[Rotator cuff rupture. Surgical results in relation to the approach]

This paper presents the results of surgery in a total of 43 cases of rupture of rotator muscle sheaths which were followed up. Surgery was carried out from a saber-cut incision (n = 24) and from a transacromial approach (n = 19). The follow-up period for the first group was 42.2 months, for the second 14.3 months. The procedures employed were, almost without exception, the Schuhnestel or continuous suture and transosseous fixation after McLaughlin. In Group I the results were very good and good in 22 patients (91.6%); results in two shoulders were poor. In Group II the results were somewhat poorer, with 76.5% very good and good results; this is attributable principally to the much shorter follow-up period. The poor results are analyzed. The coraco-acromial ligament was severed or resected in 22 cases. Neer acromioplasty is now performed routinely. The surgical approach appears to have no decisive influence on the result. Advantages and disadvantages of the various approaches are described. A particularly important factor is the small therapeutic team (surgeon and physiotherapist).