Partial Rotator Cuff Repair in Massive Rotator Cuff Tears: Long-Term Follow-Up (SS-17)

Abstract

Introduction Surgical options for the patient with a massive rotator cuff tear remain limited. Tendon transfers offer significant perioperative morbidity, and procedures such as interval tendon slides have raised concerns about the vascularity of the remaining tendon, with a recent study showing only 25% of patients with interval slides had solid healing on MRI follow-up. Xenograft and allograft patches have shown significant complications and mixed results. Burkhart (1994) and others pioneered the concept of partial rotator cuff repairs as an arthroscopic-assisted procedure, with good preliminary results. The procedure is however difficult, especially to access the infraspinatus and subscapularis from a deltoid split. Presented here is the first report of all-arthroscopic partial rotator cuff repair in the treatment of massive, unrepairable rotator cuff tears. Methods Eighty patients with large or massive rotator cuff tears were evaluated. All patients were Thomazeau class 2 to 3 for atrophy, and Goutallier class 2 to 4 for fatty infiltration. All patients had primary closure attempted; interval slides or other heroic techniques were avoided. If solid closure without tension could not be obtained by primary repair, but a portion of the cuff could be solidly reapproximated, partial rotator cuff repair with acromioplasty, preserving the coracoacromial ligament, was performed. All patients were reexamined, with UCLA, SST, and ASES scores obtained, and follow-up radiographs and MRI scans were obtained and compared to preoperative studies. Results Sixty five patients had repair of the infraspinatus only, with 15 patients combined infraspinatus and subscapularis. Follow-up was a minimal of 24 months (average 40.7 months). Good or excellent results were obtained in 88% of cases based on UCLA scores, with SST scores averaging 10.11 and ASES scores 86.2. No complications occurred, specifically no hardware issues, infections, or neurologic injuries. All procedures were performed successfully as an outpatient procedure. Pain scores showed the most significant decrease, with functional scores based on ASES and Constant scores showed less improvement. External rotation strength improved 1.2 grades. No patient developed anterosuperior instability, and no patients developed cuff tear arthropathy. Radiographs at final follow-up showed no evidence of vertical migration. MRI scanning showed no progression of atrophy and interval healing of the repaired segment in 68%. Conclusion Good results can be obtained with arthroscopic partial rotator cuff repair for large and massive rotator cuff tears. Arthroscopic exposure of the rotator cuff is much simpler that with mini-open technique, and direct suturing of the available tendons is possible without damaging the deltoid. While not approaching the results of complete arthroscopic repair, this technique represents a reasonable, low-morbidity salvage option for the patient with a rotator cuff tear that is not primarily repairable.