Abstract

BARCLAY, Fernando; CAVALLO, Jorge; LEUNDA, Javier  and  MARANGONI, Lucas. Massive rotator cuff tears: Surgical technique and results in correlation With preoperative prognostic factors. Rev. Asoc. Argent. Ortop. Traumatol. [online]. 2010, vol.75, n.1, pp.48-56. ISSN 1852-7434.

Background: The surgical treatment of massive rotator cuff injuries is a real challenge for arthroscopist surgeons, and its results do not generally meet the patient and surgeon's expectations. Identifying and considering preoperatively poor prognostic factors, e.g. patients' age, chronicity of injury, tissue quality, muscle atrophy, fatty infiltration, and degree of retraction, may better define the therapeutic approach. Methods: Twenty-two patients with a diagnosis of massive rotator cuff tears partially or fully repaired arthroscopically with anchors were evaluated, with a minimum of two years follow-up. For the clinical evaluation, we used the Constant score and patient satisfaction. In sixteen patients an MRI was obtained to objectively assess the degree of scarring of the repair. Several clinical and structural factors were included for statistical purposes. Results: 86.35% of the patients got a Constant score between good and excellent; 21 of 22 patients were satisfied or somewhat satisfied with the surgery performed. The incidence of re-ruptures, diagnosed by NMR was 25%. Chronicity of injury and muscle atrophy significantly influenced the functional outcome (Constant). Age, degree of retraction and fatty infiltration tend to worsen the clinical outcomes, but not enough to be statistically significant. No association was found between the Constant score and the degree of scarring or re-ruptures. There is a tendency to improve the clinical outcome in cases where healing is complete. Conclusions: These results showed that the arthroscopic management of massive rotator cuff injuries may guarantee acceptable and predictable results, if prognostic factors are considered when making the therapeutic decision. Functional results do not correlate with the incidence of re-ruptures, and there is a tendency to improve clinical outcomes in cases where healing is complete.

Keywords : Massive rotator cuff tears; Prognostic factors.

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