Arthroscopic Repair of Massive “Irreparable” Tears of the Rotator Cuff Using Double Interval Slides: Clinical And Magnetic Resonance Imaging Results (SS-43)

Abstract

The objective of this study was to examine the clinical and anatomical outcomes following arthroscopic double interval slides in the repair of massive, otherwise “irreparable” rotator cuff tears. 11 patients were evaluated clinically and with MRI at a minimum 12 months post-operative. Double interval slides resulted in improved shoulder specific quality of life scores (post-operative versus pre-operative) and improved forward flexion. Active external rotation demonstrated no significant change. Anatomically, 55% of patients demonstrated massive re-tearing on MRI, 18% demonstrated a thin though grossly intact repair, and 27% showed a robust repair. Some chronic massive rotator cuff tears are irreparable using standard mobilization techniques. The double interval slide releases the interval between the supraspinatus and rotator interval (i.e. the anterior interval slide) and the interval between the supraspinatus and infraspinatus (i.e. the posterior interval slide) allowing repair of some massive “irreparable” rotator cuff tears. The purpose of this study was to review the clinical and MRI results following arthroscopic rotator cuff repair of massive “irreparable” rotator cuff tears using double interval slides. Eleven patients (5 females, 6 males; mean age 57.5 +/- 8 years) with massive, contracted, immobile rotator cuff tears that were irreparable using standard mobilization techniques, but reparable using arthroscopic double interval slides, were reviewed. The mean duration of symptoms was 16 +/- 12 months with 9 primary and 2 revision procedures. All patients had massive tears of the rotator cuff isolated to the supraspinatus and infraspinatus. All tears were irreparable using standard releases including capsular release but were reparable using a double interval slide mobilization technique and standard arthroscopic suture anchor repair to bone. All patients were reviewed using a standardized clinical examination by an independent observer, the ASES shoulder index and the Simple shoulder test (SST). All patients were evaluated by MRI interpreted by a musculoskeletal trained radiologist. Paired two-tailed t-tests were used to determine significant differences between preoperative and postoperative scores and unpaired t-tests were used to determine significant differences between intact and re-ruptured repairs. A p<0.05 was considered statistically significant. At a mean follow-up of 21 +/- 10 months (range: 12-42 months), 10 of 11 patients were satisfied with surgery and would have surgery again. The ASES shoulder index increased from a mean of 41.5 +/- 18.3 preoperatively to a mean of 79.1 +/- 17.4 post-operatively (p< 0.0001) and the SST increased from 2.8 +/- 2.6 out of 12 preoperatively to 8.8 +/− 2.7 out of 12 post-operatively (p< 0.0001). The mean active forward elevation increased significantly from 119.5 o +/- 45.2o to 152.7o +/- 23.0o (p=0.05). However, the mean active external rotation did not significantly change (preop= 38.2o +/- 17.1o; postop= 32.3o +/- 17.4o; p=0.5). MRI demonstrated that 6 patients (55%) had massive re-tearing of the rotator cuff to its original size, 2 had a thin but grossly intact repair and 3 had a thick and robust repair. Patients with intact repairs had significantly more external rotation strength on manual muscle testing (p=0.002) and trended toward improved ASES scores (ASES= 87 versus 72; p=0.15) but was not significantly different. The current early results suggest that rotator cuff repair using the double interval slide can provide significantly improved subjective and objective results even in the presence of a re-torn rotator cuff. Furthermore, although 55% of patients had massive re-tearing of the rotator cuff to its original size, 5 of 11 patients had at least some tissue connecting the rotator cuff to bone with some evidence for improved results. Level of Evidence Level IV case series.