Pseudoparalysis: the importance of rotator cable integrity

The purpose of this study was to clinically examine the relationship between rotator cable integrity and the presence of pseudoparalysis. A retrospective review was performed of a consecutive series of arthroscopic repairs of massive rotator cuff tears performed between January 2007 and June 2009. A total of 127 massive tears were identified. Group 1 comprised 24 patients with preoperative pseudoparalysis. Group 2 comprised 97 patients (103 repairs) with active forward flexion more than 90°. In group I, no patient maintained integrity of both rotator cable attachments; 1 rotator cable attachment was disrupted in 45.8% of cases; and both rotator cable attachments were disrupted in 54.2% of cases. In group II, both rotator cable attachments were intact in 22.3% of cases; 1 rotator cable attachment was disrupted in 62.1% of cases; and both rotator cable attachments were disrupted in 15.5% of cases. The difference in the distribution of cable attachments between the 2 groups was statistically significant (P<.001). Overall, preoperative pseudoparalysis predicted a disruption of both rotator cables with 88.8% specificity, 44.8% sensitivity, and 77.8% accuracy. Pseudoparalysis requires the disruption of at least 1 rotator cable attachment. This study reinforces the concept of rotator cable integrity and the ability of patients to maintain forward flexion above shoulder level and highlights the importance of reinforcing the rotator cable attachments in the repair of massive rotator cuff tears.