Should massive rotator cuff tears be reconstructed even when only partially repairable?

Area of Science:

• Orthopedic surgery
• Sports medicine
• Musculoskeletal research

Background:

• Massive rotator cuff tears present a significant challenge in orthopedic surgery.
• Evaluating functional outcomes and prognostic factors is crucial for optimizing treatment strategies.
• Arthroscopic repair is a common surgical approach for these complex injuries.

Purpose of the Study:

• To assess midterm functional outcomes following arthroscopic repair of massive rotator cuff tears.
• To identify prognostic factors influencing the success of these repairs.
• To test the hypothesis that partial and complete repairs achieve comparable clinical score improvements.

Main Methods:

• Analysis of a prospective series of 73 patients with massive rotator cuff tears undergoing arthroscopic repair.
• Midterm functional evaluation using the Constant score (CS), shoulder strength, and subjective shoulder value at a median of 41 months.
• Assessment of tear characteristics, including tendon involvement and fatty infiltration, and repair completeness.

Main Results:

• Significant improvement in median Constant score from 34 to 81 (p < 0.001).
• Two-tendon tears (posterosuperior and anterosuperior) showed better outcomes than three-tendon tears (p < 0.001).
• Early-stage fatty infiltration correlated with superior outcomes; complete and partial repairs demonstrated similar CS improvements.

Conclusions:

• Arthroscopic repair of massive rotator cuff tears leads to favorable midterm functional outcomes.
• Partial and complete repairs result in equivalent improvements in Constant scores, supporting the initial hypothesis.
• While two-tendon tears yield superior outcomes, three-tendon repairs offer significant relative improvement and patient satisfaction.