International Orthopaedics

, Volume 41, Issue 7, pp 1423–1430 | Cite as

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

  • Jason E. Hsu
  • Jacob Gorbaty
  • Robert Lucas
  • Stacy M. Russ
  • Frederick A. MatsenIII
Original Paper



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


Irreparable 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

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.

Informed consent


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.


  1. 1.
    Colvin AC, Egorova N, Harrison AK, Moskowitz A, Flatow EL (2012) National trends in rotator cuff repair. J Bone Joint Surg Am 94(3):227–233. doi: 10.2106/jbjs.j.00739 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    McElvany MD, McGoldrick E, Gee AO, Neradilek MB, Matsen FA 3rd (2015) Rotator cuff repair: published evidence on factors associated with repair integrity and clinical outcome. Am J Sports Med 43(2):491–500. doi: 10.1177/0363546514529644 CrossRefPubMedGoogle Scholar
  3. 3.
    Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K (2004) The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am 86-a(2):219–224CrossRefPubMedGoogle Scholar
  4. 4.
    Harryman DT 2nd, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA 3rd (1991) Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. J Bone Joint Surg Am 73(7):982–989CrossRefPubMedGoogle Scholar
  5. 5.
    Paxton ES, Teefey SA, Dahiya N, Keener JD, Yamaguchi K, Galatz LM (2013) Clinical and radiographic outcomes of failed repairs of large or massive rotator cuff tears: minimum ten-year follow-up. J Bone Joint Surg Am 95(7):627–632. doi: 10.2106/JBJS.L.00255 CrossRefPubMedGoogle Scholar
  6. 6.
    Russell RD, Knight JR, Mulligan E, Khazzam MS (2014) Structural integrity after rotator cuff repair does not correlate with patient function and pain: a meta-analysis. J Bone Joint Surg Am 96(4):265–271. doi: 10.2106/JBJS.M.00265 CrossRefPubMedGoogle Scholar
  7. 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
  8. 8.
    Warner JP (2000) Management of massive irreparable rotator cuff tears: the role of tendon transfer. J Bone Joint Surg Am 82(6):878–878CrossRefGoogle Scholar
  9. 9.
    Keener JD, Steger-May K, Stobbs G, Yamaguchi K (2010) Asymptomatic rotator cuff tears: patient demographics and baseline shoulder function. J Shoulder Elb Surg 19(8):1191–1198. doi: 10.1016/j.jse.2010.07.017 CrossRefGoogle Scholar
  10. 10.
    Yamaguchi K, Ditsio K, Middleton WD, Hildebolt CF, Galatz LM, Teefey SA (2006) The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders. J Bone Joint Surg Am 88(8):1699–1704. doi: 10.2106/JBJS.E.00835 PubMedGoogle Scholar
  11. 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. 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
  13. 13.
    Wieser K, Rahm S, Schubert M, Fischer MA, Farshad M, Gerber C, Meyer DC (2015) Fluoroscopic, magnetic resonance imaging, and electrophysiologic assessment of shoulders with massive tears of the rotator cuff. J Shoulder Elb Surg 24(2):288–294. doi: 10.1016/j.jse.2014.05.026 CrossRefGoogle Scholar
  14. 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
  15. 15.
    Tashjian RZ, Deloach J, Green A, Porucznik CA, Powell AP (2010) Minimal clinically important differences in ASES and simple shoulder test scores after nonoperative treatment of rotator cuff disease. J Bone Joint Surg Am 92(2):296–303. doi: 10.2106/jbjs.h.01296 CrossRefPubMedGoogle Scholar
  16. 16.
    Fenlin JM Jr, Chase JM, Rushton SA, Frieman BG (2002) Tuberoplasty: creation of an acromiohumeral articulation-a treatment option for massive, irreparable rotator cuff tears. J Shoulder Elb Surg 11(2):136–142. doi: 10.1067/mse.2002.121764 CrossRefGoogle Scholar
  17. 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
  18. 18.
    Scheibel M, Lichtenberg S, Habermeyer P (2004) Reversed arthroscopic subacromial decompression for massive rotator cuff tears. J Shoulder Elb Surg 13(3):272–278. doi: 10.1016/S1058274604000242 CrossRefGoogle Scholar
  19. 19.
    Henkus HE, de Witte PB, Nelissen RG, Brand R, van Arkel ER (2009) Bursectomy compared with acromioplasty in the management of subacromial impingement syndrome: a prospective randomised study. J Bone Joint Surg Br 91(4):504–510. doi: 10.1302/0301-620X.91B4.21442 CrossRefPubMedGoogle Scholar
  20. 20.
    Park JG, Cho NS, Song JH, Baek JH, Rhee YG (2015) Long-term outcome of tuberoplasty for irreparable massive rotator cuff tears: is tuberoplasty really applicable? J Shoulder Elb Surg 25(2):224–231. doi: 10.1016/j.jse.2015.07.025 CrossRefGoogle Scholar
  21. 21.
    Kempf JF, Gleyze P, Bonnomet F, Walch G, Mole D, Frank A, Beaufils P, Levigne C, Rio B, Jaffe A (1999) A multicenter study of 210 rotator cuff tears treated by arthroscopic acromioplasty. Arthroscopy 15(1):56–66. doi: 10.1053/ar.1999v15.015005 CrossRefPubMedGoogle Scholar
  22. 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
  23. 23.
    Klinger HM, Steckel H, Ernstberger T, Baums MH (2005) Arthroscopic debridement of massive rotator cuff tears: negative prognostic factors. Arch Orthop Trauma Surg 125(4):261–266. doi: 10.1007/s00402-004-0738-6 CrossRefPubMedGoogle Scholar
  24. 24.
    Liem D, Lengers N, Dedy N, Poetzi W, Steinbeck J, Marquardt B (2008) Arthroscopic debridement of massive irreparable rotator cuff tears. Arthroscopy 24(7):743–748. doi: 10.1016/j.arthro.2008.03.007 CrossRefPubMedGoogle Scholar
  25. 25.
    Rockwood CA Jr, Williams GR Jr, Burkhead WZ Jr (1995) Debridement of degenerative, irreparable lesions of the rotator cuff. J Bone Joint Surg Am 77(6):857–866CrossRefPubMedGoogle Scholar
  26. 26.
    Shon MS, Koh KH, Lim TK, Kim WJ, Kim KC, Yoo JC (2015) Arthroscopic partial repair of irreparable rotator cuff tears: preoperative factors associated with outcome deterioration over 2 years. Am J Sports Med 43(8):1965–1975. doi: 10.1177/0363546515585122 CrossRefPubMedGoogle Scholar
  27. 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
  28. 28.
    Curry EJ, Matzkin EE, Dong Y, Higgins LD, Katz JN, Jain NB (2015) Structural characteristics are not associated with pain and function in rotator cuff tears: the ROW cohort study. Orthop J Sports Med 3(5):2325967115584596. doi: 10.1177/2325967115584596 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Barlow JD, Bishop JY, Dunn WR, Kuhn JE, Group MS (2016) What factors are predictors of emotional health in patients with full-thickness rotator cuff tears? J Shoulder Elb Surg 25(11):1769–1773. doi: 10.1016/j.jse.2016.04.007 CrossRefGoogle Scholar
  30. 30.
    Potter MQ, Wylie JD, Greis PE, Burks RT, Tashjian RZ (2014) Psychological distress negatively affects self-assessment of shoulder function in patients with rotator cuff tears. Clin Orthop Relat Res 472(12):3926–3932. doi: 10.1007/s11999-014-3833-1 CrossRefPubMedPubMedCentralGoogle Scholar
  31. 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
  32. 32.
    Duralde XA, Bair B (2005) Massive rotator cuff tears: the result of parital rotator cuff repair. J Shoulder Elb Surg 14(2):121–127. doi: 10.1016/j.jse.2004.06.015 CrossRefGoogle Scholar
  33. 33.
    Galasso O, Riccelli DA, DeGori M, DeBenedetto M, Orlando N, Gasparini G, Castricini R (2016) Quality of life and functional results of arthroscopic partial repair of irreparable rotator cuff tears. Arthroscopy 33(2):261–268. doi: 10.1016/j.arthro.2016.06.024 CrossRefPubMedGoogle Scholar
  34. 34.
    Kim SJ, Lee IS, Kim SH, Lee WY, Chun YM (2012) Arthroscopic partial repair of irreparable large to massive rotator cuff tears. Arthroscopy 28(6):761–768. doi: 10.1016/j.arthro.2011.11.018 CrossRefPubMedGoogle Scholar
  35. 35.
    Wellmann M, Lichtenberg S, da Silva G, Magosch P, Habermeyer P (2013) Results of arthroscopic partial repair of large retracted rotator cuff tears. Arthroscopy 29(8):1275–1282. doi: 10.1016/j.arthro.2013.05.006 CrossRefPubMedGoogle Scholar
  36. 36.
    Gupta AK, Hug K, Berkoff DJ, Boggess BR, Gavigan M, Malley PC, Toth AP (2012) Dermal tissue allograft for the repair of massive irreparable rotator cuff tears. Am J Sports Med 40(1):141–147. doi: 10.1177/0363546511422795 CrossRefPubMedGoogle Scholar
  37. 37.
    Mihata T, Lee TQ, Watanabe C, Fukunishi K, Ohue M, Tsujimura T, Kinoshita M (2013) Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthroscopy 29(3):459–470. doi: 10.1016/j.arthro.2012.10.022 CrossRefPubMedGoogle Scholar
  38. 38.
    Senekovic V, Poberaj B, Kovacic L, Mikek M, Adar E, Dekel A (2013) Prospective clinical study of a novel biodegradable sub-acromial spacer in treatment of massive irreparable rotator cuff tears. Eur J Orthop Surg Traumatol 23(3):311–316. doi: 10.1007/s00590-012-0981-4 CrossRefPubMedGoogle Scholar
  39. 39.
    El-Azab HM, Rott O, Irlenbusch U (2015) Long-term follow-up after latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears. J Bone Joint Surg Am 97(6):462–469. doi: 10.2106/JBJS.M.00235 CrossRefPubMedGoogle Scholar
  40. 40.
    Elhassan BT, Wagner ER, Werthel JD (2016) Outcome of lower trapezius transfer to reconstruct massive irreparable posterior-superior rotator cuff tear. J Shoulder Elb Surg 25(8):1346–1353. doi: 10.1016/j.jse.2015.12.006 CrossRefGoogle Scholar
  41. 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
  42. 42.
    Henseler JF, Nagels J, Nelissen RG, de Groot JH (2014) Does the latissimus dorsi tendon transfer for massive rotator cuff tears remain active postoperatively and restore active external rotation? J Shoulder Elb Surg 23(4):553–560. doi: 10.1016/j.jse.2013.07.055 CrossRefGoogle Scholar
  43. 43.
    Moroder P, Schulz E, Mitterer M, Plachel F, Resch H, Lederer S (2017) Long-term outcome after pectoralis major transfer for irreparable anterosuperior rotator cuff tears. J Bone Joint Surg Am 99(3):239–245. doi: 10.2106/JBJS.16.00485 CrossRefPubMedGoogle Scholar
  44. 44.
    Villacis D, Merriman J, Wong K, Hatch GF III (2013) Latissimus dorsi tendon transfer for irreparable rotator cuff tears: a modified technique using arthroscopy. Arthrosc Tech 2(1):e27–e30. doi: 10.1016/j.eats.2012.10.004 CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Zingg PO, Jost B, Sukthankar A, Buhler M, Pfirrmann CW, Gerber C (2007) Clinical and structural outcomes of nonoperative management of rotator cuff tears. J Bone Joint Surg Am 89(9):1928–1934. doi: 10.2106/JBJS.F.01073 PubMedGoogle Scholar
  46. 46.
    Moseley JB, O’Malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH, Hollingsworth JC, Ashton CM, Wray NP (2002) A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 347(2):81–88. doi: 10.1056/NEJMoa013259 CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2017

Authors and Affiliations

  • Jason E. Hsu
    • 1
  • Jacob Gorbaty
    • 2
  • Robert Lucas
    • 3
  • Stacy M. Russ
    • 1
  • Frederick A. MatsenIII
    • 1
    • 4
  1. 1.Department of Orthopaedics and Sports MedicineUniversity of WashingtonSeattleUSA
  2. 2.Department of OrthopaedicsCarolinas Medical CenterCharlotteUSA
  3. 3.John Muir HealthLafayetteUSA
  4. 4.Department of Orthopaedics and Sports MedicineUniversity of Washington Medical CenterSeattleUSA

Personalised recommendations