Arthroscopic Repair of Massive Rotator Cuff Tears Leads to Functional Improvement in Most Patients at 4-Year Follow-up

Theresa Pak; Simon Hwang; Javier Ardebol; Kassem Ghayyad; Mariano E Menendez; Reuben Gobezie; Patrick J Denard

doi:10.1016/j.asmr.2023.05.007

Arthroscopic Repair of Massive Rotator Cuff Tears Leads to Functional Improvement in Most Patients at 4-Year Follow-up

Arthrosc Sports Med Rehabil. 2023 Jun 27;5(4):100750. doi: 10.1016/j.asmr.2023.05.007. eCollection 2023 Aug.

Authors

Theresa Pak¹, Simon Hwang¹, Javier Ardebol¹, Kassem Ghayyad¹, Mariano E Menendez¹, Reuben Gobezie², Patrick J Denard¹

Affiliations

¹ Oregon Shoulder Institute, Medford, Oregon, U.S.A.
² Cleveland Shoulder Institute, Beachwood, Ohio, U.S.A.

Abstract

Purpose: To assess functional outcomes and healing 4 years after arthroscopic repair of massive rotator cuff tears (MRCTs).

Methods: We conducted a retrospective study of patients who underwent arthroscopic rotator cuff repair of an MRCT-defined as a complete 2-tendon tear or a tear greater than 5 cm in any dimension-performed by 2 surgeons at different institutions between January 2015 and December 2018. At a minimum of 4 years postoperatively, patient-reported outcomes collected included the visual analog scale pain score, American Shoulder and Elbow Surgeons (ASES) score, Veterans RAND 12 (VR-12) score, and Subjective Shoulder Value (SSV) score. Repair technique and concomitant procedures were also gathered. Tendon healing was evaluated via ultrasound at final follow-up.

Results: Functional outcomes were available for 101 patients at a mean of 63.6 ± 8.8 months (range, 48-82 months) postoperatively. Mean ASES scores improved from 40.1 to 78 (P < .001); VR-12 scores, from 37.1 to 47.7 (P < .001); and SSV scores, from 36.7 to 84.6 (P < .001). Forward flexion improved from 126° to 144° (P = .001), external rotation remained unchanged (from 47° to 44°, P = .268), and internal rotation improved by 2 spinal levels (from L4 to L2, P = .0001). Eighty-eight percent of patients (89 of 101) were satisfied with the procedure, and only 5% underwent reverse shoulder arthroplasty within the study period. Among the 39 patients who underwent postoperative ultrasound to assess healing, 56% showed complete tendon healing. There was no difference in healing or outcomes according to tear pattern. Additionally, tendon healing did not affect outcomes.

Conclusions: Arthroscopic repair of MRCTs leads to functional improvements and patient satisfaction in most cases at 4-year follow-up. The rates of patients achieving the minimal clinically important difference were 77.5%, 87.6%, 59.7%, and 80.6% for the ASES score, SSV score, VR-12 score, and visual analog scale pain score, respectively. Complete tendon healing is difficult to achieve but does not appear to limit functional improvements.

Level of evidence: Level IV, therapeutic case series.