Clinical Outcome of Partial Repair of Irreparable Rotator Cuff Tears

Retrospective case series evaluating patients with massive rotator cuff tears who underwent partial arthroscopic repair. The primary outcome was the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) at 24 months. The secondary outcomes were the Modified-University of California at Los Angeles Shoulder Rating Scale (UCLA), and the following subdomains: satisfaction, active forward flexion and strength of forward flexion subdomains.

Results

We evaluated 33 patients. The ASES scale evolved from 39.7 ± 19.6 to 77.6 ± 17.4 (p < 0.001). The UCLA scale evolved from 13.3 ± 5.5 to 27.9 ± 5.6 (p < 0.001). The satisfaction rate was 97%. The number of patients with active forward flexion > 150° increased from 12 (36.4%) to 25 (75.8%) (p = 0.002). The number of patients with normal or good strength of forward flexion increased from 9 (27.3%) to 22 (66.7%) (p = 0.015).

Conclusion

Partial repair of irreparable rotator cuff tears leads to significant improvement according to the ASES and UCLA scales.

Keywords
rotator cuff; arthroscopy; shoulder; evaluation of results of therapeutic interventions

	n	%
Gender
Male	16	48.5
Female	17	51.5
Dominant side
Yes	25	75.8
No	8	24.2
Smoking
Smoker	2	6.1
Former smoker	6	18.2
No	25	75.8
Diabetes
Yes	7	21.2
No	27	81.8
Systemic arterial hypertension
Yes	14	42.4
No	19	57.6
Hypothyroidism
Yes	4	12.1
No	29	87.9
Rheumatoid arthritis
Yes	5	15.2
No	28	84.8
Chronic corticosteroid use
Yes	1	3.0
No	32	97.0
Previous surgery
Yes	2	6.1
No	31	93.9
Previous infiltration
Yes	3	9.1
No	30	90.9
Work-related issues
Yes	5	15.2
No	28	84.8

	n	%
Supraspinatus tear - Retraction
Stage III	15	45.5
Stage IV	18	54.5
Fuchs classification (supraspinatus)
Grade I	11	33.3
Grade II	11	33.3
Grade III	11	33.3
Infraspinatus tear - Extension
Intact	2	6.1
Superior half	25	75.8
The entire tendon	6	18.2
Infraspinatus tear - Retraction
Stage I	10	30.3
Stage II	6	18.2
Stage III	14	42.4
Stage IV	3	9.1
Fuchs classification (infraspinatus)
Grade I	14	42.4
Grade II	10	30.3
Grade III	9	27.3
Subscapularis tear
Intact	9	27.3
Partial, superior 1/3	7	21.2
Full-thickness, superior 1/3	6	18.2
Full-thickness, superior 2/3	8	24.2
The entire tendon	3	9.1
Fuchs classification (subscapularis)
Grade I	23	69.7
Grade II	8	24.2
Grade III	2	6.1
Long head of the biceps tear
Intact	15	45.5
Partial tear	14	42.4
Complete tear	4	12.1
Instability at the long head of the biceps
Stable	11	33.3
Instable	9	27.3
Dislocation	10	30.3
Not applicable	3	9.1
Mild glenohumeral arthrosis
Yes	5	15.2
No	28	84.8

	n	%
Supraspinatus or infraspinatus anchors
1	10	30.3
2	17	51.5
≥ 3	6	18.2
Subscapularis anchors
0	11	33.3
1	20	60.6
2	2	6.1
Acromioplasty
Yes	9	27.3
No	24	72.7
Long head of the biceps procedure
None	9	27.3
Tenotomy	12	36.4
Tenodesis	12	36.4

	Mean	Standard deviation	Median	IQR	p-value
UCLA
Preoperative	13.3	5.5	12.7	7.5	p < 0.001^* * values from the Friedman test.
6 months	27.2	5.8	28.0	6.5
12 months	28.1	6.4	29.0	7.0
24 months	27.9	5.6	29.0	10.5
ASES
Preoperative	39.7	19.6	37.0	22.9	p < 0.001^* * values from the Friedman test.
6 months	69.6	21.2	73.3	31.5
12 months	75.7	20.5	80.0	30.0
24 months	77,6	17,4	83,8	27,6

	Active anterior flexion
	Preoperative		24 months		p-value
	n	%	n	%
≥ 150°	12	36.4	25	75.8	0.002
120°-150°	11	33.3	1	3.0
90°-120°	7	21.2	5	15.2
45-90°	1	3.0	1	3.0
<45°	2	6.1	1	3.0

	Active anterior flexion force
	Preoperative		24 months		p-value
	n	%	n	%
Grade 5 (Normal)	3	9.1	12	36.4	0.015
Grade 4 (Good)	6	18.2	10	30.3
Grade 3 (Regular)	12	36.4	7	21.2
Grade 2 (Poor)	6	18.2	3	9.1
Grade 1 (Muscle contraction)	6	18.2	1	3.0

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

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[1] Address for correspondence Eduardo Angeli Malavolta, MD, PhD, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, São Paulo, SP, 05403-010, Brasil (e-mail: eduardomalavolta@gmail.com).

Brasil

Brasil

Clinical Outcome of Partial Repair of Irreparable Rotator Cuff Tears* * Study performed at Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.

Abstract

Objective

Methods

Results

Conclusion

Clinical Outcome of Partial Repair of Irreparable Rotator Cuff Tears^* * Study performed at Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.