Massive rotator cuff tears: geometric classification, complete repair, and prognosis

This study aims to summarize tear patterns of massive rotator cuff tears (MRCTs) and outline our surgical techniques for complete repair.

From January 2018 to May 2023, 394 shoulders in 389 individuals with consecutive MRCT received arthroscopic MRCT repair. The tear pattern of each case was identified and generalized based on preoperative magnetic resonance imaging and interoperative arthroscopy. To evaluate prognosis of complete repair, outcome scores, comprising the University of California at Los Angeles (UCLA) score, the Constant-Murley Shoulder (CMS) score, the American Shoulder and Elbow Surgeons (ASES) score, the visual analog scale pain score, and the integrity and level of healing were obtained preoperatively and at 6 months, 12 months, and the last visit after surgery.

The tear patterns of 394 MRCT cases could be divided into 3 types depending on the number of longitudinal tears between cuffs. The complete repair rate was negatively correlated with age, duration of symptoms and number of longitudinal tears. To evaluate the outcomes of surgical techniques for complete repair, 51 patients (n = 17 men; n = 34 women) with a mean follow-up of 1.7 years (range: 1-4.8 years) and a mean age of 63 years old (range: 48-75 years old) were included. Clinical parameters of ASES, CMS, and UCLA were significantly enhanced at the last follow-up in contrast to those preoperatively (scores of ASES, CMS, and UCLA at the final follow-up were 79.02 ± 13.80, 79.53 ± 15.66, and 28.62 ± 4.21 vs. 36.58 ± 13.04, 51.18 ± 17.63 and 15.71 ± 4.14 preoperatively). Visual analog scale score decreased from 5.00 to 1.00 (P < .01). All 4 scores above reached minimum clinically important difference. Furthermore, postoperative magnetic resonance imaging scans revealed that there was no case of rotator cuff retear (Sugaya types IV and V) in type Ⅰ, 3.23% rotator cuff retear rate in type Ⅱ, and 22.22% rotator cuff retear rate in type Ⅲ.

The new geometric classification according to the number of longitudinal tears offers guidance on the treatment of MRCT and prognosis after MRCT repair.