The Outcome of Debridement in Massive and Irreparable Rotator Cuff Tear - A Systematic Review

Abstract

Introduction Multiple procedures have been described for massive and irreparable rotator cuff tears (RCTs), which involve either conservative trial or surgical options such as debridement, partial repair, superior capsule reconstruction, and arthroplasty. The choice of surgical procedure depends on various factors such as the age and activity level of the patient, tear configuration, and tissue quality, including both muscle and tendon. No consensus has been reached regarding optimal treatment in massive and irreparable RCTs. Purpose To systematically review the published literature assessing the outcomes after debridement alone for irreparable and massive RCTs. Study Design: Systematic review: Level of evidence-3. Methodology A thorough literature search was carried out in July 2021, using PubMed and Science direct electronic databases based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. All studies were analyzed for the procedures performed along with debridement and the outcomes of surgery with scores such as Constant score, University of California Los Angeles score, American Shoulder and Elbow Score, Visual Analog Scale (VAS), and patient satisfaction. Results Out of 1223 search results, a total of 13 studies were included following the PRISMA guidelines, and data extraction and analysis were carried out. The total patient cohort was 360, with male predominance (62%). The mean age of the total studies included was 66.4 years (range, 60–75.6 years) and the mean follow-up duration was 57 months (range, 18 to 145 months). The constant score was used in 7/13 studies, and the range was from 31 (preoperative) to 84 (postoperative during follow-up). The American Shoulder and Elbow Surgeons was used in 4/13 studies and the range was from 24 (preoperative) to 74 (postoperative during follow-up). University of California Los Angeles score was used in 6/13 studies and the range was from 8.4 (preoperative) to 27.7 (postoperative during follow-up). VAS was used in 6/13 studies and the range was from 9 (preoperative) to 0.5 (postoperative during follow-up). Conclusion Debridement, along with any of the concomitant procedures (Acromioplasty, tuberoplasty, tenotomy of long head of biceps), is a simple procedure and has favorable patient-related outcomes in terms of pain relief. However, the range of motion and muscle strength improvement depends on various factors such as transverse couples, coracoacromial ligament release, and preoperative movement, which necessitates further high-quality prospective randomized control studies.