Surgical options for the patient with a massive rotator cuff tear remain limited. Short term reports have shown reasonable early results but long-term results remain lacking Presented here is the first report of all-arthroscopic partial rotator cuff repair in the treatment of massive, unrepairable rotator cuff tears with long-term follow-up.
Eighty patients with large or massive rotator cuff tears were evaluated. All patients were Thomazeau class 2 to 3 for atrophy, and Goutallier class 2 to 4 for fatty infiltration. All patients had primary closure attempted; if solid closure without tension could not be obtained by primary repair, partial rotator cuff repair with acromioplasty, preserving the coracoacromial ligament, was performed. All patients were reexamined, with UCLA, SST, and ASES scores obtained, and follow-up radiographs and MRI scans were obtained and compared to preoperative studies. MRI scans were obtained at a mean of 44 months postoperativeSuvivorship data was obtained, with the endpoint of reoperation and/or conversion to shoulder arthroplasty.
Sixty five patients had repair of the infraspinatus only, with 15 patients combined infraspinatus and subscapularis. Follow-up was a minimal 36 months (average 50.7 months). While initial good or excellent results were obtained in 88% of cases final follow-up showed decreases in all outcome scores. Pain scores showed the most significant decrease, with functional scores showing less improvement. MRI scanning at final follow-up showed progression of atrophy and tear size despite partial repair in 78% of cases. Despite diminished outcomes with time, survivorship was 91% at follow-up.
Good early results can be obtained with partial rotator cuff repair, but these results tend to diminish with long-term follow-up. This technique represents a reasonable, low-morbidity salvage option for the patient with a rotator cuff tear that is not primarily repairable.
© 2016 Published by Elsevier Inc.