Outcomes of Subacromial Balloon Spacer Implantation for Massive and Irreparable Rotator Cuff Tears: A Systematic Review

Background:Selection of optimal treatment for massive to irreparable rotator cuff tears (RCTs) entails a challenging decision-making process in which surgeons must consider several factors, including duration of symptoms, tear pattern, tear size, and muscle quality, as well as patient characteristics such as age, comorbidities, shoulder dominance, and activity level. Unfortunately, no clear consensus has been reached regarding optimal management.Purpose:To systematically review the published literature assessing outcomes after subacromial balloon spacer implantation for treatment of massive and irreparable RCTs.Study Design:Systematic review; Level of evidence, 4.Methods:A comprehensive literature search was performed in September 2018 through use of MEDLINE and the Cochrane Library electronic databases. Studies were assessed for multiple outcomes of interest including Constant score, Oxford Shoulder Score (OSS), University of California Los Angeles (UCLA) Shoulder Score, complications, and patient satisfaction.Results:After applying the selection criteria, 12 clinical studies were included for data extraction and analysis. In total, 291 shoulders (in 284 patients) treated with subacromial balloon spacer implantation were pooled for evaluation, with a mean follow-up of 22.9 ± 14.9 months (range, 6-60 months). Constant scores were used as an outcome metric for 267 shoulders (91.7%; 11 studies), with improvements in mean Constant score ranging from 18.5 to 49.6 points. Patient satisfaction was assessed in 105 patients (37.0%; 5 studies), with rates of patients indicating they were satisfied or very satisfied with their treatment outcome ranging from 45.8% to 100%. A total of 6 patients (2.1%) experienced complications related to balloon spacer implantation, including transient neurapraxia of the lateral antebrachial cutaneous nerve, superficial wound infection, deep wound infection, and balloon migration. Of these, 3 patients (2 balloon migration, 1 deep wound infection) required subsequent surgeries for balloon removal.Conclusion:Placement of the subacromial balloon spacer is a minimally invasive, technically simple procedure with favorable patient-reported outcomes at limited short-term follow-up. However, inherent methodological limitations and patient heterogeneity between studies may impair our ability to fully characterize the longer term efficacy, particularly relative to other potential surgical options. Further prospective randomized or comparative studies are warranted to ascertain clinical outcomes of subacromial balloon spacer in the management of massive and irreparable RCTs.

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Mid-Term Outcomes after Arthroscopic “Tear Completion Repair” of Partial Thickness Rotator Cuff Tears

Medicina ◽

10.3390/medicina57010074 ◽

2021 ◽

Vol 57 (1) ◽

pp. 74

Author(s):

Giuseppe Fama ◽

Jacopo Tagliapietra ◽

Elisa Belluzzi ◽

Assunta Pozzuoli ◽

Carlo Biz ◽

...

Keyword(s):

Patient Satisfaction ◽

Rotator Cuff ◽

Constant Score ◽

Tendon Healing ◽

Critical Zone ◽

Rotator Cuff Tears ◽

Complication Rates ◽

Range Of Movement ◽

Partial Thickness

Background and Objectives: Different arthroscopic procedures are used for partial-thickness rotator cuff tears (PT-RCTs), but there is still no evidence on the superiority of one procedure over the other. The aim of this study was to evaluate the clinical outcomes and the rate of complications of a tear completion repair (TCR) technique. Materials and Methods: Patients who had undergone arthroscopic TCR technique for PT-RCTs with a follow-up of at least 2-years after surgery were included. The TCR technique involved the removal of the “critical zone” and creating microfractures to biologically support tendon healing. Functional outcomes were assessed prospectively by the Constant score (CS) and active and passive range of movement (ROM). Pain and patient satisfaction were measured using a visual analog scale (VAS). Complication rates were recorded, and tendon integrity was assessed with magnetic resonance imaging (MRI) or ultrasound performed at least 2-years after surgery. Results: Eighty-seven patients with a median age of 57 years were followed-up for a median of 5 years. The CS score improved from 53.5 preoperatively to 94.0 postoperatively (p < 0.001). Median VAS score decreased from 8.6 to 1.0 (p < 0.0001). Median patient satisfaction was 9.3. The overall complication rate was 14.9%. Conclusions: Patients with PT-RCTs of the supraspinatus tendon treated by the TCR technique with “critical zone” removal and biological stimulation by microfractures showed good functional results with excellent strength recovery, a high degree of patient satisfaction, and resolution of painful symptoms at mid-term follow-up.

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AN APPROACH FOR MEDIASTINITIS PREVENTIONIN PATIENTS FOLLOWING CARDIAC SURGERY

HERALD of North-Western State Medical University named after I I Mechnikov ◽

10.17816/mechnikov20157438-42 ◽

2015 ◽

Vol 7 (4) ◽

pp. 38-42 ◽

Cited By ~ 1

Author(s):

A V Sotnikov ◽

V M Melnikov ◽

R V Almadi ◽

G N Gorbunov

Keyword(s):

Cardiac Surgery ◽

Wound Infection ◽

Incidence Rate ◽

Control Group ◽

Study Group ◽

Intravenous Injections ◽

Deep Wound Infection ◽

Period 2 ◽

Deep Wound

The aim of this study was to reduce incidence of sternal deep wound infection (DWI) in patients following cardiac surgery. An experience of cardiac surgery by sternotomy access in 429 consecutive patients was presented. Perioperative intravenous injections of cefazolin were used in 225 patients (control group). Combination of perioperative intravenous injections with local retrosternal irrigation of cefazolin before sternum closure was used in 204 patients (study group). In control group sternal DWI occurred in 10 patients (4.4%), and in 4 patients a resternotomy sanation required. There were no deaths in this group due to infection or sepsis. In follow-up period (3 years), instability of sternum occurred in 3 patients (1.3%), and in 1 (0.4%) sternum reosteosynthesis required. In studied group the sternal DWI did not occur (p<0.01). Sternum instability and/or indications for sternum reosteosynthesis were not determined in follow-up period (2 years). It was concluded, that combination of intravenous and local usage of cefazolin in cardiac surgery patients is a simple and effective approach to prevent sternal DWI. Application of this method significantly (p<0.01) reduces the incidence rate of mediastinitis.

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Rotátorköpeny-szakadás után kialakult zsíros degeneráció változása az ín rekonstrukcióját követően, 65 éves kor után

Orvosi Hetilap ◽

10.1556/650.2019.31326 ◽

2019 ◽

Vol 160 (14) ◽

pp. 533-539

Author(s):

Imre Sallai ◽

Márton Weidl ◽

Attila Szatmári ◽

Imre Antal ◽

Gábor Skaliczki

Keyword(s):

Rotator Cuff ◽

Muscle Atrophy ◽

Rotator Cuff Repair ◽

Constant Score ◽

Fatty Degeneration ◽

Shoulder Function ◽

Rotator Cuff Tears ◽

Before And After ◽

Cuff Repair

Abstract: Introduction: In the case of rotator cuff tears, the severity of the muscle atrophy and fatty degeneration has an effect on the success of the repair and on the functional outcome after surgery. Aim: The ability of regeneration reduces with ageing; therefore, the study examined the atrophy and the fatty degeneration after rotator cuff repair in patients over 65. Method: Eleven patients over 65 years of age were involved whose surgery was performed at the Department of Orthopaedics of Semmelweis University between 2012 and 2015. Their average age was 71.9 years and the average follow-up period was 39.9 months. Tear sizes were C1 in 3 cases, C2 in 3 cases, C3 in 4 cases, and C4 in 1 case. Each patient had magnetic resonance examination before and after the repair; the muscle atrophy and fatty degeneration were evaluated together with the type of the tear. Visual analogue scale and Constant score were used for the assessment of the pain and the shoulder function. Results: The average Constant score was 75 points. The occupancy ratio – referring to the severity of the atrophy – did not show significant improvement. The change in fatty degeneration and the atrophy were examined in different groups according to the size of the tears. In each group, the results showed progression. Conclusions: After rotator cuff repair in patients over 65, fatty degeneration and muscle atrophy also show progression. No significant relationship was found between the size of the tear and fatty degeneration or between the size of the tear and muscle atrophy. Orv Hetil. 2019; 160(14): 533–539.

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Outcome of partial repair of massive rotator cuff tears with and without human tissue allograft bridging repair

Shoulder & Elbow ◽

10.1177/1758573216665114 ◽

2016 ◽

Vol 9 (1) ◽

pp. 23-30 ◽

Cited By ~ 25

Author(s):

Radhakant Pandey ◽

Suhayl Tafazal ◽

Srinivasan Shyamsundar ◽

Amit Modi ◽

Harvinder Pal Singh

Keyword(s):

Rotator Cuff ◽

Human Tissue ◽

Constant Score ◽

Rotator Cuff Tears ◽

Partial Repair ◽

Massive Rotator Cuff Tears ◽

Tissue Allograft ◽

Tissue Matrix ◽

Repair Group

Background The surgical management of massive rotator cuff tears remains a challenge. It is suggested that, even in a massive tear that appears irreparable, attempting to repair it as much as possible can be helpful in improving functional outcomes. However the results can be short term and variable. The purpose of our study was to determine if human tissue allograft bridged repair of massive irreparable rotator cuff tears to achieve a complete repair produces similar outcomes compared to partial repair alone. Methods We prospectively reviewed outcome scores in 13 patients who underwent partial repair alone for massive irreparable rotator cuff tears and compared them to 13 patients who had partial repairs bridged with allograft. Oxford and Constant scores were compared pre-operatively and at a minimum follow-up of 2 years (range 2 years to 5 years). Results The mean improvement in the Constant score at final follow-up compared to pre-operative scores was 27.7 points in the partial repair group and 42.8 points in the allograft group ( p < 0.01). The Oxford Shoulder Score improved mean of 19.3 points in the partial repair group and 29 points in the allograft group ( p < 0.02) at 2 years. Conclusions Human tissue matrix allograft provides a better outcome for open bridging of irreparable rotator cuff tears than partial repair alone.

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Treatment of Catastrophic Failures of Achilles Tendon Repairs Due to Deep Wound Complications

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000086 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0000

Author(s):

Jamal Ahmad

Keyword(s):

Surgical Treatment ◽

Achilles Tendon ◽

Wound Infection ◽

Clinical Outcomes ◽

Single Stage ◽

Wound Complications ◽

Deep Wound Infection ◽

Deep Wound ◽

Catastrophic Failures

Category: Sports Introduction/Purpose: The Achilles tendon is the most commonly injured tendon in the lower extremity. Whether these ruptures are acute or chronic, a surgical Achilles repair or reconstruction is often needed to restore tendon integrity and function. Risks from such surgeries include superficial or deep wound infections and/or dehiscence. To date, there is scant literature regarding the treatment of catastrophic failures of Achilles tendon repairs or reconstructions from deep wound infection and dehiscence. The purpose of this study is to retrospectively examine clinical outcomes from uniform single-stage surgical treatment of catastrophic failures of Achilles tendon repairs or reconstructions from deep wound complications. Methods: Between 2007 and 2016, 10 patients developed a deep wound infection and dehiscence after surgical treatment of an acute or chronic Achilles rupture. Medical co-morbidities included obesity in 4, diabetes in 3, and nicotine use in 2 patients. Six and 4 patients had a mid-substance and insertional Achilles rupture respectively. Three patients had an acute injury that received an end-to-end suture repair. Seven patients had a chronic injury with Achilles retraction, which necessitated proximal Achilles or gastrocnemius lengthening. These patients required surgery for their wound problem due to depth and involvement of their Achilles repair/reconstruction site. Surgery involved a single-stage wound irrigation and debridement, Achilles excisional debridement at the repair/reconstruction site, flexor hallucis longus transfer to the calcaneus to replace the compromised or failed Achilles repair/reconstruction, and primary or vacuum assisted wound closure. Patients were followed for 6 months after this surgery and invited for recent follow-up to collect data. Results: With uniform surgical treatment, full resolution of deep wound infection and dehiscence after Achilles repair/reconstruction was achieved in all 10 patients. No patients developed a recurrence of wound complications and/or infection to necessitate any further surgical debridements. All 10 patients presented for recent follow-up at a mean of 57.3 months. Mean Foot and Ankle Ability Measures increased from 36.3% at initial presentation before Achilles repair/reconstructive surgery to 84.2% at latest follow-up (P<0.05). Mean Visual Analog Scores of pain decreased from 6.6 of 10 before the Achilles repair/reconstruction to 1.5 of 10 at latest follow-up (P<0.05). All patients were able to return to normal gait and full activities at home, with 3 reporting difficulties with prolonged ankle activities at work. Conclusion: This study demonstrates that our method of single-stage surgical treatment of catastrophic failures of Achilles tendon repairs or reconstructions from deep wound complications can achieve a high rate of improved patient function and pain relief. Clinical outcomes of treating patients with this particular complication of Achilles repair/reconstruction in this manner have not been previously reported in the orthopaedic literature. As catastrophic failures of Achilles tendon repairs or reconstructions from deep wound complications are studied further, our method of surgical care should be strongly considered as treatment.

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Lateral acromioplasty for correction of the critical shoulder angle

Obere Extremität ◽

10.1007/s11678-020-00578-w ◽

2020 ◽

Vol 15 (3) ◽

pp. 228-232

Author(s):

Mark Tauber ◽

Peter Habermeyer ◽

Nikolaus Zumbansen ◽

Frank Martetschläger

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Constant Score ◽

Logical Consequence ◽

Clinical Results ◽

Rotator Cuff Tears ◽

Critical Shoulder Angle ◽

Cuff Repair ◽

Shoulder Angle

Abstract The critical shoulder angle (CSA) was introduced as a radiological parameter associated with a higher incidence of rotator cuff tears. As a logical consequence, correcting the CSA together with rotator cuff repair should prevent re-tear and provide reliable and good clinical results. We present an all-arthroscopic technique resecting the lateral edge of the acromion (lateral acromioplasty) in order to reduce and correct the CSA after preoperative planning. Preliminary results from 20 patients with an average age of 62 years after rotator cuff repair are reported showing good clinical outcome with a Constant score of 88 points and no re-tear after an average follow-up of 16 months. The CSA was reduced from 39.7° to 32.1°. Previous concerns regarding weakening of the deltoid origin were not confirmed and there were no complications linked to lateral acromioplasty.

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Repair of Rotator Cuff Tears in the Elderly: Does It Make Sense? A Systematic Review

The American Journal of Sports Medicine ◽

10.1177/0363546519834574 ◽

2019 ◽

Vol 48 (3) ◽

pp. 744-753 ◽

Cited By ~ 2

Author(s):

Burak Altintas ◽

Nicole L. Anderson ◽

Rafael Pitta ◽

Patrick S. Buckley ◽

Sanjeev Bhatia ◽

...

Keyword(s):

Systematic Review ◽

Rotator Cuff ◽

Clinical Success ◽

Rotator Cuff Tears ◽

Age Group ◽

Level Of Evidence ◽

Imaging Evaluation ◽

Small Series ◽

Retear Rate

Background: The indications and outcomes for rotator cuff repair (RCR) among patients ≥70 years old are not widely reported. Many active patients in this age range desire a joint-preserving option, and several small series reported successful clinical outcomes after RCR among patients aged ≥70 years. Purpose: To systematically review the literature on the outcomes of RCR among patients ≥70 years old. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The electronic databases of PubMed and Cochrane were used for the literature search. The quality of the included studies was evaluated according to the Coleman Methodology Score. Studies in English evaluating repair of full-thickness rotator cuff tears among patients aged ≥70 years were included. Results: Eleven studies were reviewed, including 680 patients (694 shoulders) who were treated with arthroscopic and/or open RCR with a mean follow-up of 24.2 months (range, 12-40.8 months). Forty patients were lost to follow-up, leaving 654 shoulders with outcome data. This age group demonstrated a significant increase in clinical and functional outcomes after RCR with high satisfaction. American Shoulder and Elbow Surgeons scores showed an improvement from 44.2 (range, 35.4-56) preoperatively to 87.9 (range, 84-90.3) postoperatively, while Constant scores improved from 41.7 (range, 22.6-53.6) to 70.8 (range, 58.6-76). Postoperative imaging evaluation was performed on 513 shoulders, revealing a retear rate of 27.1% (139 shoulders). There were 45 retears after open repair and 94 after arthroscopic repair. The difference in retear rate among patients receiving arthroscopic repairs was not significantly different than open repairs ( P = .831). Pain according to a visual analog scale improved from 5.5 (range, 4.6-6.4) preoperatively to 1.3 (range, 0.5-2.3) postoperatively. Conclusion: RCR among patients ≥70 years old shows high clinical success rates with good outcomes and overall excellent pain relief. Although patients in this age group have a high potential for retear or persistent defects on imaging studies, RCR offers a joint-preserving option with significant functional and clinical improvement for the appropriately indicated patient.

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Complication rates associated with 3-column osteotomy in 82 adult spinal deformity patients: retrospective review of a prospectively collected multicenter consecutive series with 2-year follow-up

Journal of Neurosurgery Spine ◽

10.3171/2016.10.spine16849 ◽

2017 ◽

Vol 27 (4) ◽

pp. 444-457 ◽

Cited By ~ 50

Author(s):

Justin S. Smith ◽

Christopher I. Shaffrey ◽

Eric Klineberg ◽

Virginie Lafage ◽

Frank Schwab ◽

...

Keyword(s):

Pleural Effusion ◽

Wound Infection ◽

Adult Spinal Deformity ◽

Complication Rates ◽

Dural Tear ◽

Deep Wound Infection ◽

Deep Wound ◽

Rod Breakage ◽

Delayed Complications

OBJECTIVEAlthough 3-column osteotomy (3CO) can provide powerful alignment correction in adult spinal deformity (ASD), these procedures are complex and associated with high complication rates. The authors' objective was to assess complications associated with ASD surgery that included 3CO based on a prospectively collected multicenter database.METHODSThis study is a retrospective review of a prospectively collected multicenter consecutive case registry. ASD patients treated with 3CO and eligible for 2-year follow-up were identified from a prospectively collected multicenter ASD database. Early (≤ 6 weeks after surgery) and delayed (> 6 weeks after surgery) complications were collected using standardized forms and on-site coordinators.RESULTSOf 106 ASD patients treated with 3CO, 82 (77%; 68 treated with pedicle subtraction osteotomy [PSO] and 14 treated with vertebral column resection [VCR]) had 2-year follow-up (76% women, mean age 60.7 years, previous spine fusion in 80%). The mean number of posterior fusion levels was 12.9, and 17% also had an anterior fusion. A total of 76 early (44 minor, 32 major) and 66 delayed (13 minor, 53 major) complications were reported, with 41 patients (50.0%) and 45 patients (54.9%) affected, respectively. Overall, 64 patients (78.0%) had at least 1 complication, and 50 (61.0%) had at least 1 major complication. The most common complications were rod breakage (31.7%), dural tear (20.7%), radiculopathy (9.8%), motor deficit (9.8%), proximal junctional kyphosis (PJK, 9.8%), pleural effusion (8.5%), and deep wound infection (7.3%). Compared with patients who did not experience early or delayed complications, those who had these complications did not differ significantly with regard to age, sex, body mass index, Charlson Comorbidity Index, American Society of Anesthesiologists score, smoking status, history of previous spine surgery or spine fusion, or whether the 3CO performed was a PSO or VCR (p ≥ 0.06). Twenty-seven (33%) patients had 1–11 reoperations (total of 44 reoperations). The most common indications for reoperation were rod breakage (n = 14), deep wound infection (n = 15), and PJK (n = 6). The 24 patients who did not achieve 2-year follow-up had a mean of 0.85 years of follow-up, and the types of early and delayed complications encountered in these 24 patients were comparable to those encountered in the patients that achieved 2-year follow-up.CONCLUSIONSAmong 82 ASD patients treated with 3CO, 64 (78.0%) had at least 1 early or delayed complication (57 minor, 85 major). The most common complications were instrumentation failure, dural tear, new neurological deficit, PJK, pleural effusion, and deep wound infection. None of the assessed demographic or surgical parameters were significantly associated with the occurrence of complications. These data may prove useful for surgical planning, patient counseling, and efforts to improve the safety and cost-effectiveness of these procedures.

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Comparison of Superior Capsular Reconstruction and Partial Infraspinatus Repair: A Matched-Pair Analysis of Irreparable Rotator Cuff Tears

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120984264 ◽

2021 ◽

Vol 9 (2) ◽

pp. 232596712098426

Author(s):

Stefan Greiner ◽

Max Kaeaeb ◽

Andreas Voss ◽

Robert Lawton ◽

Pushkar Bhide ◽

...

Keyword(s):

Rotator Cuff ◽

Constant Score ◽

Rotator Cuff Tears ◽

Matched Pair ◽

Dash Score ◽

Western Ontario Rotator Cuff ◽

Superior Capsular Reconstruction ◽

Patient Reported ◽

The Mean

Background: Superior capsular reconstruction (SCR) represents a new option for the treatment of irreparable rotator cuff tears. Purpose/Hypothesis: This study aimed to evaluate the clinical and radiologic outcomes of SCR and compare them with the outcomes of partial repair (PR) of the infraspinatus tendon. The hypothesis was that there would be no significant differences between the clinical and radiologic outcome parameters of SCR and PR after a minimum follow-up of 2 years. Study Design: Cohort study; Level of evidence, 3. Methods: Of 21 patients who underwent SCR, 20 patients were matched in a 1:1 ratio according to sex, age, and tear configuration with 20 of 60 patients who had undergone PR; all patients were prospectively evaluated for a minimum follow-up of 2 years. The investigated outcome measures included the Constant score; Western Ontario Rotator Cuff (WORC) index; Disabilities of the Arm, Shoulder and Hand (DASH) score; and radiologic analysis of acromiohumeral distance (AHD) and humeral head centralization (HHC). Results: There were no differences in the demographic data between the SCR and PR groups. The mean age of both groups was 62.3 years (range, 47-79 years), the mean tear configuration was Bateman 3.0 and Patte 2.8, and the mean follow-up period was 29.4 months (range, 24-53 months). At final follow-up, no significant differences were seen between the SCR and PR groups with regard to Constant score (77.1 vs 82.7), age- and sex-adapted Constant score (85.5% vs 91.4%), DASH score (15.6 vs 7.8), or WORC index (81.1 vs 90.4). No significant differences in the AHD or HHC were seen between the groups. The reoperation rate was 4.8% (1/21) in the SCR cohort and 15% (9/60) in the PR cohort. Conclusion: Both SCR and PR resulted in significant improvements in patient-reported outcomes at 2-year follow-up, with no significant differences in clinical outcomes between the 2 techniques. Further follow-up is needed to determine whether there are long-term differences in HHC and development of cuff tear arthropathy. Further investigations should also focus on the cost-effectiveness of the respective procedures.

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Arthroscopic Side-to-Side Repair of Massive Rotator Cuff Tears Maintains Adequate Functional Improvement at 12 to 14 Years’ Follow-up

The American Journal of Sports Medicine ◽

10.1177/0363546520985224 ◽

2021 ◽

Vol 49 (2) ◽

pp. 298-304

Author(s):

Marie Caroline Merlet ◽

Virginie Guinet ◽

Thomas Rousseau ◽

Floris van Rooij ◽

Mo Saffarini ◽

...

Keyword(s):

Rotator Cuff ◽

Constant Score ◽

Reverse Shoulder Arthroplasty ◽

Case Series ◽

Rotator Cuff Tears ◽

Functional Improvement ◽

Shoulder Injuries ◽

Massive Rotator Cuff Tears ◽

Ultrasound Assessment

Background: Rotator cuff tears are common shoulder injuries that often cause pain and loss of function. Nonanatomic side-to-side techniques facilitate repair by minimizing tensions within tendons to improve healing and optimize the thickness of sutured tissues. Purpose/Hypothesis: The purpose was to evaluate long-term clinical and radiographic outcomes of arthroscopic side-to-side repair of massive rotator cuff tears (mRCTs). The hypothesis was that, at a minimum follow-up of 12 years, arthroscopic side-to-side repair maintains clinically important improvements. Study Design: Case series; Level of evidence, 4. Methods: The authors reviewed records of all patients who underwent arthroscopic repair of mRCTs over 2 consecutive years. A total of 30 adult patients met the eligibility criteria and underwent side-to-side repair. Patients were evaluated clinically using the Constant score (CS) and ultrasound to assess retears at 3 timepoints after surgery: 2 to 4 years, 5 to 7 years, and 12 to 14 years. Results: At first follow-up (3.2 ± 0.5 years), all 30 patients had clinical and ultrasound assessment, which revealed 13 retears (43%). At second follow-up (6.2 ± 0.5 years), all 30 patients had clinical and ultrasound assessment, which revealed 2 new retears (total 50%). At final follow-up (13.0 ± 0.7 years), only 21 patients had clinical assessment (1 died and 8 could not be reached), and only 19 patients had ultrasound assessment, which revealed 6 new retears (total 79%). Both absolute CS and age-/sex-adjusted CS improved significantly from baseline values at first follow-up (73.5 and 96.6, respectively), and remained stable at second follow-up (69.0 and 91.9, respectively), and final follow-up (64.4 and 87.0, respectively). Compared to shoulders with intact repairs, those with retears tended to have lower absolute CS at all follow-up visits, although differences were not statistically significant. Conclusion: Patients with mRCTs maintain satisfactory clinical scores at 12 to 14 years after arthroscopic side-to-side repair despite a high incidence of retears. Repair is a safe and effective treatment for mRCTs, providing a less invasive and less complex alternative to reverse shoulder arthroplasty and tendon transfer procedures.

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