Introduction
Managing patients who have rotator cuff pathology and glenohumeral arthritis poses a difficult clinical dilemma. The aim of this study was to examine the clinical outcomes of patients undergoing arthroscopic management of rotator cuff pathology with subacromial decompression and rotator cuff repair as well as debridement for glenohumeral arthritis.
Methods
A retrospective review of 55 consecutive patients with clinical and radiographic findings strongly suggestive of rotator cuff pathology as well as with clear radiographic and clinical evidence of glenohumeral joint osteoarthritis was conducted. Surgical treatment included arthroscopic debridement, chondroplasty, and microfracture of grade III and IV humeral and glenoid lesions, subacromial decompression, and rotator cuff repair if warranted. Pain, range of motion, and progression of osteoarthritis on radiographic imaging were evaluated in all patients. A shoulder questionnaire at final follow up was used to assess subjective measures and patient satisfaction. Outcomes were evaluated using ANOVA statistical analyses and post hoc tests.
Results
All 55 consecutive patients with an average age of 64.7 years were evaluated. Chondroplasty and microfracture techniques were employed to address all articular lesions. Arthroscopic rotator cuff repairs were performed in 29 (53%) patients. Average follow up was 38.1 months at which time average forward flexion and external rotation improved from 119 to 144 degrees (p<0.038) and 24 to 40 degrees (p<0.043) respectively. 67% of patients reported mild or no limitations with the use of their shoulder and 44 (80%) reported improvements in pain level. Only 3 (6%) patients reported severe limitations. Two of these patients underwent subsequent shoulder replacement within 1 year after the index procedure.
Conclusion
Often, patients with rotator cuff pathology have concurrent glenohumeral arthritis. Failure of conservative management has often been met with limited options, namely shoulder replacement in this specific patient population. The results of this study suggest that arthroscopic subacromial decompression and rotator cuff repair, if warranted, along with glenohumeral debridement for arthritis consistently improved motion and function in patients with this specific group of pathologies and should be considered as a surgical alternative to shoulder replacement.
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Copyright
© 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
