Treatment of irreparable cuff tears with smoothing of the humeroscapular motion interface without acromioplasty
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.
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.
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.
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
KeywordsIrreparable cuff tears Humeroscapular motion interface Smooth and move Patient reported outcome
We thank Susan DeBartolo (University of Washington, Department of Orthopedics and Sports Medicine) for her editorial work on the manuscript.
Compliance with ethical standards
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.
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.
- 7.Cuff DJ, Pupello DR, Santoni BG (2016) Partial rotator cuff repair and biceps tenotomy for the treatment of patients with massive cuff tears and retained overhead elevation: midterm outcomes with a minimum 5 years of follow-up. J Shoulder Elb Surg 25(11):1803–1809. doi: 10.1016/j.jse.2016.04.001 CrossRefGoogle Scholar
- 11.Codman EA (1934) The shoulder: rupture of the supraspinatus tendon and other lesions in or about the subacromial bursa. NE J Med. doi: 10.1016/j.jse.2010.10.031
- 12.Romeo AA, Loutzenheiser T, Rhee YG, Sidles JA, Harryman DT II, Matsen FA III (1998) The humeroscapular motion interface. Clin Orthop Relat Res (350):120–127Google Scholar
- 14.Angst F, Schwyzer HK, Aeschlimann A, Simmen BR, Goldhahn J (2011) Measures of adult shoulder function: disabilities of the arm, shoulder, and hand questionnaire (DASH) and its short version (QuickDASH), shoulder pain and disability index (SPADI), American shoulder and elbow surgeons (ASES) society standardized shoulder assessment form, Constant (Murley) score (CS), simple shoulder test (SST), Oxford shoulder score (OSS), shoulder disability questionnaire (SDQ), and Western Ontario shoulder instability index (WOSI). Arthritis Care Res Suppl 11:S174–S188. doi: 10.1002/acr.20630 CrossRefGoogle Scholar
- 17.Verhelst L, Vandekerckhove PJ, Sergeant G, Liekens K, Van Hoonacker P, Berghs B (2010) Reversed arthroscopic subacromial decompression for symptomatic irreparable rotator cuff tears: mid-term follow-up results in 34 shoulders. J Shoulder Elb Surg 19(4):601–608. doi: 10.1016/j.jse.2009.10.001 CrossRefGoogle Scholar
- 22.Klinger HM, Spahn G, Baums MH, Steckel H (2005) Arthroscopic debridement of irreparable massive rotator cuff tears—a comparison of debridement alone and combined procedure with biceps tenotomy. Acta Chir Belg 105(3):297–301Google Scholar
- 27.Dunn WR, Kuhn JE, Sanders R, An Q, Baumgarten KM, Bishop JY, Brophy RH, Carey JL, Holloway GB, Jones GL, Ma CB, Marx RG, McCarty EC, Poddar SK, Smith MV, Spencer EE, Vidal AF, Wolf BR, Wright RW (2014) Symptoms of pain do not correlate with rotator cuff tear severity: a cross-sectional study of 393 patients with a symptomatic atraumatic full-thickness rotator cuff tear. J Bone Joint Surg Am 96(10):793–800. doi: 10.2106/jbjs.l.01304 CrossRefPubMedPubMedCentralGoogle Scholar
- 31.Wylie JD, Suter T, Potter MQ, Granger EK, Tashjian RZ (2016) Mental health has a stronger association with patient-reported shoulder pain and function than tear size in patients with full-thickness rotator cuff tears. J Bone Joint Surg Am 98(4):251–256. doi: 10.2106/JBJS.O.00444 CrossRefPubMedGoogle Scholar
- 41.Gerber C, Rahm SA, Cantanzaro S, Farshad M, Moor BK (2013) Latissimus dorsi tendon transfer for treatment of irreparable posterosuperior rotator cuff tears: long-term results at a minimum follow-up of ten years. J Bone Joint Surg Am 95(21):1920–1926. doi: 10.2106/JBJS.M.00122 CrossRefPubMedGoogle Scholar