Purpose: The purpose of this study was to assess the functional results of arthroscopic repair
of massive rotator cuff tears in patients who had stage 3 and 4 fatty degeneration
of the rotator cuff musculature, according to the Goutallier scale. Methods: From January 1997 to December 2001, 22 patients with massive rotator cuff tears and
Goutallier stage 3 or 4 fatty degeneration of the infraspinatus, with a mean age of
66.5 ± 9.26 years, underwent arthroscopic rotator cuff repair and were available for
follow-up. The average tear size was 4.8 ± 0.85 cm in medial-to-lateral width and
6.2 ± 1.53 cm in anterior-to-posterior length, with an approximate tear size area
of 30.0 ± 10.0 sq cm, and involved 2 tendons (supraspinatus and infraspinatus) or
3 tendons (supraspinatus, infraspinatus, and subscapularis) in each case. The mean
time from surgery to follow-up was 39.3 months (range, 24-60 months). In addition
to comparison of preoperative and postoperative range of motion, strength and University
of California, Los Angeles (UCLA) score, outcomes were also assessed with the Constant
score. Results: The increase of mean active forward elevation was 53.7° (preoperative: 103.2° and
postoperatively: 156.9°). The gain of mean active external rotation was 19.1° (preoperative:
35.7° and postoperative: 54.8°). The gain of mean external rotation power was 1.9
(preoperative: 2.3 and postoperative: 4.2). The improvement in the UCLA score was
17.2 points (preoperative: 12.3 and postoperative: 29.5). The mean postoperative Constant
score was 74.8/100, and the weighted postoperative Constant score was 88.5/100. In
5 patients with fatty degeneration greater than 75% (advanced stage 4), results were
less dramatically improved than in 17 patients with fatty degeneration of 50% to 75%,
all of whom exhibited clinical improvement. However, clinical improvement was achieved
even in 2 of 5 patients with advanced stage 4 involvement. Conclusions: Arthroscopic rotator cuff repair in patients with grade 3 or 4 fatty degeneration
(≥50%) can provide significant functional improvement. Those with 50% to 75% fatty
degeneration showed a much greater degree of improvement (with all 17 cases exhibiting
beneficial postoperative increases in their UCLA scores ranging from 12 to 26 points)
than those with >75% fatty degeneration (with only 2 of 5 cases showing an increase
of 10 or more points in their UCLA scores). However, clinical improvement was observed
in 86.4% of cases that would have been classified as likely to fail by the Goutallier
criteria. Level of Evidence: Level IV, therapeutic case series.
Key Words
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Footnotes
The other authors report no conflict of interest.
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© 2007 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
