Arthroscopic single-row repair of massive potentially irreparable postero-superior cuff tear

• Published in: Musculoskeletal surgery Vol. 102; no. Suppl 1; pp. 13 - 19
• Main Authors: Carbone, S., Razzano, C., Passaretti, D., Mezzoprete, R.
• Format: Journal Article
• Language: English
• Published: Milan Springer Milan 01.10.2018; Springer; Springer Nature B.V
• Subjects: Adult; Anabolic steroids; Arthroscopy; Arthroscopy - methods; Female; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Orthopedics; Patient satisfaction; Prospective Studies; Retrospective Studies; Rotator cuff; Rotator Cuff Injuries - surgery; Shoulder; Surgical Orthopedics; Tangent sign; Superior capsular reconstruction; Rotator cuff tear; Tendon degeneration; Anabolic steroids; Fatty atrophy; Massive irreparable cuff
• ISSN: 2035-5106; 2035-5114
• DOI: 10.1007/s12306-018-0555-7

Purpose We retrospectively evaluated the results of complete repair of massive potentially irreparable postero-superior tears in a consecutive cohort of patients. With the increasing and widespread use of superior capsular reconstruction, a complete repair of the superior cuff, also if not functional, may be a valuable option for irreparable cuff lesions. Methods A consecutive case series of massive potentially irreparable postero-superior cuff tears that underwent complete repair was included in the study. Irreparability of cuff tear was defined when on preoperative MRI images, a positive tangent sign, a Goutallier 3–4 stage of fatty infiltration, and an absent acromion–humeral distance were present. A single-row complete repair was performed using triple-loaded titanium suture anchors. Operative time was recorded, as well as intra- and postoperative complications. Patients were followed for 12 months post-op; they were clinically evaluated with the use of constant score (CS) and subjective shoulder value (SSV) at 3, 6, and 12 months; a 12-month postoperative ultrasound evaluation was obtained. Results Thirty-two patients satisfying the inclusion criteria were enrolled. The mean age was 52 years (range 41–58). The repair was completed with a mean use of 2.4 triple-loaded suture anchors (range 2–4); the mean operative time was 70 min (range 45–90). The mean preoperative CS was 55 (range 45–75, SD 17), while the SSV was 40 (range 30–70, SD 22). At the final follow-up, the mean CS and SSV were 72 (range 62–85, SD 8) and 80 (range 60–90, SD 10) ( p  < 0.001 with respect to the preoperative scores), respectively. At the final follow-up, sonography showed a complete healing of the cuff in 20 cases (62.5%). No intra-operative complications occurred; at the final follow-up, five patients (15, 6%) were not satisfied of the results and asked for revision surgery. Conclusions The complete repair of massive potentially irreparable rotator cuff tear in patients younger than 60 years old yielded good results at a short-term follow-up, with a sonographic re-tear rate of about 20%. Even if it is logical to consider a tendon with severe fatty degeneration as non-functional, the superior soft tissue reconstruction we achieved may have at least the same results of a superior capsular reconstruction, with obvious lower costs. Level of evidence Level 4, case series with no comparison group.