Arthroscopic partial repair of irreparable large to massive rotator cuff tears

Abstract

Purpose: The aim of this study was to evaluate the outcome of arthroscopic partial repair and margin convergence of irreparable large to massive rotator cuff tears.

Methods: Between January 2003 and July 2008, 27 patients who met the inclusion criteria underwent arthroscopic partial repair and margin convergence of irreparable large to massive rotator cuff tears. An irreparable tear was defined as a tear with a minimum anterior-to-posterior width of 3 cm or larger, where it was not feasible to completely cover the humeral head with the cuff at the time of surgery.

Results: The mean preoperative tear size was 42.1 ± 6.2 mm. The mean size of the postoperative residual defect in the repaired tendon along the medial margin of the greater tuberosity was 12.0 ± 5.5 mm. All shoulder scores showed improvement. The Simple Shoulder Test improved from 5.1 ± 1.2 to 8.8 ± 2.1 (P < .001), the Constant score from 43.6 ± 7.9 to 74.1 ± 10.6 (P < .001), and the University of California, Los Angeles score from 10.5 ± 3.0 to 25.9 ± 5.0 (P < .001). Both Constant and University of California, Los Angeles shoulder scores also showed an inverse correlation with defect size. We compared muscle strength between the affected and contralateral sides and found that the strength of the affected side was not restored to the same level as the contralateral side (P < .001).

Conclusions: Arthroscopic partial repair and margin convergence showed satisfactory short-term outcomes in irreparable large to massive rotator cuff tears. Thus it is suggested that, even in a large to massive tear that appears irreparable, attempting to repair it as much as possible to possibly convert it into a functional rotator cuff tear by re-creating a balanced forced couple can be helpful in reducing pain, as well as improving functional outcomes.

Level of evidence: Level IV, therapeutic case series.