Partial repair can yield good results in ‘irreparable’ rotator cuff tears

By David Douglas

NEW YORK (Reuters Health) – For some massive rotator cuff tears, only partial arthroscopic repair is possible – but a new study shows that in the short term, at least, the outcome may be just as good as with complete repair.

The investigators — Dr. Nicholas D. Iagulli and colleagues at the Mississippi Sports Medicine and Orthopaedic Center in Jackson — say patients can have near normal function despite unrepaired defects in the rotator cuff.

“Massive rotator cuff tears are a challenging patient group that can be difficult to treat,” Dr. Iagulli told Reuters Health by email. The new study, he added, shows that even in cases that appear irreparable, “with proper indications and careful patient selection, partial repair of massive rotator cuff tears can lead to comparable results as complete repair of massive tears.”

In a paper published online March 13 in The American Journal of Sports Medicine, the researchers report on 97 patients with massive rotator cuff tears measuring 30 cm2 or more. This group accounted for 9% of the 1,128 patients treated by the authors over a two-year period.

Eleven of the 97 patients were lost to follow up. Of the remainder, over an average follow-up of 24 months, the 45 patients with a complete repair achieved a mean University of California, Los Angeles (UCLA) shoulder score of 29.49 compared to a baseline of 11.22. The UCLA score in the 41 patients with a partial repair was 29.64, up from 12.10 at baseline.

Overall, 71.1% of the complete repair group and 75.6% of the partial repair group had satisfactory results.

No injury was completely irreparable, and no tears were treated with debridement alone. The only baseline difference between the groups was the larger average preoperative tear size in the partial repair group.

But Dr. Iagulli warns that other factors need to be considered as well. “The patient’s activity level, recent functional decline, and medical comorbidities all play a part in determining if a partial repair of a massive rotator cuff tear would be successful in restoring function to the patient,” he said.

This study, he concluded, “allows us to identify patients who may benefit from a partial repair, whereas before their tear may have been deemed irreparable. Partial repair in select patients enables us to restore strength and function in this challenging patient group.”

SOURCE: http://bit.ly/HBfO46

Am J Sports Med 2012.