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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 24, Issue 12, pp 3828–3837 | Cite as

Arthroscopic management of massive rotator cuff tears: an evaluation of debridement, complete, and partial repair with and without force couple restoration

  • Philipp R. Heuberer
  • Roman Kölblinger
  • Stefan Buchleitner
  • Leo Pauzenberger
  • Brenda Laky
  • Alexander Auffarth
  • Philipp Moroder
  • Sylvia Salem
  • Bernhard Kriegleder
  • Werner Anderl
Shoulder

Abstract

Purpose

To evaluate the effectiveness of arthroscopic debridement (DB), partial (PR), and complete repair (CR) for massive rotator cuff tears (mRCT) in terms of functional and subjective parameters, and repair integrity.

Methods

For this single-centre study, 68 consecutive shoulders with mRCT involving at least three tendons and treated with arthroscopic DB (n = 23), PR (n = 22), and CR (n = 23) were included. All patients (52–81 years) were prospectively assessed before and at a mean of 45 months after surgery using functional and subjective parameters. Preoperative tendon rupture pattern and post-operative repair integrity were assessed by MRI. A coding system describing accurately rotator cuff rupture, treatment, and integrity was established.

Results

All treatment groups improved significantly from pre- to post-operative (P < 0.01), while preoperative parameters, except fatty degeneration, were not significantly different. However, post-operative comparisons revealed similar scores with DB (constant score, CS 65.8 ± 14.7, qDASH 24.1 ± 20.6) and PR (CS 67.5 ± 9.9, P = n.s.; qDASH 20.5 ± 14.4, P = n.s.), while CR were significantly better (CS 80.3 ± 8.9; qDASH 7.0 ± 8.7; P ≤ 0.001). Force couple restoration of PR did not significantly influence outcome. Re-tear rates with CR (29 %) were lower compared to PR (53 %). Intact CR compared to intact PR showed better CS (83.4 ± 7.3 vs. 68.5 ± 10.6, P = 0.009) and qDASH (5.4 ± 8.3 vs. 21.2 ± 9.5, P = 0.006). The vast majority of patients were satisfied with their arthroscopic procedure (DB 87 %; PR 86 %; CR 91 %).

Conclusion

Arthroscopic DB, PR, and CR were effective in treating mRCT involving at least three tendons. Reparability of mRCT was influenced by fatty degeneration of the muscles. However, CR showed the most favourable short-term improvements.

Level of evidence

IV.

Keywords

Massive rotator cuff tear Arthroscopy Debridement Partial repair Complete repair Force couple 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

167_2015_3739_MOESM1_ESM.pdf (201 kb)
Supplementary material 1 (PDF 200 kb)

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015

Authors and Affiliations

  • Philipp R. Heuberer
    • 1
  • Roman Kölblinger
    • 1
  • Stefan Buchleitner
    • 1
  • Leo Pauzenberger
    • 1
  • Brenda Laky
    • 1
  • Alexander Auffarth
    • 2
  • Philipp Moroder
    • 2
  • Sylvia Salem
    • 1
  • Bernhard Kriegleder
    • 1
  • Werner Anderl
    • 1
  1. 1.Department of OrthopedicsSt. Vincent HospitalViennaAustria
  2. 2.Department of Traumatology and Sports InjuriesParacelsus Medical UniversitySalzburgAustria

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