[Surgical treatment of rotator cuff rupture. Prognostic factors]

A retrospective study of 67 total ruptures of the rotator cuff operated on was carried on, with an average follow-up of 25 months. The lesions were characterised by their size (19 tears of less than 2 cm, 30 between 2 and 4 cm, 18 over 4 cm) and location (27 tears of the supraspinatus, 15 tears of the supraspinatus extending to the front (coraco-humeral, long biceps, subscapular), 20 supra and infra-spinatus, 5 "massive" tears). The tendon of the long biceps was pathological in half of the cases. Fourteen patients presented with a subacromial osteoarthritis. All patients benefited from a decompression and repair of the rupture. Whereas the subjective results indicate 92 per cent satisfied patients, from the objective point of view the average score with Constant's rating was 62.5 pts with 53 per cent favorable results. Evaluation of force was a particular subject of attention: the results obtained with three charts were compared; the conclusion was in favour of an objective measurement using a dynamometer but with a weighting according to age and sex. The characteristics of the tear (location especially), the state of the long biceps, the presence of a subacromial osteoarthritis and the pre-operative mobility affected statistically and significantly the final result. The authors reserve reconstructive surgery for tears without osteoarthritis, isolated lesions of the supraspinatus having the best prognosis. The existence of a subacromial osteoarthritis, always a sign of a massive tear, in elderly patients should lead one to choose a procedure a minima under arthroscopy.