Arthroscopic tuberoplasty, acromioplasty lead to less pain in massive rotator cuff tears

Lee BG. Arthroscopy. 2011. doi:10.1016/j.arthro.2011.06.016

Diminished pain and improvement of active forward elevation in cases of irreperable massive rotator cuff tears may be achieved through arthroscopic tuberoplasty with concomitant acromioplasty in addition to biceps tendon treatment when indicated, according to this study from Korean researchers.

The researchers performed arthroscopic tuberoplasty on 32 patients with a mean age of 62.4 years who presented with irreparable massive rotator cuff tears, following up on these patients for a minimum of 24 months (mean of 40 months). Clinical evaluation was performed using the Constant and UCLA scores, with radiologic evaluation being performed through acromiohumeral interval and inferior scapulohumeral line continuity.

In all, the authors reported, 26 patients underwent acromioplasty concomitant to tuberoplasty, with 6 undergoing only arthroscopic tuberoplasty. Mean Constant scores increased from 47.6 points preoperatively to 70.5 points at final follow-up. Mean UCLA scores also improved from 15.4 preoperatively to 27.1 points at the last follow-up.

Three shoulders (9%) were rated as excellent, 23 (72%) as good and 6 (19%) as poor, the authors wrote, with active range of forward flexion improving from 115.9° to 142.7°. Preoperative acromiohumeral interval and inferior scapulohumeral line continuity were both statistically correlated to the positivity of the final results.

“In particular, satisfactory results during the minimum follow-up period of 24 months can be achieved in the cases with good preservation of the preoperative and postoperative acromiohumeral interval and continuity in the inferior scapulohumeral line, regardless of preoperative mobility,” the authors wrote.

This study reiterates and confirms the efficacy of tuberoplasty as a treatment for the painful irreparable rotator cuff tear, a treatment that has long been advocated by John Fenlin, MD. The authors note that the best results are in those who have maintained their acromiohumeral interval. This would indicate that these patients had balanced force couples and therefore would be expected to do better. My concern with this study is that it does not indicate how the authors determined that these tears were irreparable. Thirty-two cases of irreparable cuff tears is quite a large number, and I wonder if any of the interval slide techniques for repair were utilized in these patients.

— Stephen S. Burkhart, MD
San Antonio, TX

Disclosure: Burkhart is a paid consultant for Arthrex, Inc. He also receives inventor's royalties from Arthrex.