[Recent experience with reconstruction operations in ruptures of the rotator cuff.]

The author presents his short-term experience with reconstruction operations in ruptures of the rotator cuff which were performed according to principles accepted at present in twenty five patients (26 shoulders) during 1993-1996. Men predominated in the group (16 men) and the majority of patients were in the age bracket from 50-70 years. The follow-up period was 6-36 months. Massive ruptures with a lesion of the cuff exceeding 5 cm (10 times) predominated, followed by ruptures with a lesion under 2 cm (9 times). In the majority of patients the operatoin was made using the Kessel-Gschwend approach. After anterior acromionplasty the tendons of the cuff were released and fixed into the ridge between the articular area of the head of the joint and the large tubercle. The operated extremity was fixed on an abduction splint for 4-6 weeks and this was followed by controlled rehabilitation for 1-2 months. According to Constant's functional score excellent results were achieved in 31 % of the operated patients, a satisfactory result in 11 % and an unsatisfactory result in 23 % of the operated patients. The presented results are consistent above all with the subjective evaluation and evaluation of pain resulting from subacromial decompression. The functional result is consiostent with the achieved extent of mobility of the shoulder. In the majority of patients however marked restriction of strength in abduction persists due to muscular hypotrophy asa result of predominating inveterate massive ruptures. Unsatisfactory results were recorded in six patients in conjunction with the following circumstances: reoperation in the subacromial space, mechanical failure of the suture, deep infection in diabetes mellitus, operation of an occupational injury with attempted compensation and refractory cervicobrachial syndrome with an impact on the shoulder joint. From this initial experience ensues that reconstructions of the rotator cuff are successful provided the indication is correct, the operation is of a high technical standard, and consquential postoperative fixation and rehabilitation after treatment are provided. Key words: injury of the rotator cuff, surgery of the rotator cuff.