Y. Bellumore et al., RESULTS OF SURGICAL REPAIR OF TORN SHOULD ER ROTATOR CUFF - RADIOGRAPHIC AND CLINICAL CORRELATION, Revue de chirurgie orthopedique et reparatrice de l'appareil moteur, 80(7), 1994, pp. 582-594
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.