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Treatment of irreparable cuff tears with smoothing of the humeroscapular motion interface without acromioplasty

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Abstract

Purpose

We sought to determine whether shoulders with irreparable rotator cuff tears and retained active elevation can be durably improved using a conservative surgical procedure that smoothes the interface between the proximal humeral convexity and the concave undersurface of the coracoacromial arch followed by immediate range of motion exercises.

Methods

We reviewed 151 patients with a mean age of 63.4 (range 40–90) years at a mean of 7.3 (range 2–19) years after this surgery.

Results

In 77 shoulders with previously unrepaired irreparable tears, simple shoulder test (SST) scores improved from an average of 4.6 (range 0–12) to 8.5 (range 1–12) (p < 0.001). Fifty-four patients (70%) improved by at least the minimally clinically important difference (MCID) of 2 SST points. For 74 shoulders with irreparable failed prior repairs, SST scores improved from 4.0 (range 0–11) to 7.5 (range 0–12) (p < 0.001). Fifty-four patients (73%) improved by the MCID of 2 SST points.

Conclusion

Smoothing of the humeroscapular interface can improve symptomatic shoulders with irreparable cuff tears and retained active elevation. This conservative procedure offers an alternative to more complex procedures in the management of irreparable rotator cuff tears.

Level of Evidence: Level IV

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Acknowledgement

We thank Susan DeBartolo (University of Washington, Department of Orthopedics and Sports Medicine) for her editorial work on the manuscript.

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Authors and Affiliations

  1. Department of Orthopaedics and Sports Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA

    Jason E. Hsu, Stacy M. Russ & Frederick A. Matsen III

  2. Department of Orthopaedics, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA

    Jacob Gorbaty

  3. John Muir Health, 3717 Mt. Diablo Blvd. #100, Lafayette, CA, 94549, USA

    Robert Lucas

  4. Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA

    Frederick A. Matsen III

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  1. Jason E. Hsu
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Correspondence to Frederick A. Matsen III.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This was a retrospective cohort study approved by our Institutional Review Board (IRB #49186). For this type of study, formal consent is not required.

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Conflict of interest

Outside of this submitted work, Dr. Frederick A. Matsen has received royalties from the Elsevier Publishing Company for The Shoulder, 4th edn by Rockwood CA Jr. and Matsen FA III. The other four authors declare that they have no conflict of interest.

Ethical review committee statement

Approved by University of Washington Institutional Review Board (IRB #49186). Financial remuneration the authors, or any member of their family, may have received related to the subject of the article: None.

Dr. Frederick A. Matsen III does receive royalties from Elsevier Publishing Company for The Shoulder, 4th edn, by Rockwood CA, Jr. and Matsen FA, III. These fees are outside of the submitted work.

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Hsu, J.E., Gorbaty, J., Lucas, R. et al. Treatment of irreparable cuff tears with smoothing of the humeroscapular motion interface without acromioplasty. International Orthopaedics (SICOT) 41, 1423–1430 (2017). https://doi.org/10.1007/s00264-017-3486-2

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