All-Arthroscopic Supraspinatus and Infraspinatus Muscle Advancement Leads to High Healing Rate and Excellent Outcomes in Patients With Massive, Retracted Rotator Cuff Tears, Even in Patients With Pseudoparalysis

Ashish Gupta; Kristine Italia; Mohammad N Jomaa; Andrew M Ker; Roberto Pareyon; Amaris En-Hui Tok; Jashint Maharaj; Sarah L Whitehouse; Kenneth Cutbush

doi:10.1016/j.arthro.2024.03.041

All-Arthroscopic Supraspinatus and Infraspinatus Muscle Advancement Leads to High Healing Rate and Excellent Outcomes in Patients With Massive, Retracted Rotator Cuff Tears, Even in Patients With Pseudoparalysis

Arthroscopy. 2024 Apr 8:S0749-8063(24)00264-0. doi: 10.1016/j.arthro.2024.03.041. Online ahead of print.

Authors

Ashish Gupta¹, Kristine Italia², Mohammad N Jomaa³, Andrew M Ker², Roberto Pareyon³, Amaris En-Hui Tok⁴, Jashint Maharaj⁵, Sarah L Whitehouse², Kenneth Cutbush⁶

Affiliations

¹ Queensland Unit for Advanced Shoulder Research, Queensland University of Technology, Brisbane, Australia; Australian Shoulder Research Institute, Brisbane, Australia; Greenslopes Private Hospital, Brisbane, Australia. Electronic address: research@qoc.com.au.
² Queensland Unit for Advanced Shoulder Research, Queensland University of Technology, Brisbane, Australia.
³ Queensland Unit for Advanced Shoulder Research, Queensland University of Technology, Brisbane, Australia; Australian Shoulder Research Institute, Brisbane, Australia; Greenslopes Private Hospital, Brisbane, Australia; St Andrews War Memorial Hospital, Brisbane, Australia.
⁴ Greenslopes Private Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia.
⁵ Queensland Unit for Advanced Shoulder Research, Queensland University of Technology, Brisbane, Australia; Australian Shoulder Research Institute, Brisbane, Australia.
⁶ Queensland Unit for Advanced Shoulder Research, Queensland University of Technology, Brisbane, Australia; Australian Shoulder Research Institute, Brisbane, Australia; St Andrews War Memorial Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia.

PMID: 38599536
DOI: 10.1016/j.arthro.2024.03.041

Abstract

Purpose: To evaluate the clinical and radiographic outcomes of an all-arthroscopic rotator cuff repair technique involving muscle advancement and double-layer lasso loop (DLLL) repair for massive, retracted posterosuperior cuff tears.

Methods: This was a retrospective case series of patients with massive, retracted posterosuperior cuff tears who underwent the all-arthroscopic muscle advancement technique from March 2017 to September 2021, with a minimum follow-up of 12 months. Key steps included suprascapular nerve release, advancement of the supraspinatus and infraspinatus muscles, and DLLL repair. Preoperative and postoperative visual analog scale score for pain, American Shoulder and Elbow Surgeons (ASES) shoulder score, Constant score, University of California, Los Angeles (UCLA) shoulder score, active range of motion, and strength were compared. Preoperative and postoperative structural radiologic characteristics were analyzed.

Results: We evaluated 43 shoulders in 38 patients with a mean follow-up period of 18.8 months (range, 12-55 months). Of the 43 shoulders, 4 showed repair failure (9.3% retear rate). Visual analog scale, ASES, Constant, and UCLA scores significantly improved (P < .001) in patients who showed healing on postoperative magnetic resonance imaging (n = 39). ASES, Constant, and UCLA scores were significantly better in the healed group, with 100% exceeding the minimal clinically important difference for the ASES score and UCLA score and 84.2%, for Constant score. A lower proportion of patients in the retear group achieved the minimal clinically important difference. Active range of motion in all planes significantly improved for patients who had healed repairs (P < .001). Relative abduction strength, supraspinatus strength, and infraspinatus strength were at least 90% of those on the contralateral side. The recovery rate of pseudoparalysis (7 patients) was 100%.

Conclusions: All-arthroscopic muscle advancement, coupled with DLLL repair, leads to a high healing rate with excellent clinical outcomes and recovery of strength to at least 90%, even in patients with pseudoparalysis.

Level of evidence: Level IV, retrospective case series.