Functional outcomes after non-operative treatment of irreparable massive rotator cuff tears: Prospective multicenter study in 68 patients

Massive rotator cuff tears are one of the most common shoulder problems among the elderly, leading to pain and disability of the upper extremity. Muscle transfer, which can compensate for some of the deficits, has been advocated as the primary treatment of irreparable massive rotator cuff tears or as a salvage procedure after failed repairs. Latissimus dorsi transfers offer a promising solution in the treatment of irreparable posterosuperior rotator cuff tears, resulting in pain relief and function improvement of patients with the tears. However, the clinical results are variable and the factors which determine outcome are poorly understood. Prior studies have revealed that the functional outcomes of latissimus dorsi transfers were adversely affected if there was a deficit in deltoid and teres minor muscles [1, 2]. For the patient with a deltoid injury, the transfer that follows a failed rotator cuff repair produces less functional improvement than if the transfer is performed as the primary treatment to repair the rotator cuff. It was revealed that the presence of a tear of the teres minor muscle might have some predictive value prior to surgery with regard to motion and function [1], whereas the degree of fatty infiltration also played a critical role after the transfer [2]. Outcomes of muscle transfers have been reported in the literature, but the effects of extrinsic muscle integrity on the functional outcomes in the latissumus dorsi transfer have not been addressed quantitatively. The purpose of this work was to study the effects of the extrinsic muscle integrity on the functional outcomes in the latissumus dorsi transfer using a three-dimensional integrated model of the upper extremity [3]. First, the effects of extrinsic muscle integrity on the preoperative functions of shoulders with massive rotator cuff tears were investigated. Second, these effects on the functional outcomes of muscle transfers were evaluated quantitatively.

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Functional and Structural Outcomes After Retears of Arthroscopically Repaired Large and Massive Rotator Cuff Tears

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211035752 ◽

2021 ◽

Vol 9 (10) ◽

pp. 232596712110357

Author(s):

Suguru Tanaka ◽

Masafumi Gotoh ◽

Koji Tanaka ◽

Yasuhiro Mitsui ◽

Hidehiro Nakamura ◽

...

Keyword(s):

Rotator Cuff ◽

Outcome Measures ◽

Functional Outcomes ◽

Japanese Orthopaedic Association ◽

Case Series ◽

Fatty Degeneration ◽

Rotator Cuff Tears ◽

Massive Rotator Cuff Tears ◽

The Mean ◽

Tear Size

Background: Most studies have shown acceptable clinical results in patients with large or massive tears treated by arthroscopic rotator cuff repair (ARCR); however, the effects of retears after surgery in these patients remain unknown. Purpose: To evaluate functional and structural outcomes after retears of large and massive rotator cuff tears treated by ARCR. Study Design: Case series; Level of evidence, 4. Methods: A total of 196 consecutive patients with large to massive rotator cuff tears underwent physical examination and magnetic resonance imaging before and after ARCR at 6, 12, and 24 months. Of these, 9 patients were lost at 6 months after surgery. Therefore, 187 patients were followed up for 24 months after surgery; 148 patients showed no postsurgical ruptures. Consequently, the remaining 39 patients with postsurgical ruptures were included in this study (mean age at surgery, 64.2 ± 8.7 years). Functional outcome measures comprised the University of California, Los Angeles (UCLA) and Japanese Orthopaedic Association (JOA) scores. Structural outcome measures consisted of the global fatty degeneration index (GFDI), mediolateral tear size, and residual tendon attachment area as evaluated by our own scoring system. Results: The mean UCLA and JOA scores significantly improved from 16.3 ± 3.9 and 63.2 ± 10.7 preoperatively to 27.9 ± 5.5 ( P < .0001) and 84.5 ± 9.4 ( P < .0001) at final follow-up, respectively. The mean mediolateral tear size ( P = .03, .02, and .02, respectively) and residual tendon attachment area ( P = .04, .03, and .04, respectively) significantly improved from preoperatively to 6, 12, and 24 months postoperatively. The correlation analysis between the functional and structural variables confirmed significant associations between the residual tendon attachment area, the JOA and UCLA scores at 24 months postoperatively, and the preoperative GFDI ( r = –0.81 to 0.78). Conclusion: The residual tendon attachment area after a retear was significantly larger at 24 months after surgery than before surgery. In addition, significant associations were confirmed between preoperative fatty degeneration, the residual tendon attachment area, and functional outcomes after a retear. These results may explain why functional outcomes significantly improved even after retears in this series.

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Bone Marrow Stimulation in Arthroscopic Repair for Large to Massive Rotator Cuff Tears With Incomplete Footprint Coverage

The American Journal of Sports Medicine ◽

10.1177/0363546520959314 ◽

2020 ◽

Vol 48 (13) ◽

pp. 3322-3327

Author(s):

Chul Kim ◽

Yun-Jae Lee ◽

Sung-Jae Kim ◽

Tae-Hwan Yoon ◽

Yong-Min Chun

Keyword(s):

Rotator Cuff ◽

Clinical Outcomes ◽

Functional Outcomes ◽

Structural Integrity ◽

Arthroscopic Repair ◽

Rotator Cuff Tears ◽

Bone Marrow Stimulation ◽

Marrow Stimulation ◽

Massive Rotator Cuff Tears

Background: There is no research on incomplete footprint coverage with single-row repair related to bone marrow stimulation (BMS) in large to massive rotator cuff tears (RCTs). Purpose/Hypothesis: The purpose was to compare the clinical results and structural integrity between BMS and non-BMS groups that underwent arthroscopic repair of large to massive rotator cuff tears with <50% footprint coverage. It was hypothesized that both groups would exhibit improved clinical outcomes at 2 years after surgery but the BMS group would have significantly better clinical outcomes and structural integrity. Study Design: Cohort study; Level of evidence, 3. Methods: This study included 98 patients who underwent arthroscopic repair with <50% footprint coverage for large to massive RCTs with (BMS group; n = 56) or without (non-BMS group; n = 42) BMS. Functional outcomes at the 2-year follow-up were assessed using the visual analog scale for pain score, subjective shoulder value; American Shoulder and Elbow Surgeons score; University of California, Los Angeles, shoulder score; and active range of motion. Structural integrity was evaluated using magnetic resonance arthrography or computed tomography arthrography results at 6 months postoperatively. Results: At the 2-year follow-up, all functional outcomes significantly improved in both groups compared with preoperative values ( P < .001). However, there were no significant postoperative differences between groups. On follow-up magnetic resonance arthrography or computed tomography arthrography, the overall retear rate was not significantly different between the BMS group (30.3%; 17/56) and the non-BMS group (35.7%; 15/42). Conclusion: While both groups exhibited functional improvement after single-row repair with <50% footprint coverage for large to massive RCTs, BMS did not produce better clinical outcomes or structural integrity.

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