Long-term outcomes after deltoid muscular flap transfer for irreparable rotator cuff tears

Abstract

We reviewed 20 cases (18 patients) with massive, irreparable rotator cuff tears that were treated with a deltoid flap transfer. The mean follow-up was 13.9 years. The mean absolute Constant score increased from 49.1 points preoperatively to 71.9 points at the last follow-up (P < .001). Pain scores improved from 5.3 to 13.8 points, regardless of the state of the deltoid flap (P < .001), and the scores for activities of daily living increased from 8.6 to 17 points (P < .001). The mean muscular strength improved from 4.4 points preoperatively to 7.6 points at the last follow-up (P = .009), and 16 patients (80%) had a positive test for supraspinatus strength. Deltoid flaps were completely ruptured in 3 cases in the short term and 10 cases at later follow-up; the mean thickness of nonruptured deltoid flaps was 4.2 mm. The mean acromiohumeral distance decreased from 6.95 mm preoperatively to 3.05 mm postoperatively (P < .00001). Osteoarthritis rates increased from stage 0.6 to stage 2.0 by the classification of Samilson and Prieto (P < .0001). This study shows that the results of a deltoid flap transfer over short- or medium-term follow-up were satisfactory for individuals who wished to return to work or for pain relief, with an improvement in the total function of the shoulder. However, the long-term outcomes were poor; deltoid flaps were ruptured in 10 shoulders (50%), and stage 2 or 3 osteoarthritis occurred in 14 shoulders (70%). Therefore, we do not recommend further use of this procedure in the treatment of massive, irreparable rotator cuff tears.