SURGICAL RESULTS OF 49 ISOLATED TEARS OF THE SUPRA SPINATUS MUSCLE

Purpose of the study The purpose of this study was to assess the resul ts of surgical repairs in 49 << isolated >> tears of the supra-spinatu s in 49 patients, 32 males and 17 females. Material and Methods The av erage age at operation was 54,2 years (35 to 72) and the dominant side was injured in 30 patients (12 opposite side and 5 unknown). Accordin g to Constant's score the pain was permanent in 23 patients, it occure d at moderate exertion in 21 patients and at important exertion in 5. The average pain duration was 43,4 months (0 to 360 months). The range of motion was normal (40 points) in 24 patients, diminished in 15 (30 points), very diminished (10 points) in 7 and the shoulder was stiff in one patient (2 files were uncomplete). All the patients were distur bed in daily living activity and the strength assessment was disturbed because of the pain. In all cases we performed an anterior acromiopla sty. At operation, 39 patients had an isolated tear of the supra-spina tus and 10 an associated tear of the long head of the biceps (7 tendin ities, 1 dislocation and 2 ruptures). The size of the rupture was less than 2 cm(2) in 21 cases comprised between 2 and 5 cm(2) in 27 and gr eater than 5 cm(2) in one case. The surgical procedure was a Neviaser' s technique in 4 cases, a single suture in 19, a transosseous suture i n 19 and a deltoid muscular flap in 7 cases (large retracted tear), in addition we performed 14 resections of the distal end of the clavicle and 4 tenodesis of the long head of the biceps. Results The results w ere assessed according to Constant's score on 46 patients (3 lost to f ollow-up), the average follow-up was 31,5 months (12 to 86). The avera ge scores were : pain 12,3 points (3 to 15), range of motion 35,5 (14 to 40), daily living activity 17,4 (8 to 20), and strength 11,4 (<< he althy >> side 14,8 points). The total Constant's scores were 75,7 per cent (actual score) and 88,3 per cent (weighted score), according to t he weighted score 24 patients had 100 per cent; 9 were comprized betwe en 85 and 100, 5 between 65 and 85, and 8 were less than 65 per cent. The average post-operative acromio-humeral height was 9,84 mm (pre-ope rative height = 11 mm). Discussion - Conclusion If we compare the resu lts in terms of surgical procedure the difference was not statisticall y significant although the transosseous suture was not so good single suture 91,5 per cent, deltoid muscular flap 90,9 per cent, Neviaser's technique 87 per cent, and transosseous suture 79,1 per cent. Neverthe less the results are not so good (p = 0,01) if it is an industrial inj ury and if the post operative acromio-humeral height is diminished. On the other hand, age, sex, duration of the pain, occupation, tenodesis of the long head of the biceps and resection of the distal end of the clavicle don't have any pejorative influence on the results.