Functional outcome after arthroscopic repair of massive rotator cuff tears in individuals with pseudoparalysis

The purpose of this study was to evaluate the functional results after arthroscopic rotator cuff repair (ARCR) for patients with preoperative pseudoparalysis.

This retrospective review examined massive rotator cuff tears treated with an ARCR over a 10-year period. Pseudoparalysis was defined as active forward flexion (FF) less than or equal to 90° with full passive FF. Primary ARCRs (group I) and revision ARCRs (group II) were included. Postoperative reversal of pseudoparalysis, functional outcome, and complications were self-assessed at a minimum of 2 years postoperatively.

In group I 39 patients with a mean age of 62 years at the time of surgery were available for follow-up at a mean of 75 months. Active FF improved from 49° preoperatively to 155° postoperatively (P < .001), and pseudoparalysis was reversed in 90% of patients. In group II 14 patients with a mean age of 63 years at the time of surgery were available for follow-up at a mean of 72 months. Active FF improved from 43° to 109° (P < .001), and pseudoparalysis was reversed in 43% of patients. The mean American Shoulder and Elbow Surgeons score improved in both group I (P < .001) and group II (P = .033). Recovery of FF greater than 90° in group I was associated with a shorter interval before repair (P = .021) and a complete repair (P = .026).

ARCR of massive rotator cuff tears with advanced mobilization techniques can lead to reversal of preoperative pseudoparalysis in 90% of patients who have not had previous surgery. In these patients functional improvement can be obtained with a low rate of complications. However, in the setting of a revision ARCR and pseudoparalysis, only 43% of patients regained FF above 90°.

Level IV, therapeutic case series.