Clinical and Radiological Results of Arthroscopic Repair of Massive Rotator Cuff Tears at Two Years- Does It Improve The Natural History?
*Chrysi Tsiouri, Daniel H Mok and Ramiah Chidambaram
Department of Orthopedics, Aristotle University of Thessaloniki, Greece
Submission: April 24, 2017; Published: April 28, 2017
*Corresponding author: Chrysi Tsiouri, Department of Orthopedics, Aristotle University of Thessaloniki, Greece, Tel:30694805 6477; Email: xpysat@yahoo.co.uk
How to cite this article: Chrysi T, Daniel H M, Ramiah C. Clinical and Radiological Results of Arthroscopic Repair of Massive Rotator Cuff Tears at Two Years-Does It Improve The Natural History?. Ortho & Rheum Open Access 2017; 6(3): 555690. DOI: 10.19080/OROAJ.2017.06.555690
Introduction
During the last decade the use of Reverse Shoulder Replacement as first line treatment for massive rotator cuff tears with or without cuff arthropathy has increased worryingly. It is a beautiful operation that may provide excellent results in terms of pain relief and function however as any joint replacement one should always think about revision. In our Upper Limb Department, familiarity with Reverse Shoulder Replacements was not an excuse not to first try arthroscopic repair of massive cuff tears, a technically demanding procedure that we believe can delay the need for a replacement.
We performed a study to answer the following questions we commonly faced from colleagues-
A. Is there any clinical or radiological benefit in repairing massive rotator cuff tears?
B. Is there a clinical or radiological difference between failed and healed repairs?
Between November 2004 and May 2006 the senior author performed 430 rotator cuff tears out of which 58 were classified as massive according to DeOrio and Cofield (JBJS 1984). 7 patients died and 6 were lost to follow up leaving 45 available for review. The mean age was 68 years with the majority between 60 to 80and the repair was affected with biodegradable 5.5mm sutures anchors (Lacto screw 5.5 Biomet) The principles of repair were based on Burkhart’s suspension bridge technique.
Our average follow up was 31months, with a minimum of 24, done by an independent observer. Objectively the patients were assessed with the Constant score, and subjectively using the Oxford. Cuff integrity was assessed using the Sonosite ultrasound machine in 45 and the progression of arthritis with x-ray in 45. Statistics were performed using the SPSS. 93% of our patients achieved good to excellent results in 31 months according to the Oxford score with a mean score of 44. The mean Constant score at last follow up was 90.2 with 71 % scoring over 85. The improvement was very significant statistically in all parameters (Table 1) (Figure 1).
We found no correlation between the scores and rotator cuff integrity in ultrasound in the 18 patients with a retear. 15 of the 18 with a retear were good or excellent with a mean constant score of 87.7 and a mean Oxford score of 43 and again, significant improvement from preoperative scores and parameters (Figure 2). In the 7 patients that developed postoperative OA and had a re tear, 75% had good or excellent results. There was one poor score. Mean Constant score in the 7 patients with OA and failure was 84.6 and mean Oxford score was 43 with significant improvement from preoperative scores (Figures 3-5). Our experience supports that of Steven Burkhart that the suspension bridge principle was effective in repairs of massive retracted rotator cuff. Arthroscopic repair of massive cuff tears certainly offers good pain relief and function for the patients without the morbidity of open surgery. It is simpler than muscle transfers and more cost effective than any other means of treatment repairing massive tears of the rotator cuff may not alter the progression of OA but there is significant clinical benefit regardless of healing.
In conclusion we believe that repairing massive rotator cuff tears arthroscopically should be the first line of treatment. It has less morbidity than open repairs and offers pain relief and improved function over time and should always precede any component related procedure. ed, despite severe soft tissue injury, it may have a good result.