[Endoscopic acromioplasty in total rupture of the rotator cuff]

The authors have conducted a study to evaluate the possible efficacy of endoscopic decompression without repair in the treatment of rotator cuff tears.

We report 42 cases of endoscopic acromioplasty realized for full-thickness rotator cuff tears. Mean follow-up was 28.8 months. The principal presenting symptom was pain, with a mean duration of 29 months. Antero-external acromioplasty was realized by endoscopy using motorized drill bits, with sectioning or resecting the acromio-coracoid ligament. Revision consisted of a standard clinical examination, following the protocol of Constant, and a radiologic examination by sub-acromial frontal and scapular profile x-rays as advised by Liotard.

The functional results were very good, with 94 per cent of patients satisfied. The mean Constant score was 67.4 (14-100) corresponding on the average to 84 per cent of the score of a healthy shoulder for the same age and sex. The improvement concerned essentially the score of the pain, which increased on the average 7.4 points out of 15 (10.2/15 at revision) and of the activity level (14.8/20 as opposed to 8/20 initially). Less important was the improvement of the active mobility score (from 25.2 to 34/40 at revision). The force was measured according to the Constant scale, with a mean of 8.3 points out of 25. The mean duration of absence from work for the active patients was 2.4 months. Neither infectious nor neurological complications were noted. The radiographic analysis showed a decrease of the acromial edge, significative as compared to the opposite side. On the profile x-ray, we observed 48 per cent flat acromions in contrast to 80 per cent curved types on the opposite side. The only element influencing the pain score was the size of the rupture, but the statistical result was weak. The final Constant score was strongly influenced by by the size of the rupture, the active mobility, the pre-operative active and passive mobility, as well as by the presence of head excentration on pre-operative x-rays.

Comparison with other series of endoscopic acromioplasty for full-thickness rotator cuff tears has permitted us to confirm the validity of our series. We have especially evaluated this series in comparison to those with surgical repair. The subjective results, as well as those for pain, are equivalent; results on active mobility and force were not as good. We propose, therefore, this technique of low morbidity, in the presence of total ruptures in older and sedentary patients. The antalgic effect of endoscopic acromioplasty allows, in these patients, a functionally satisfying rehabilitation.