2017 ISAKOS Biennial Congress ePoster #2251
Arthroscopic Repair of Anterosuperior Massive Rotator Cuff Tear: Does Repair Integrity Affect Outcomes?
Sung-Jae Kim, MD, PhD, Seoul KOREA, REPUBLIC OF
Min Jung, MD, PhD, Seoul KOREA, REPUBLIC OF
Sung-Hwan Kim, MD, PhD, Seoul KOREA, REPUBLIC OF
Wonyong Lee, MD, Painted Post, NY UNITED STATES
Jong-Min Kim, MD, Incheon, Gyeonggi KOREA, REPUBLIC OF
Yong-Min Chun, MD, PhD, Assoc. Prof., Seoul KOREA, REPUBLIC OF
Arthroscopy and Joint Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, KOREA, REPUBLIC OF
FDA Status Not Applicable
Summary
After arthroscopic repair of anterosuperior massive RCTs, the healed group had better functional outcomes than the re-tear group. The subscapularis re-tear subgroup exhibited inferior outcomes compared to the subgroup with intact subscapularis repair. Despite postoperative functional improvement, failed subscapularis repair of anterosuperior massive RCTs may not meet patient expectations.
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Abstract
Background
The purpose of this study was to investigate clinical outcomes and structural integrity following arthroscopic repair of anterosuperior massive rotator cuff tears (RCTs). Clinical outcomes were compared between healed and re-tear groups and between re-tear subgroups.
Methods
This study included 73 patients who underwent arthroscopic repair of an anterosuperior massive RCT. Functional outcomes after 2-year follow-up were assessed using the visual analog scale (VAS) pain score, subjective shoulder value (SSV), American Shoulder and Elbow Surgeons (ASES) score, University of California at Los Angeles (UCLA) shoulder score, and active range of motion. Patients were assigned to the healed group (Group H, n=34) or re-tear group (Group R, n=39) based on magnetic resonance arthrography results 6 months postoperatively. Group R contained Subgroup R1 (failed subscapularis repair) and R2 (intact subscapularis repair).
Results
Re-tearing occurred in 53% of patients. At 2-year follow-up, Group H exhibited better outcomes for all functional scores (p < 0.001): VAS pain score (1.0 versus 2.1), SSV (90.2 versus 77.4), ASES score (90.8 versus 76.6), and UCLA shoulder score (31.0 versus 24.9). Within both groups, all scores improved significantly compared with preoperative numbers (p < 0.001). At follow-up, Group H had significantly better forward flexion (p=0.018) and internal rotation (p=0.002) than Group R; within both groups, active ROM improved in all planes compared to preoperative condition (p<0.001). Subgroup R1 exhibited inferior outcomes versus Subgroup R2: VAS pain score (2.6 versus 1.5, p=0.012), ASES score (70.9 versus 83.6, p=0.013), SSV (70.9 versus 85.4, p=0.005), and UCLA shoulder score (22.0 versus 28.5, p=0.001).
Conclusion
After arthroscopic repair of anterosuperior massive RCTs, 53% of patients exhibited re-tearing. The healed group had better functional outcomes than the re-tear group. The subscapularis re-tear subgroup exhibited significantly inferior outcomes compared to the subgroup with intact subscapularis repair. Despite postoperative functional improvement, failed subscapularis repair of anterosuperior massive RCTs may not meet patient expectations.