Summary

In patients with irreparable cuff tears treated by arthroscopic partial repair, functional scores improved after surgery, although the defect size increased in Satisfactory / Unsatisfactory groups.

Abstract

Introduction

Massive, irreparable rotator cuff tears are challenging to treat and associated with pain and severe limitation in shoulder motion. Many treatment options exist for managing the irreparable rotator cuff tears, including corticosteroid injections, tuberoplasty with biceps tenotomy and debridement, partial rotator cuff repair, tendon transfers, reverse total shoulder arthroplasty, and even glenohumeral joint arthrodesis. The effects of the arthroscopic partial repair after surgery remain unknown. The purpose of the present study was to evaluate clinical and structural outcomes in patients with irreparable cuff tears treated by arthroscopic partial repair.

Methods

Between January 2009 and December 2016, we conducted a retrospective study of consecutive 424 patients with rotator cuff tears who underwent ARCR. The inclusion criteria for this study were (1) those who had cuff tears repaired by ARCR; (2) those who had partial coverage during surgery; (3) those who were available for magnetic resonance imaging (MRI) before surgery and after surgery; (4) those who underwent appointed postoperative rehabilitation program and were followed up for 24 months postoperatively; (5) those who had UCLA scores before surgery and after surgery. The exclusion criteria were: (1) Patients with advanced glenohumeral arthritis and fractures around the shoulder and (2) those who underwent open repairs or revision surgeries. Consequently, 32 patients were subjects for this study. The mean age at surgery was 64 ± 9 years. Functional outcome measures comprised the Japanese Orthopedic Association (JOA) and University of California, Los Angeles (UCLA) score. According to the UCLA score at the final follow-up, the patients were divided into 2 groups: Satisfactory group (=28 points, n = 19) and Unsatisfactory group (<28 points, n = 13). Structural outcome measures evaluated by MRI consisted of tear size in the coronal / sagittal plane and fatty degeneration of the rotator cuff muscles (Goutallier classification). These outcome measures were evaluated before surgery and 3, 6, 12, and 24 months after surgery.

Results

Preoperative JOA and UCLA scores significantly improved after surgery. There was no significant difference in the mean preoperative JOA and UCLA scores between the 2 groups . Univariate logistic regression analysis showed that preoperative abduction range (P = 0.02), pain degree in the rest position (P = 0.007), and the Goutallier stages of the infraspinatus / subscapularis before surgery (P = 0.02 and P < 0.001) were significantly associated with worse UCLA score at the final follow-up. In both group, the tendon defect size in the coronal and sagittal planes before surgery temporarily decreased at 3 months after surgery but gradually increased thereafter.

Discussion And Conclusion

In patients with irreparable cuff tears treated by arthroscopic partial repair, functional scores significantly improved at 24 months after surgery; the tendon defect size was temporally decreased 3 months after surgery but increased thereafter. Under these condition, preoperative abduction range, pain degree in the rest position, and the subscapularis / infraspinatus fatty degeneration contributed to the worse functional outcome at the final follow-up.