Long-term study shows satisfactory results with partial arthroscopic rotator cuff repair

SAN DIEGO — Partial arthroscopic rotator cuff repair can provide satisfactory results in patients with massive rotator cuff tears, according to a study presented here.

Stephen C. Weber, MD, shared the findings of his long-term follow-up study at the 2011 American Orthopaedic Society for Sports Medicine Specialty Day.

He cautioned that more data is needed, however, and noted that the procedure itself is more difficult.

Stephen C. Weber

“Partial rotator cuff repair was pioneered by Dr. Burkhart as an open procedure, feeling that even if you could not close all the defects, if you balanced the forces, a good clinical result could occur,” Weber said. “These are the results of long-term follow-up of arthroscopic partial rotator cuff repair.”

Study methods

Weber evaluated 80 patients with large or massive rotator cuff tears. All of the patients, he reported, were Thomazeau class 2 or 3 for atrophy, and Goutallier class 2 to 4 for fatty infiltration. Primary closure was attempted on all patients, and interval slides were avoided.

Partial rotator cuff repair with acromioplasty was performed in situations wherein a portion of the cuff could be re-approximated, but solid closure without tension could not be obtained by primary repair. In these cases, the coracoacromial ligament was preserved.

All of the patients were re-examined and their UCLA, American Shoulder and Elbow Surgeons (ASES) and Simple Shoulder Test (SST) scores were recorded. Follow-up radiographs and MRI scans were also obtained and compared to preoperative findings.

Pain scores decreased

Weber reported 65 patients underwent repair of the infraspinatus only, with 15 patients undergoing combined infraspinatus and subscapularis repairs. With a minimum follow-up of 24 months, Weber found “good or excellent results” were obtained in 88% of cases based on UCLA scores. SST scores averaged 10.11, and ASES scores averaged 86.2. External rotation strength was reported to have improved 1.2 grades.

Pain scores showed significant decrease, he added, though functional outcomes based on ASES and Constant scores indicated less improvement.

According to the study findings, none of the patients developed anterosuperior instability. In addition, none of the patients developed cuff tear arthropathy. Radiographs and MRIs taken at final follow-up showed no signs of vertical migration or progression of atrophy. Interval healing of the repaired segment was found in 68% of patients.

A reasonable option

Weber noted that the results of arthroscopic partial repair still do not approach the results of complete arthroscopic repair, but the partial technique does represent “a reasonable, low-morbidity salvage option” for a patient with a rotator cuff tear that proves impossible to primarily repair.

“It does appear to offer theoretical advantages: low complication rates and certainly reasonable results,” he concluded. “However, prospective randomized data is clearly what we need.”

Reference:
Weber SC. Arthroscopic partial repair of massive rotator cuff tears: Long-term follow-up. Paper 9656. Presented at the 2011 American Orthopaedic Society for Sports Medicine Specialty Day. Feb. 19, 2011. San Diego.
Disclosure: Weber has reported no relevant financial disclosures.

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