Clinical and MRI results of arthroscopic repair for massive rotator cuff tear

Abstract

Objective To investigate the clinical and MRI outcomes of the arthroscopic rotator cuff repair for massive rotator cuff tear at minimum 2 years after surgery. Methods From October, 2010 to March, 2013, data of 79 shoulders in 77 patients with massive rotator cuff tear who were treated with arthroscopic rotator cuff repair were retrospectively analyzed. There were 42 male (44 shoulders) and 35 female (35 shoulders). The average age before surgery was 57.4 years (43.1-80.4 years). There were 64 right shoulders and 15 left shoulders. The dominate side were involved in 70 cases. A trauma history was documented in 52 shoulders. The symptoms persisted less than 3 months in 42 shoulders, between 3 and 6 months in 11 shoulders, between 6 and 12 months in 11 shoulders and more than 1 year in 15 shoulders. No revision case was included. The clinical results (range of motion, forward elevation strength, external rotation strength and American Shoulder & Elbow Surgeons (ASES) score and MRI results were collected. Results All 77 cases were followed up more than 2 years. The forward elevation (156.9°±20.0° to 103.2°±54.5°), external rotation (40.6°±15.5° to 32.0°±21.4°), internal rotation (L1 to L2), forward elevation strength (9.7±4.7 lb to 4.6±4.9 lb), external rotation strength (11.1±5.1 lb to 8.3±5.4 lb) and ASES score (82.7±14.6 to 45.2±17.4) were all improved significantly at the latest follow-up. During the surgery, complete repair were achieved in 68 shoulders. The forward elevation (146.4°±31.4° to 110.0°±56.7°), external rotation (45.0°±14.8° to 34.1°±20.8°) and ASES score (78.6±14.9 to 54.5±13.9) were all improved significantly at the latest follow-up in patients with partial repair during the surgery. But the forward elevation strength (10.5±4.9 lb to 6.2±3.2 lb) and external rotation strength (11.5±5.1 lb to 8.3±3.8 lb) were significantly better improved in patients who had complete repair. In 68 shoulders with complete repair during the surgery, 20 shoulders were found to have rotator cuff re-tear. The re-tear rate was 29.4%. But none of the patient with postoperative re-tear received revision surgery. The forward elevation (152.0±23.3 to 103.5±60.5), forward elevation strength (8.5±4.7 lb to 5.0±4.7 lb) and ASES score (76.9±16.5 to 40.8±18.6) were all improved significantly at the latest follow-up in patients with postoperative re-tear of the rotator cuff tendon. But the forward elevation (161.4°±13.4° to 152.0°±23.3°), forward elevation strength (11.3±4.7 lb to 8.5±4.7 lb), external rotation strength (12.4±4.8 lb to 9.6±5.3 lb) and ASES score (86.0±13.0 to 76.9±16.5) were significantly better in patients with complete healed rotator cuff tendon comparing with the re-tear group. Conclusion The rotator cuff repair can significantly improve the shoulder function of massive rotator cuff tear even when the rotator cuff tendon can only be partially repaired or re-tear after the surgery. The shoulder function is significantly better in patients with complete healed rotator cuff tendon comparing with the partial repair group and the re-tear group. Key words: Shoulder joint; Arthroscopy; Soft tissue injuries