Partial and complete repairs of massive rotator cuff tears maintain similar long-term improvements in clinical scores

Abstract

Purpose

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.

Methods

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).

Results

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).

Conclusions

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

IV.

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Correspondence to Mo Saffarini.

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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.

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The work was supported by the Groupement de Coopération Sanitaire Ramsay Santé pour l’enseignement et la Recherche.

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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).

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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

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Keywords

  • Massive rotator cuff tears
  • Partial arthroscopic repair
  • Complete arthroscopic repair
  • Pseudoparalysis