The Management of large and massive rotator cuff tears- Current trends amongst UK shoulder surgeons

Background: Management of large and massive rotator cuff tears remains controversial. Such tears are often irreparable, and results of treatment are unpredictable. This study documents the current practice of orthopaedic surgeons in the British Elbow and Shoulder Society. Methods: A questionnaire was prepared pertaining to the management of large and massive rotator cuff tears with minimal degenerative changes in three age groups: Patients of 50 years (young), 65 years (still active), aged 75 years (elderly) were considered. Various risk factors for failure of repair were considered. Results: Physiotherapy and arthroscopic debridement were the most commonly selected management options in young and middle groups in cases of a large/massive rotator cuff tear. Patch repairs were offered by 30% of respondents overall. Latissimus dorsi transfer was utilised by 30%, 8% and 2% respectively in each age group. Reverse shoulder replacement was indicated by 8%, 36% and 76% respectively. Discussion: There was a marked inconsistency in the pre-op planning and number and choice of options between respondents. Most surgeons offered non-augmented repairs in a scenario where they admitted failure was likely. The need for a multicenter trial is widely recognised and 87% of respondents were willing to participate in such a trial.

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38 Case Discussions on Surgical Decision Making for Massive Rotator Cuff Tears: Repair, Reconstruction, or Reverse Shoulder Replacement?

Video Atlas of Arthroscopic Rotator Cuff Repair ◽

10.1055/b-0041-179900 ◽

2021 ◽

Keyword(s):

Decision Making ◽

Rotator Cuff ◽

Rotator Cuff Tears ◽

Shoulder Replacement ◽

Surgical Decision ◽

Massive Rotator Cuff Tears ◽

Case Discussions ◽

Reverse Shoulder Replacement ◽

Surgical Decision Making

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Comparison of Clinical and Structural Outcomes by Subscapularis Tendon Status in Massive Rotator Cuff Tear

The American Journal of Sports Medicine ◽

10.1177/0363546517721187 ◽

2017 ◽

Vol 45 (11) ◽

pp. 2555-2562 ◽

Cited By ~ 8

Author(s):

Sung Hyun Lee ◽

Dae Jin Nam ◽

Se Jin Kim ◽

Jeong Woo Kim

Keyword(s):

Magnetic Resonance Imaging ◽

Rotator Cuff ◽

Rotator Cuff Tear ◽

Rotator Cuff Tears ◽

Subscapularis Tendon ◽

Resonance Imaging ◽

Massive Rotator Cuff Tear ◽

Cuff Tear ◽

Massive Rotator Cuff Tears

Background: The subscapularis tendon is essential in maintaining normal glenohumeral biomechanics. However, few studies have addressed the outcomes of tears extending to the subscapularis tendon in massive rotator cuff tears. Purpose: To assess the clinical and structural outcomes of arthroscopic repair of massive rotator cuff tears involving the subscapularis. Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2010 and January 2014, 122 consecutive patients with massive rotator cuff tear underwent arthroscopic rotator cuff repair. Overall, 122 patients were enrolled (mean age, 66 years; mean follow-up period, 39.5 months). Patients were categorized into 3 groups based on subscapularis tendon status: intact subscapularis tendon (I group; n = 45), tear involving less than the superior one-third (P group; n = 35), and tear involving more than one-third of the subscapularis tendon (C group; n = 42). All rotator cuff tears were repaired; however, subscapularis tendon tears involving less than the superior one-third in P group were only debrided. Pain visual analog scale, Constant, and American Shoulder and Elbow Surgeons scores and passive range of motion were measured preoperatively and at the final follow-up. Rotator cuff integrity, global fatty degeneration index, and occupation ratio were determined via magnetic resonance imaging preoperatively and 6 months postoperatively. Results: We identified 37 retears (31.1%) based on postoperative magnetic resonance imaging evaluation. Retear rate in patients in the C group (47.6%) was higher than that in the I group (22.9%) or P group (20.0%) ( P = .011). Retear subclassification based on the involved tendons showed that subsequent subscapularis tendon retears were noted in only the C group. The improvement in clinical scores after repair was statistically significant in all groups but not different among the groups. Between-group comparison showed significant differences in preoperative external rotation ( P = .021). However, no statistically significant difference was found in any shoulder range of motion measurements after surgery. Conclusion: Arthroscopic repair of massive tears results in substantial improvements in shoulder function, despite the presence of combined subscapularis tears. However, this study showed a high failure rate of massive posterosuperior rotator cuff tear repair extending more than one-third of the subscapularis tendon. When combined subscapularis tendon tear was less than the superior one-third of the subscapularis tendon, arthroscopic debridement was a reasonable treatment method where comparable clinical and anatomic outcomes could be expected.

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Long-Term Outcomes of Massive Rotator Cuff Tear Repair: A Systematic Review

HSS Journal ® ◽

10.1177/15563316211008137 ◽

2021 ◽

pp. 155633162110081

Author(s):

Nihar S. Shah ◽

Emil Suriel Peguero ◽

Yuta Umeda ◽

Zachary T. Crawford ◽

Brian M Grawe

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Tears ◽

Long Term Outcomes ◽

Massive Rotator Cuff Tear ◽

Cuff Tear ◽

Massive Rotator Cuff Tears ◽

Outcome Scores ◽

Long Term Follow Up

Background: With an increase in the treatment options available for massive rotator cuff tears, understanding the long-term outcomes of the chosen modality is important. Questions/Purpose: The purpose of this study was to systematically review the available literature on repair of massive rotator cuff repairs and learn the longevity of outcomes, the failure rate, outcomes after failure, and any contributing factors to poor outcomes or failure. Methods: We conducted a systematic review of the MEDLINE, Cochrane, and Embase databases to find studies that investigated the long-term results of repair of massive rotator cuff repairs. Studies were excluded if they did not stratify results of massive tears, provide a definition for a massive rotator cuff tear, or report isolate patients with long-term follow-up. Results: Six studies met the inclusion criteria, for a total of 472 shoulders; average patient age was 57.6 years. Follow-up ranged from 119 to 240 months. Outcome scores improved significantly following repair and were maintained throughout follow-up. The repair failure rate across studies was 39.2%. Patients who suffered retear had significantly worse outcome scores than patients with intact tendons at long-term follow-up. Conclusions: The existing literature on long-term follow-up after massive rotator cuff repair is scarce and not of high level of evidence. This review found repair of massive rotator cuff tears leads to long-term maintained improvements in outcome measures. Failure of repair is quite common, but results following failure are superior to preoperative outcomes.

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