Partial Rotator Cuff Repair for Massive Tears Rarely Require Revision Surgery

Abstract

Arthroscopic management of massive rotator cuff tears is a challenging and technically demanding problem. Despite advances in surgical devices and techniques, a complete repair is not always possible. The goal of this study was to determine the significance of initial and residual rotator cuff tear defect size on the need for revision surgery in a consecutive group of patients undergoing partial repair of massive rotator cuff tears. A retrospective chart review was carried out for all arthroscopic rotator cuff repairs performed by a single surgeon between January of 2013 and December of 2016 (n=1954). All of the patients with massive rotator cuff tears (>30cm2) that underwent partial repair were included in the study (38 of 1954 shoulders). The cross-sectional area of the initial and residual tear defect was measured arthroscopically, and patients were followed postoperatively for a minimum of 2 years (mean 4.5 years). Outcomes for the surgical procedure were measured based on the necessity for revision surgery or adjunct therapy including steroid injections or additional physical therapy after initial release from care. The mean initial rotator cuff defect size, 38.7 cm2 (30 - 48 cm2), was reduced intraoperatively to a mean defect size of 7.5 cm2 (1 - 20 cm2) following partial repair. Those patients undergoing revision surgery represented 5.2% (2/38) of the series and had an average initial / residual tear defect area of 45.0 / 7.0 cm2. Patients requiring adjunct therapy represented 7.9% (3/38) of the series and possessed an average initial / residual tear defect size of 40.0 / 16.0 cm2. The remaining 33 (86.9%) patients did not require revision surgery or adjunct therapy at a minimum follow up of 2 years. These patients requiring no additional treatment following surgical intervention had an average initial / residual tear defect size of 38.2 / 6.8 cm2. There was no correlation between initial and/or residual rotator cuff tear defect size and the need for revision surgery. However, there was a significant difference in the mean residual defect size in the patients requiring additional nonoperative treatment after initial release from care (p=0.012). This consecutive series demonstrates that partial repair of massive rotator cuff tears proved to be a durable intervention with only 5.2% of patients requiring subsequent surgical intervention at an average follow up of 4.5 years after index surgery. Larger residual rotator cuff defects did correlate with the necessity for subsequent nonoperative interventions. However, there was no correlation between residual cuff defect size and need for revision surgery. Partial repair of massive cuff tears is a viable option when managing these complex patients and preserves the option for more invasive salvage operations if needed.