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Abstract Presented at the 26th Annual Meeting of the Arthroscopy Association of North America| Volume 23, ISSUE 6, SUPPLEMENT , e13-e14, June 2007

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Arthroscopic Debridement of Massive Irreparable Rotator Cuff Tears (SS-26)

      Purpose

      The purpose of this study was to evaluate clinical and radiological results of arthroscopic debridement of massive rotator cuff tears. 31 patients (av. Age 70.6 years) were retrospectively reviewed an average of 47 months (24 – 69) after arthroscopic debridement of an irreparable rotator cuff tear. The ASES Score was improved from 24.0 to 69.8 points. Scores for pain were reduced from 7.8 to 2.9 points. There was progression of osteoarthritis in 10 cases (32.3%), without influence on the ASES score. For elderly patients arthroscopic debridement in combination with biceps tenotomy leads to significant functional improvement.
      Arthroscopic debridement is a common treatment option for older patients with low physical demands suffering from irreparable rotator cuff tears. The purpose of this study was to evaluate clinical and radiological results of this procedure at mid- to long-term follow up.

      Methods

      31 consecutive patients (av. Age 70.6 years) were retrospectively reviewed an average of 47 months (24 – 69) after arthroscopic debridement of an irreparable rotator cuff tear. Operative treatment included biceps tenotomy in 24 cases (77.4%) while in 4 cases (12.9%) the biceps tendon was already ruptured. No acromioplasty was performed to maintain the coracoacromial arch.
      Clinical outcome was assessed by an independent observer with ASES-Scores as well as measurement of abduction strength and elbow flexion strength in comparison to the contralateral side at final follow up. Preoperative and follow up X-Rays were evaluated for acromiohumeral distance and grade of osteoarthritis.

      Results

      The average ASES Score was significantly improved from 24.0 to 69.8 points at follow up. Scores for pain were reduced from 7.8 to 2.9 points on a 0-10 VAS scale. The age and gender adjusted Constant Score was 72.2%. On a VAS scale from 0-10 satisfaction with the procedure was rated at 7.7. Radiological analysis showed progression of osteoarthritis in 10 cases (32.3%) however this had no influence on the ASES score. Acromiohumeral distance decreased from 8.3 mm to 7.0 mm. Biceps strength was measured at 6.1 kg on the operated and 6.3 kg on the contralateral side. Abduction strength was significantly lower on the operated side at 2.6 kg versus 3.7 kg on the contralateral side. No complication related to the procedure was reported.

      Conclusions

      For elderly patients with low functional demands arthroscopic debridement in combination with biceps tenotomy is a safe procedure and leads to significant functional improvement without loss of biceps strength. Progression of osteoarthritic changes can not be achieved however no influence on the clinical result could be demonstrated.