Does Open Repair of Anterosuperior Rotator Cuff Tear Prevent Muscular Atrophy and Fatty Infiltration?

Abstract

Repair of cuff tears involving rotator interval reportedly improves function. However, it is unclear whether successful repair prevents shoulder degenerative changes. Therefore, we (1) documented the minimal 4-year function of patients who underwent open surgical repair for rotator interval tears; (2) evaluated repaired tendon healing with postoperative MRI; and (3) sought to determine the influence of tendon healing on muscular and glenohumeral joint changes. We retrospectively analyzed 22 patients (23 shoulders) treated by open transosseous reinsertion of supraspinatus and subscapularis tendons. The mean age of the patients was 53years (range, 37-64years). The tear was traumatic in four cases. Repair healing and muscular changes were assessed using MRI. The minimum followup was 46months (mean, 75months; range, 46-103months). We observed an improvement in the absolute Constant-Murley score from 63 points preoperatively to 76 points postoperatively. With the last followup MRI, the supraspinatus tendon repair had failed in two of the 23 shoulders, whereas the subscapularis tendon repair had healed in all cases. Once healing of the repaired tendon occurred, supraspinatus muscle atrophy never worsened. However, on MRI fatty infiltration of the rotator cuff muscles increased despite successful tendon repair. Glenohumeral arthritis remained stable. Postoperative abduction and internal rotation strengths were better when the standardized supraspinatus muscle area was greater than 0.5 at the final evaluation. Durable functional improvement and limited degenerative articular and muscular changes can be expected in most patients 4 to 10years after open repair of anterosuperior cuff tears provided that healing of the cuff is obtained. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.