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

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Musculoskeletal Research

Background:

• Massive rotator cuff tears (MRCTs) present complex surgical challenges.
• Understanding tear patterns is crucial for successful rotator cuff repair.
• Arthroscopic techniques offer a minimally invasive approach to MRCTs.

Purpose of the Study:

• To classify tear patterns in massive rotator cuff tears (MRCTs).
• To outline surgical techniques for complete arthroscopic repair of MRCTs.
• To evaluate the prognosis and outcomes following complete MRCT repair.

Main Methods:

• A consecutive series of 394 shoulders with MRCTs underwent arthroscopic repair between January 2018 and May 2023.
• Tear patterns were classified based on preoperative MRI and intraoperative arthroscopy.
• Patient outcomes were assessed using UCLA, CMS, ASES scores, and VAS pain scores preoperatively and postoperatively.

Main Results:

• A new 3-type geometric classification for MRCTs was established based on longitudinal tears.
• Complete repair rates correlated negatively with patient age, symptom duration, and number of longitudinal tears.
• Significant improvements in ASES, CMS, and UCLA scores were observed post-surgery, with reduced VAS pain scores. Retear rates varied by tear type (0% for Type I, 3.23% for Type II, 22.22% for Type III).

Conclusions:

• A novel geometric classification system for MRCTs aids in treatment planning.
• Arthroscopic complete repair of MRCTs leads to significant functional improvement and pain reduction.
• The classification system provides valuable prognostic information for patients undergoing MRCT repair.