Partial rotator cuff repair and biceps tenotomy for the treatment of patients with massive cuff tears and retained overhead elevation: midterm outcomes with a minimum 5 years of follow-up

• Published in: Journal of shoulder and elbow surgery Vol. 25; no. 11; pp. 1803 - 1809
• Main Authors: Cuff, Derek J., MD, Pupello, Derek R., MBA, Santoni, Brandon G., PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2016
• Subjects: Aged; Algorithms; Arthroscopy; biceps tenotomy; cuff repair; Female; Follow-Up Studies; Humans; Male; Massive rotator cuff tear; Middle Aged; Orthopedics; Patient Satisfaction; Range of Motion, Articular; Retrospective Studies; Rotation; Rotator Cuff Injuries - surgery; surgical management; Tenotomy; Treatment Study; Level IV; surgical management; Case Series; Massive rotator cuff tear; cuff repair; biceps tenotomy; arthroscopy
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2016.04.001

Background A subset of patients with massive irreparable rotator cuff tears present with retained overhead elevation and pain as their primary complaint. Our aim was to evaluate the outcomes of partial arthroscopic rotator cuff repair with biceps tenotomy and to report the failure rate of this procedure for patients with >5 years of follow-up. Methods Thirty-four patients underwent partial rotator cuff repair and biceps tenotomy for treatment of a massive rotator cuff tear. Patients had preoperative active forward elevation >120° and no radiographic evidence of glenohumeral arthritis. Patients were followed up clinically and radiographically, and 28 patients had a minimum of 5 years of follow-up. Failure was defined as an American Shoulder and Elbow Surgeons score of <70, loss of active elevation >90°, or revision to reverse shoulder arthroplasty during the study period. Results Patients demonstrated improvements in average preoperative to postoperative American Shoulder and Elbow Surgeons scores (46.6 to 79.3 [ P  < .001]) and Simple Shoulder Test scores (5.7 to 9.1 [ P  < .001]) along with decrease in visual analog scale for pain scores (6.9 to 1.9 [ P  < .001]). No significant change in forward elevation (168° to 154° [ P  = .07]), external rotation (38° to 39° [ P  = 1.0]), or internal rotation (84% to 80% [ P  = 1.0]) was identified; 36% of patients had progression of the Hamada stage. The failure rate was 29%; 75% of patients were satisfied with their index procedure. Conclusion Partial rotator cuff repair and biceps tenotomy for patients with massive irreparable rotator cuff tears with retained overhead elevation and pain as the primary complaint produced reasonable outcomes at midterm follow-up of at least 5 years.