RESULTS OF SURGICAL REPAIR OF TORN SHOULD ER ROTATOR CUFF - RADIOGRAPHIC AND CLINICAL CORRELATION

Introduction This study was undertaken to evaluate the functional resu lts of rotator cuff tear repair. Material and Methods This retrospecti ve study concerned 108 shoulders operated with a minimal follow up of 1 year (mean 5,5 years). The average age of this masculine population was 55 years, The rotator cuff tear involved: 39 times the supra-spina tus, 59 times the supra-spinatus and infra-spinatus, 6 times the supra and infra-spinatus and the teres minor, 4 times the supra-spinatus an d superior part of the sub-scapularis. All these patients were reviewe d using the Constant's score. The functional results were compared wit h an ultrasonographic study and a radiographic protocol including 5 vi ews. Muscle strength was measured objectively with the aid of an isoki netics testing (Cybex II). Results The results were satisfactory conce rning pain (67 per cent did not suffer anymore) daily activity (78 per cent experienced a slight disability) and mobility (92 per cent of th e patients had an anteflexion > 120 degrees and 82 per cent an externa l rotation > 40 degrees). Concerning strength, the results were variab le and related to the posterior extension of the tear. Most of the pat ients complained of weakness (mean objective deficit of strength = 25 per cent), specially a disability during repetitive over head activiti es. The radiographic protocol analysed the humeral head position (16 p er cent of spontaneous acromio-humeral interval narrowing on the stand ard X Ray and 43 per cent of dynamic narrowing on Leclercq view). The spontaneous narrowing was correlated with a severe omarthrosis and a r e-rupture of the rotator cuff. All these re-ruptures involved an infra spinatus lesion. Dynamic narrowing, with an acromial interval < 7mm, w ere seen in 71 per cent of the patients with posterior extension of th e rotator cuff tear explaining the poor final result; the ultrasonogra phic assessment found a thinning (75 per cent of patient) and a hetero geneity in the infraspinatus even after repair. We found 14 re-rupture s and 6 ultrasonographic disorganised structures. Discussion A well pr eserved external rotation and a centred head gave good result because they were associated with the integrity of the infra-spinatus, essenti al to the muscular balance of the rotator cuff and necessary for the d ynamic ans static centring of the humeral head. In 71 per cent of the cases, the suture of the posterior cuff tear did not allow a good dyna mic position of the humeral head. A spontaneous narrowing (static view ) of the acromio-humeral interval was in relation with a re-rupture wh ich evolved to omarthrosis, A dynamic narrowing with a Leclercq radiog raph was associated with a functional deficit after rotator cuff repai r. Conclusion Humeral head stabilisation, supplied by posterior muscle s of the rotator cuff, is essential in prevention of omarthrosis and i n recovery of good strength. In several specific cases, we think that the transfer of an external rotator muscle, with a good humeral head s tabilization action, may restore strength.