The authors have previously published early outcomes of arthroscopic repairs of 86 massive rotator cuff tears (mRCTs) and aimed to determine whether their clinical scores are maintained or deteriorate after 5 more years.
Of the initial series of 86 shoulders, 2 had deceased, 16 lost to follow-up and 4 reoperated, leaving 64 for assessment. The repairs were complete in 44 and partial in 20, and 17 shoulders had pseudoparalysis. Preoperative assessment included absolute Constant score, shoulder strength, tear pattern, tendon retraction, and fatty infiltration. Patients were evaluated at 8.1 ± 0.6 years (range 7.1–9.3) using absolute and age-/sex-adjusted Constant score, subjective shoulder value (SSV), and simple shoulder test (SST).
Absolute Constant score was 80.0 ± 11.7 at first follow-up (at 2–5 years) but diminished to 76.7 ± 10.2 at second follow-up (at 7–10 years) (p < 0.001). Adjusted Constant score was 99.7 ± 15.9 at first follow-up and remained 98.8 ± 15.9 at second follow-up (ns). Comparing other outcomes revealed a decrease in strength over time (p < 0.001) but no change in pain, SSV or SST. Partially-repaired shoulders had lower strength at both follow-ups (p < 0.05). Pseudoparalytic shoulders had lower absolute and adjusted Constant score at second follow-up (p < 0.05), but their net improvements in absolute Constant score were higher (p = 0.014).
Both partial and complete arthroscopic repairs grant satisfactory long-term outcomes for patients with mRCTs, regardless of their tear pattern, fatty infiltration and presence of pseudoparalysis. Absolute Constant score decreased over time for both repair types, but adjusted Constant score remained stable, suggesting that decline is due to aging rather than tissue degeneration. The clinical relevance of this study is that arthroscopic repair should be considered for mRCTs, even if not completely repairable, rather than more invasive and/or risky treatments, such as reverse shoulder arthroplasty.
Level of evidence
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Agout C, Berhouet J, Bouju Y, Godeneche A, Collin P et al (2018) Clinical and anatomic results of rotator cuff repair at 10 years depend on tear type. Knee Surg Sports Traumatol Arthrosc 26(8):2490–2497
Agout C, Berhouet J, Spiry C, Bonnevialle N, Joudet T et al (2018) Functional outcomes after non-operative treatment of irreparable massive rotator cuff tears: Prospective multicenter study in 68 patients. Orthop Traumatol Surg Res 104(8s):S189–S192
Barth J, Fotiadis E, Barthelemy R, Genna S, Saffarini M (2015) Ultrasonic evaluation of the repair integrity can predict functional outcomes after arthroscopic double-row rotator cuff repair. Knee Surg Sports Traumatol Arthrosc 23(2):376–385
Bedi A, Dines J, Warren RF, Dines DM (2010) Massive tears of the rotator cuff. J Bone Joint Surg Am 92(9):1894–1908
Boileau P, Baque F, Valerio L, Ahrens P, Chuinard C et al (2007) Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg Am 89(4):747–757
Burkhart SS, Denard PJ, Adams CR, Brady PC, Hartzler RU (2016) Arthroscopic superior capsular reconstruction for massive irreparable rotator cuff repair. Arthrosc Tech 5(6):e1407–e1418
Carbone S, Razzano C, Passaretti D, Mezzoprete R (2018) Arthroscopic single-row repair of massive potentially irreparable postero-superior cuff tear. Musculoskelet Surg 102(Suppl 1):13–19
Carver TJ, Kraeutler MJ, Smith JR, Bravman JT, McCarty EC (2018) Nonarthroplasty surgical treatment options for massive, irreparable rotator cuff tears. Orthop J Sports Med 6(11):2325967118805385
Cavalier M, Jullion S, Kany J, Grimberg J, Lefebvre Y et al (2018) Management of massive rotator cuff tears: prospective study in 218 patients. Orthop Traumatol Surg Res 104(8s):S193–s197
Charousset C, Bellaiche L, Duranthon LD, Grimberg J (2005) Accuracy of CT arthrography in the assessment of tears of the rotator cuff. J Bone Joint Surg Br 87(6):824–828
Cho NS, Lee BG, Rhee YG (2011) Arthroscopic rotator cuff repair using a suture bridge technique: is the repair integrity actually maintained? Am J Sports Med 39(10):2108–2116
Chung SW, Kim JY, Kim MH, Kim SH, Oh JH (2013) Arthroscopic repair of massive rotator cuff tears: outcome and analysis of factors associated with healing failure or poor postoperative function. Am J Sports Med 41(7):1674–1683
Cofield RH (1985) Rotator cuff disease of the shoulder. J Bone Joint Surg Am 67(6):974–979
Collin P, Colmar M, Thomazeau H, Mansat P, Boileau P et al (2018) Clinical and MRI outcomes 10 years after repair of massive posterosuperior rotator cuff tears. J Bone Joint Surg Am 100(21):1854–1863
Constant CR, Gerber C, Emery RJ, Sojbjerg JO, Gohlke F et al (2008) A review of the constant score: modifications and guidelines for its use. J Shoulder Elbow Surg 17(2):355–361
Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164
Cuff DJ, Pupello DR, Santoni BG (2016) Partial rotator cuff repair and biceps tenotomy for the treatment of patients with massive cuff tears and retained overhead elevation: midterm outcomes with a minimum 5 years of follow-up. J Shoulder Elbow Surg 25(11):1803–1809
Davidson JF, Burkhart SS, Richards DP, Campbell SE (2005) Use of preoperative magnetic resonance imaging to predict rotator cuff tear pattern and method of repair. Arthroscopy 21(12):1428
El-Azab HM, Rott O, Irlenbusch U (2015) Long-term follow-up after latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears. J Bone Joint Surg Am 97(6):462–469
Ernstbrunner L, Andronic O, Grubhofer F, Camenzind RS, Wieser K et al (2019) Long-term results of reverse total shoulder arthroplasty for rotator cuff dysfunction: a systematic review of longitudinal outcomes. J Shoulder Elbow Surg 28(4):774–781
Fossati C, Arrigoni P, Ragone V, Spennacchio P, Banfi G et al (2014) How do massive immobile rotator cuff tears behave after arthroscopic interval slides? Comparison with mobile tears Joints 2(2):66–70
Franceschi F, Papalia R, Vasta S, Leonardi F, Maffulli N et al (2015) Surgical management of irreparable rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 23(2):494–501
Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 8(6):599–605
Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K (2004) The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am 86(2):219–224
Gerber C, Fuchs B, Hodler J (2000) The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am 82(4):505–515
Gerber C, Rahm SA, Catanzaro S, Farshad M, Moor BK (2013) Latissimus dorsi tendon transfer for treatment of irreparable posterosuperior rotator cuff tears: long-term results at a minimum follow-up of ten years. J Bone Joint Surg Am 95(21):1920–1926
Gilbart MK, Gerber C (2007) Comparison of the subjective shoulder value and the Constant score. J Shoulder Elbow Surg 16(6):717–721
Godeneche A, Freychet B, Lanzetti RM, Clechet J, Carrillon Y, Saffarini M (2017) Should massive rotator cuff tears be reconstructed even when only partially repairable? Knee Surg Sports Traumatol Arthrosc 25(7):2164–2173
Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83
Goutallier D, Postel JM, Chevalier X, Beaudreuil J, Zilber S (2010) Intermediate term functional outcome prediction following full thickness rotator cuff tear reparative or not reparative surgery. Orthop Traumatol Surg Res 96(7):727–733
Goutallier D, Postel JM, Lavau L, Bernageau J (1998) Influence of muscular degeneration of the supra- and infra-spinatus on the prognosis of surgical repair of the rotator cuff. Acta Orthop Belg 64(Suppl 2):42–45
Grassi FA, Tajana MS (2003) The normalization of data in the Constant-Murley score for the shoulder. A study conducted on 563 healthy subjects. Chir Organi Mov 88(1):65–73
Heuberer PR, Kolblinger R, Buchleitner S, Pauzenberger L, Laky B et al (2015) Arthroscopic management of massive rotator cuff tears: an evaluation of debridement, complete, and partial repair with and without force couple restoration. Knee Surg Sports Traumatol Arthrosc 24(12):3828–3837
Holtby R, Razmjou H (2014) Relationship between clinical and surgical findings and reparability of large and massive rotator cuff tears: a longitudinal study. BMC Musculoskelet Disord 15:180
Iagulli ND, Field LD, Hobgood ER, Ramsey JR, Savoie FH 3rd (2012) Comparison of partial versus complete arthroscopic repair of massive rotator cuff tears. Am J Sports Med 40(5):1022–1026
Imhoff AB, Hodler J (1996) Correlation of MR imaging, CT arthrography, and arthroscopy of the shoulder. Bull Hops Joint Dis 54(3):146–152
Katolik LI, Romeo AA, Cole BJ, Verma NN, Hayden JK et al (2005) Normalization of the constant score. J Shoulder Elbow Surg 14(3):279–285
Konig MA, Braunstein VA (2017) Tendon repair leads to better long-term clinical outcome than debridement in massive rotator cuff tears. Open Orthop J 11:546–553
Kukkonen J, Kauko T, Vahlberg T, Joukainen A, Aarimaa V (2013) Investigating minimal clinically important difference for constant score in patients undergoing rotator cuff surgery. J Shoulder Elbow Surg 22(12):1650–1655
Le BT, Wu XL, Lam PH, Murrell GA (2014) Factors predicting rotator cuff retears: an analysis of 1000 consecutive rotator cuff repairs. Am J Sports Med 42(5):1134–1142
Lippitt SB, Harryman DTn, Matsen FAr (1993) A practical tool for evaluating function: the Simple Shoulder Test. In: The shoulder: a balance of mobility and stability. American Academy of Orthopaedic Surgeons, Rosemont
Malahias MA, Brilakis E, Avramidis G, Antonogiannakis E (2019) Satisfactory mid-term outcome of subacromial balloon spacer for the treatment of irreparable rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 27(12):3890–3896
Malahias MA, Kostretzis L, Chronopoulos E, Brilakis E, Avramidis G et al (2019) Arthroscopic partial repair for massive rotator cuff tears: does it work? A systematic review. Sports Med Open 5(1):13
Melis B, DeFranco MJ, Chuinard C, Walch G (2010) Natural history of fatty infiltration and atrophy of the supraspinatus muscle in rotator cuff tears. Clin Orthop Relat Res 468(6):1498–1505
Oh JH, Kim SH, Choi JA, Kim Y, Oh CH (2010) Reliability of the grading system for fatty degeneration of rotator cuff muscles. Clin Orthop Relat Res 468(6):1558–1564
Patte D (1990) Classification of rotator cuff lesions. Clin Orthop Relat Res 254:81–86
Petrillo S, Longo UG, Papalia R, Denaro V (2017) Reverse shoulder arthroplasty for massive irreparable rotator cuff tears and cuff tear arthropathy: a systematic review. Musculoskelet Surg 101(2):105–112
Ruiz Iban MA, Lorente Moreno R, Ruiz Diaz R, Alvarez Sciamanna R, Paniagua Gonzalez A et al (2018) The absorbable subacromial spacer for irreparable posterosuperior cuff tears has inconsistent results. Knee Surg Sports Traumatol Arthrosc 26(12):3848–3854
Sevivas N, Ferreira N, Andrade R, Moreira P, Portugal R et al (2017) Reverse shoulder arthroplasty for irreparable massive rotator cuff tears: a systematic review with meta-analysis and meta-regression. J Shoulder Elbow Surg 26(9):e265–e277
Thes A, Hardy P, Bak K (2015) Decision-making in massive rotator cuff tear. Knee Surg Sports Traumatol Arthrosc 23(2):449–459
Tokish JM, Alexander TC, Kissenberth MJ, Hawkins RJ (2017) Pseudoparalysis: a systematic review of term definitions, treatment approaches, and outcomes of management techniques. J Shoulder Elbow Surg 26(6):e177–e187
Werner CM, Steinmann PA, Gilbart M, Gerber C (2005) Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am 87(7):1476–1486
Wiater JM, Fabing MH (2009) Shoulder arthroplasty: prosthetic options and indications. J Am Acad Orthop Surg 17(7):415–425
Yoo JC, Ahn JH, Yang JH, Koh KH, Choi SH et al (2009) Correlation of arthroscopic repairability of large to massive rotator cuff tears with preoperative magnetic resonance imaging scans. Arthroscopy 25(6):573–582
Yoon TH, Kim SJ, Choi CH, Yoon SP, Chun YM (2019) An intact subscapularis tendon and compensatory teres minor hypertrophy yield lower failure rates for non-operative treatment of irreparable, massive rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 27(10):3240–3245
Zumstein MA, Jost B, Hempel J, Hodler J, Gerber C (2008) The clinical and structural long-term results of open repair of massive tears of the rotator cuff. J Bone Joint Surg Am 90(11):2423–2431
Conflict of Interest
GH and MS consult and receive fees from ReSurg. None of the authors have any conflicts of interest in relation to this work.
The work was supported by the Groupement de Coopération Sanitaire Ramsay Santé pour l’enseignement et la Recherche.
All patients provided informed consent for the use of their data for research, and the study was approved by the ethical board in advance (IRB reference number: COS-RGDS-2019–05-002-GODENECHE-A).
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Besnard, M., Freychet, B., Clechet, J. et al. Partial and complete repairs of massive rotator cuff tears maintain similar long-term improvements in clinical scores. Knee Surg Sports Traumatol Arthrosc 29, 181–191 (2021). https://doi.org/10.1007/s00167-020-05907-8
- Massive rotator cuff tears
- Partial arthroscopic repair
- Complete arthroscopic repair