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Does Margin Convergence Reverse Pseudoparalysis in Patients with Irreparable Rotator Cuff Tears?
Hiroaki Inui1, Jumpei Yamada, Katsuya Nobuhara
1H. Inui, J. Yamada, K. Nobuhara, Nobuhara Hospital & Institute of Biomechanics, Hyogo, Japan.
Clinical Orthopaedics and Related Research
|January 4, 2021
Summary
Margin convergence effectively reverses pseudoparalysis in most patients with irreparable rotator cuff tears, improving shoulder function. However, retear rates remain a concern, necessitating further research for specific patient groups.
Area of Science:
- Orthopedic surgery
- Shoulder reconstruction
- Rotator cuff repair
Background:
- Margin convergence is a surgical technique for rotator cuff tears.
- Its clinical effectiveness in patients with pseudoparalysis due to irreparable tears is not well-established.
- This study investigates the outcomes of margin convergence in such cases.
Purpose of the Study:
- To determine the proportion of patients with massive irreparable rotator cuff tears who experience reversal of pseudoparalysis after margin convergence.
- To assess the improvement in American Shoulder and Elbow Surgeons (ASES) scores post-procedure.
- To evaluate the survivorship free from Magnetic Resonance Imaging (MRI) evidence of retear.
Main Methods:
- A retrospective study of 203 patients with pseudoparalysis and rotator cuff tears between 2000 and 2015.
- Margin convergence was performed for irreparable tears.
- Outcomes included pseudoparalysis reversal (active elevation >90°), ASES scores, and MRI-based retear rates at a minimum 2-year follow-up.
- 80 patients were analyzed.
Main Results:
- Pseudoparalysis reversal was achieved in 93% of patients (74/80).
- Significant improvement in ASES scores was observed (22 to 62, p < 0.01).
- The 8-month retear-free survival rate was 72% (95% CI 63% to 81%).
Conclusions:
- Margin convergence is a viable treatment for pseudoparalysis in irreparable rotator cuff tears, despite notable retear rates.
- Lower reversal rates were observed in patients with three-tendon involvement.
- Further research is needed to optimize treatment for this subgroup.
