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Management of massive rotator cuff tears: prospective study in 218 patients

Cavalier, Maxime and Jullion, Stéphane and Kany, Jean and Grimberg, Jean and Lefebvre, Yves and Oudet, Didier and Grosclaude, Sophie and Charousset, Christophe and Boileau, Pascal and Joudet, Thierry and Bonnevialle, Nicolas Management of massive rotator cuff tears: prospective study in 218 patients. (2018) Orthopaedics & Traumatology: Surgery & Research, 104 (8). S193-S197. ISSN 1877-0568

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Official URL: https://doi.org/10.1016/j.otsr.2018.09.007


BACKGROUND: No consensus exists about the management of massive and symptomatic rotator cuff tears (RCTs). The objective of this study was to compare the 12-month clinical outcomes of various treatment options for massive RCTs. HYPOTHESIS: Arthroscopic surgery has a role to play in the treatment of massive and apparently irreparable RCTs. MATERIAL AND METHODS: A prospective multicentre non-randomised study was performed in patients with massive RCTs managed non-operatively (NONOP) or by arthroscopic tenotomy/tenodesis of the long head of biceps (aTLB), arthroscopic partial tendon repair (aPTR), arthroscopic latissimus dorsi transfer (aLDT), or reverse shoulder arthroplasty (RSA). Clinical outcomes were evaluated based on the Constant score, Subjective Shoulder Value (SSV), and American Shoulder and Elbow Surgeons (ASES) score after 3, 6, and 12 months. RESULTS: The 218 included patients (mean age, 69 years) were distributed as follows: NONOP, n=71; aTLB, n=26; aPTR, n=61; aLDT, n=25; and RSA, n=35. After 12 months, the mean Constant score, SSV, and ASES score values were 70, 68%, and 73, respectively, and had improved significantly versus the preoperative values in all treatment groups. RSA was the only treatment followed by improvements in all Constant score items. Active forwards elevation improved significantly in the NONOP (+25°), aPTR (+26°), and RSA (+66°) groups. An improvement in active external rotation was seen only in the RSA group, where it was small (+10°, p=0.046). Significant increases in internal rotation were seen in the NONOP (+1.6 points) and aPTR (+1.7 points) groups. CONCLUSION: Arthroscopic techniques (aTLB, aPTR, and aLDT) for managing massive irreparable RCTs produce significant functional gains. Partial tendon repair (aPTR) and RSA may provide better outcomes than isolated aTLB or aLDT.

Item Type:Article
HAL Id:hal-02135078
Audience (journal):International peer-reviewed journal
Uncontrolled Keywords:
Institution:Other partners > Centre Hospitalier Universitaire de Nancy - CHU Nancy (FRANCE)
Other partners > Centre Hospitalier Universitaire de Nice - CHU Nice (FRANCE)
Other partners > Clinique chirurgicale du Libournais (FRANCE)
Other partners > Clinique de l’Alliance - Saint-Cyr-sur-Loire (FRANCE)
Other partners > Clinique du Parc Lyon (FRANCE)
Other partners > Clinique Rhéna (FRANCE)
Other partners > Clinique Turin (FRANCE)
Other partners > Clinique de l’Union - Saint-Jean (FRANCE)
Other partners > Centre Hospitalier Universitaire de Toulouse - CHU Toulouse (FRANCE)
Other partners > Institut de Recherche en Chirurgie Orthopédique et Sportive - IRCOS (FRANCE)
French Society of Arthroscopy - SFA (FRANCE)
Deposited On:11 Apr 2019 07:15

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