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Clinical Outcome vs. Structural Integrity: What Really Matters?

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Massive and Irreparable Rotator Cuff Tears

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Abstract

Symptomatic repairable massive rotator cuff tears remain a surgical challenge because they are surgically demanding procedures with often unpredictable outcomes. Despite the evolution of surgical techniques and available materials, failure rates after arthroscopic repair remain significantly high. However, in the great majority of these cases the functional score improvement is not detrimentally affected by the tendon repair failure. Therefore, arthroscopic repair of a massive tear is not contraindicated, even in elderly patients. However, surgeons should still strive to achieve an anatomical repair with tendon healing and focus on the postoperative strength of the operated shoulder, as this is detrimentally affected by repair failure and can greatly affect patients’ occupational abilities. Before surgical planning, surgeons should consider established prognostic factors such as muscle fatty infiltration and tear location, and also newer prognostic factors, such as the T-scale. After systematic preoperative evaluation, all possible treatment modalities can be evaluated, ranging from arthroscopic repair to reverse shoulder arthroplasty.

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Authors and Affiliations

  1. 2nd Orthopaedic Department, 401 Military Hospital of Athens, Athens, Greece

    John Bampis & Achilleas Boutsiadis

  2. Department of Orthopaedic Surgery, Centre Osteoarticulaire des Cèdres, Grenoble, France

    John Swan

  3. Chalandri, Attiki, Greece

    Achilleas Boutsiadis

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  1. John Bampis
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  3. Achilleas Boutsiadis
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Editors and Affiliations

  1. Hospital das Forças Armadas and Hospital da Luz, Porto, Portugal

    Nuno Sampaio Gomes

  2. Department of Traumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia

    Ladislav Kovačič

  3. ATOS Klinik München, Deutsches Schulterzentrum, München, Bayern, Germany

    Frank Martetschläger

  4. Department of Orthopaedics, University of Brescia, Brescia, Italy

    Giuseppe Milano

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Bampis, J., Swan, J., Boutsiadis, A. (2020). Clinical Outcome vs. Structural Integrity: What Really Matters?. In: Sampaio Gomes, N., Kovačič, L., Martetschläger, F., Milano, G. (eds) Massive and Irreparable Rotator Cuff Tears. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-61162-3_9

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