRefPubMed

35.

Wellmann M, Lichtenberg S, da Silva G, Magosch P, Habermeyer P (2013) Results of arthroscopic partial repair of large retracted rotator cuff tears. Arthroscopy 29(8):1275–1282CrossRefPubMed

36.

Yian EH, Ramappa AJ, Arneberg O, Gerber C (2005) The Constant score in normal shoulders. J Shoulder Elbow Surg 14(2):128–133CrossRefPubMed

37.

Yoo JH, Cho NS, Rhee YG (2013) Effect of postoperative repair integrity on health-related quality of life after rotator cuff repair: healed versus retear group. Am J Sports Med 41(11):2637–2644CrossRefPubMed

38.

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(5):518–523CrossRefPubMed

Title: Arthroscopic management of massive rotator cuff tears: an evaluation of debridement, complete, and partial repair with and without force couple restoration
Authors: Philipp R. Heuberer
Roman Kölblinger
Stefan Buchleitner
Leo Pauzenberger
Brenda Laky
Alexander Auffarth
Philipp Moroder
Sylvia Salem
Bernhard Kriegleder
Werner Anderl
Publication date: 01-12-2016
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2016
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-015-3739-9

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Arthroscopic management of massive rotator cuff tears: an evaluation of debridement, complete, and partial repair with and without force couple restoration

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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