Speaker: Consider history for treatment options of massive rotator cuff tears

KOLOA, Hawaii — The history of massive rotator cuff tears, in addition to patient age and occupation, are among the important issues to consider when deciding whether to fix the tear or consider transfer or reverse shoulder arthroplasty, according to a presenter here.

“Is it an acute tear? Is it an acute-on-chronic tear, or is it a chronic tear? All of those potentially have an influence on the treatment that one may chose,” John W. Sperling, MD, MBA, said at Orthopedics Today Hawaii 2015.

The patient’s active and passive motion also plays a role. Additionally, Sperling advised surgeons to understand where the pain is located and what the patient’s complaint really is.

“Is it pain, weakness or loss of motion? That also plays a role in treatment,” he said.

John W. Sperling

Factors that influence his decision to do a rotator cuff repair are acute or acute-on-chronic tears, younger physiologic age, no frank escape on examination, minimal-to-moderate fatty infiltration, minimal glenohumeral arthritis and preservation of acromiohumeral distance on anteroposterior radiograph.

Alternatively, factors that influence his decision to perform tissue transfer include younger physiologic age, no frank escape on examination, non-repairable superior cuff with significant weakness, minimal glenohumeral arthritis and intact subscapularis for latissimus transfer and limited goals.

“In my practice, there is a very narrow group that I would consider for tissue transfer,” he said.

Sperling said he considers reverse arthroplasty for massive tears that are chronic, in patients with older physiologic age, in patients with frank escape on examination with significant fatty infiltration, and where there is complete loss of acromiohumeral distance on radiographs. – by Kristine Houck, MA, ELS

Reference:

Sperling JW. Massive rotator cuff tear: Repair, transfer, replace. Presented at: Orthopedics Today Hawaii 2015. Jan. 18-22, 2015; Koloa, Hawaii.

Disclosure: Sperling receives royalties from Biomet.