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Massive Tears of the Rotator Cuff

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European Instructional Lectures

Part of the book series: European Instructional Lectures ((EICL,volume 10))

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Abstract

Even though it may seem simple to classify rotator cuff tears only by size, clinical studies tend to confirm that treatment outcomes are directly related to it. Tear size was identified as the single most important factor determining final active motion, strength, satisfaction and need for revision in a series of 105 patients who underwent open rotator cuff repair [11]. When comparing repairs performed in groups of large and massive tears with groups including small and medium sized ones there is a definite tendency to poorer outcomes in those with the bigger defects independent of the surgical technique used [22]. In this unfavourable scenario treatment protocols should be well-established. The surgeon finds himself facing a wide range of options with confusing data supporting each one. There are reports of successful non-operative management; débridement and decompression has been shown to help others; structurally-failed repairs are not unheard of with good clinical outcomes; and partial repairs can restore function [4, 27]. It is only by reviewing pertinent information and matching it with personal experience that the surgeon can make appropriate treatment decisions.

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References

  1. Ainsworth R (2006) Physiotherapy rehabilitation in patients with massive, irreparable rotator cuff tears. Musculoskeletal Care 4:140–151

    Article  PubMed  Google Scholar 

  2. Bennet WF (2003) Arthroscopic repair of massive rotator cuff tears: a prospective cohort with 2- to 4-year follow-up. Arthroscopy 19:380–390

    Article  Google Scholar 

  3. Bigliani LU, Cordasco FA, Melveen SJ, Musso ES (1992) Operative repair of massive rotator cuff tear: long-term results. J Shoulder Elbow Surg 1:120–130

    Article  Google Scholar 

  4. Boes MT, McCann PD, Dines DM (2006) Diagnosis and management of massive rotator cuff tears: the surgeon’s Dilemma. AAOS Instr Course Lect 55:45–57

    Google Scholar 

  5. Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzdakis AM, Krishnan SG (2005) Arthroscopic repair of full thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am 87:1229–1240

    Article  PubMed  Google Scholar 

  6. Boileau P, Basque F, Valerio L, Ahrens P, Chuinard C, Trojani C (2007) Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg Am 89:747–757

    Article  PubMed  Google Scholar 

  7. Bokor DJ, Hawkins RJ, Huckell GH, Angelo RL, Schickendantz MS (1993) Results of nonoperative management of full-thickneess tears of the rotator cuff. Clin Orthop Rel Res 294:103–110

    Google Scholar 

  8. Burkhart SS (1993) Arthroscopic debridement and decompression for selected rotator cuff tears: clinical results, pathomechanics and patient selection based on biomechanical parameters. Orthop Clin North Am 24:111–123

    CAS  PubMed  Google Scholar 

  9. Burkhart SS (2001) Arthroscopic treatment of massive rotator cuff tears. Clin Orthop Relat Res 390:107–118

    Article  PubMed  Google Scholar 

  10. Burkhart SS, Nottage WM, Ogilvie-Harris DJ, Kohn HS, Pachelli A (1994) Partial repair of irreparable rotator cuff tears. Arthroscopy 10:363–370

    Article  CAS  PubMed  Google Scholar 

  11. Cofield RH, Parvizi J, Hoffmeyer PJ, Lanzer WL, Ilstrup DM, Rowland CM (2001) Surgical repair of chronic rotator cuff tears. J Bone Joint Surg Am 83:71–77

    PubMed  Google Scholar 

  12. Duralde XA, Bair B (2005) Massive rotator cuff tears: the result of partial rotator cuff repair. J Shoulder Elbow Surg 14:121–127

    Article  PubMed  Google Scholar 

  13. Fenlin JM Jr, Chase JM, Rushton SA, Friedman BG (2002) Tuberoplasty: creation of an acromiohumeral articulation – a treatment option for massive, irreparable rotator cuff tears. J Shoulder Elbow Surg 11:136–142

    Article  PubMed  Google Scholar 

  14. Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscle of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 8:599–605

    Article  CAS  PubMed  Google Scholar 

  15. 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:219–224

    PubMed  Google Scholar 

  16. Gartsman GM (1997) Massive, irreparable tears of the rotator cuff. Results of operative debridement and subacromial decompression. J Bone Joint Surg Am 79:715–721

    CAS  PubMed  Google Scholar 

  17. Gerber C, Fuchs B, Hodler J (2000) The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am 82:505–515

    CAS  PubMed  Google Scholar 

  18. Gerber C, Fuchs B, Hodler J (2006) Latissimus dorsi transfer for the treatment of irreparable rotator cuff tears. J Bone Joint Surg Am 88:113–120

    Article  PubMed  Google Scholar 

  19. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83

    PubMed  Google Scholar 

  20. Hamada K, Fukuda H, Mikasa M, Kobayashi Y (1990) Roentgenographic findings in massive rotator cuff tears: a long-term observation. Clin Orthop Relat Res 254:92–96

    PubMed  Google Scholar 

  21. Iannotti JP, Codsi MJ, Kwon YW, Derwin K, Ciccone J, Brems JJ (2006) Porcine small intestine submucosa augmentation of surgical repair of chronic two-tendon rotator cuff tears: a randomized, controlled trial. J Bone Joint Surg Am 88:1238–1244

    Article  PubMed  Google Scholar 

  22. Ide J, Maeda S, Takagi K (2005) A comparison of arthroscopic and open rotator cuff repair. Arthroscopy 21:1090–1098

    Article  PubMed  Google Scholar 

  23. Jennings GJ, Keereweer S, Buijze GA, De Beer J (2007) Transfer of segmentally split pectoralis major for the treatment of irreparable rupture of the subescapularis tendon. J Shoulder Elbow Surg 16:837–842

    Article  PubMed  Google Scholar 

  24. Jost B, Puskas GJ, Lustenberger A, Gerber C (2003) Out-come of pectoralis major transfer for the treatment of irreparable subscapularis tears. J Bone Joint Surg Am 85-A:1944–1951

    PubMed  Google Scholar 

  25. Jost B, Zumstein M, Pfirrmann CW, Gerber C (2006) Long-term outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am 88:472–479

    Article  PubMed  Google Scholar 

  26. Lafosse L, Brozska R, Toussaint B, Gobezie R (2007) The outcome and structural integrity of arthroscopic rotator cuff repair with use of the double-row suture anchor technique. J Bone Joint Surg Am 89:1533–1541

    Article  PubMed  Google Scholar 

  27. Lin KC, Krishnan SG, Burkhead WZ (2008) Massive rotator cuff tears. In: Galatz LM (ed) Orthopaedic knowledge update. Shoulder and elbow 3. American Academy of Orthopaedic Surgeons, Rosemont, IL

    Google Scholar 

  28. Matthews TJ, Hand GC, Rees JL, Athanasou NA, Carr AJ (2006) Pathology of the torn rotator cuff tendon: reduction in potential for repair as tear size increases. J Bone Joint Surg Br 88:489–495

    Article  CAS  PubMed  Google Scholar 

  29. Miniaci A, Macleod M (1999) Transfer of the latissimus dorsi muscle after failed repair of a massive tear of the rotator cuff: a two to five-year review. J Bone Joint Surg Am 81:1120–1127

    CAS  PubMed  Google Scholar 

  30. Montgomery TJ, Yerger B, Savoie FH III (1994) A comparison of arthroscopic debridement with open surgical repair for full-thickness tears of the rotator cuff. J Shoulder Elbow Surg 3:70–78

    Article  Google Scholar 

  31. Moore DR, Cain EL, Schwartz ML, Clancy WG Jr (2006) Allograft reconstruction for massive, irreparable rotator cuff tears. Am J Sports Med 34:392–396

    Article  PubMed  Google Scholar 

  32. Post M, Silver R, Singh M (1983) Rotator cuff tear: diagnosis and treatment. Clin Orthop 173:78–91

    PubMed  Google Scholar 

  33. Rockwood CA Jr, Williams GR Jr, Burkhead WZ Jr (1995) Débridement of degenerative, irreparable lesions of the rotator cuff. J Bone Surg Am 77:857–866

    PubMed  Google Scholar 

  34. Sclamberg SG, Tibone JE, Itamura JM, Kasraeian S (2004) Six-month magnetic resonance imaging follow-up of large and massive rotator cuff repairs reinforced with porcine small intestinal submucosa. J Shoulder Elbow Surg 13:538–541

    Article  PubMed  Google Scholar 

  35. Tashjian RZ, Henn RF, Kang L, Green A (2006) Effect of medical co-morbidity on self-assesed pain, function and general health status after rotator cuff repair. J Bone Joint Surg Am 88:536–540

    Article  PubMed  Google Scholar 

  36. Wall B, Nove-Josserand L, O’Conner DP, Edwards TB, Walch G (2007) Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am 89:1476–1485

    Article  PubMed  Google Scholar 

  37. Warner JJ (2001) Management of massive irreparable rotator cuff tears: the role of tendon transfer. Instr Course Lect 50:63–71

    CAS  PubMed  Google Scholar 

  38. Warner JJ, Gerber C (1998) Treatment of massive rotator cuff tears: posterior-superior and anterior-superior. American Academy of Orthopaedic Surgeons, Rosemont, IL

    Google Scholar 

  39. Warner JJ, Parsons IM IV (2001) Latissimus dorsi tendon transfer: a comparative analysis of primary and salvage reconstruction of massive, irreparable rotator cuff tears. J Shoulder Elbow Surg 10:514–521

    Article  CAS  PubMed  Google Scholar 

  40. Warner JP, Krushell RJ, Masquelet A, Gerber C (1992) Anatomy and relationships of the suprascapular nerve: anatomical constraints to mobilization of the supraspinatus and infraspinatus muscles in the management of massive rotator-cuff tears. J Bone Joint Surg Am 74:36–45

    CAS  PubMed  Google Scholar 

  41. Werner CML, Steinmann PA, Gilbart M, Gerber C (2005) Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis. J Bone Joint Surg Am 87:1476–1486

    Article  CAS  PubMed  Google Scholar 

  42. Zingg PO, Jost B, Sukthankar A, Buhler M, Pfirrmann CW, Gerber C (2007) Clinical and structural outcomes of nonoperative management of massive rotator cuff tears. J Bone Joint Surg Am 89:1928–1934

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Clínico San Carlos Hospital, Complutense University of Madrid, Madrid, Spain

    Fernando Marco (Professor of Orthopaedic Surgery, Chief Shoulder Surgery Service)

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  1. Fernando Marco
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  2. Carlos García-Fernández
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Correspondence to Fernando Marco .

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Editors and Affiliations

  1. Inst. Orthopaedics, RNOHT, Brockley Hill, Stanmore, Middx., HA7 4LP, United Kingdom

    George Bentley

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Marco, F., García-Fernández, C. (2010). Massive Tears of the Rotator Cuff. In: Bentley, G. (eds) European Instructional Lectures. European Instructional Lectures, vol 10. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-11832-6_12

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  • DOI: https://doi.org/10.1007/978-3-642-11832-6_12

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-11831-9

  • Online ISBN: 978-3-642-11832-6

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