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Deltoid detachment consequent to open surgical repair of massive rotator cuff tears

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Abstract

Deltoid detachment is one of the complications in open rotator cuff repair. Although it is often described, the actual prevalence, time at which it occurs and the predisposing causes are still unknown. We prospectively studied 112 patients with massive rotator cuff tears with a mean age of 67. The surgical approach was performed with a lateral para-acromial incision. Clinical assessment was performed with Constant’s method. Of the 112 patients, 9 (8%) had deltoid detachment. It occurred about 3 months after surgery. Of the nine patients, two underwent revision surgery for the deltoid trans-bone reattachment. At the follow-up, the patients with deltoid detachment had a mean increase of only 5.5 points in the Constant score compared to that of 16.9 obtained by the control group. Deltoid reattachment, performed on the two patients, provided a mean increase of 7 points only with respect to the post-operative control at the 4th month. Considering the unsatisfactory functional result consequent to deltoid detachment and the slight improvement obtained with the reattachment, we recommend the following: use suture thread thicker than #2, do not use a simple stitch and avoid extending acromioplasty to the lateral margin of the acromion.

Résumé

La rupture du deltoïde est une des complications des réparations de coiffe de rotateur à ciel ouvert. Bien que cette complication soit souvent décrite, l’incidence actuelle, le moment d’apparition et les facteurs favorisant de cette lésion ne sont pas bien connus. Nous avons réalisé une étude prospective, à partir de 112 patients, avec rupture massive de la coiffe des rotateurs, d’âge moyen 67 ans. L’abord chirurgical était de type para-acromial latéral. La revue clinique a été réalisée avec le score de Constant. Sur les 112 patients, 9 (8%) avaient une rupture du deltoïde. Cela s’est produit environ trois mois après l’intervention. Sur les 9 patients, deux furent réopérés avec une suture trans-osseuse du deltoïde. A la révision, les patients avec une rupture du deltoïde avaient un gain moyen de 5.5 points dans le score de Constant et ceux sans rupture avaient 16.9. La refixation du deltoïde, réalisée sur les deux patients, n’a permis de gagner que 7 points par rapport au contrôle post opératoire à 4 mois. Compte tenu des résultats fonctionnels non satisfaisants consécutifs à la rupture du deltoïde et le faible gain, après réparation, nous recommandons : l’utilisation de fil de suture de diamètre supérieur à 2; de ne pas utiliser de points simples et d’éviter les acromioplasties extensives du bort latéral de l’acromion.

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Gumina, S., Di Giorgio, G., Perugia, D. et al. Deltoid detachment consequent to open surgical repair of massive rotator cuff tears. International Orthopaedics (SICO 32, 81–84 (2008). https://doi.org/10.1007/s00264-006-0285-6

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