FUNCTIONAL AND ANATOMIC RESULTS FOLLOWING SURGICAL REPAIR OF ROTATOR CUFF TEARS .2. POST OPERATIVE FUNCTIONAL AND ANATOMIC ASSESSMENT

Purpose of the study The authors examined the anatomic condition and t he function of the rotator cuff obtained after an average period of fo ur years following surgical repair in a series of 100 full thickness r otator cuff tears. The aim was to assess the validity of Constant's sc oring method and to analyse risk factors and the frequency of recurren t tears. Material and methods The series comprised 98 patients, 62 men and 36 women whose average age was 56 years. It included 69 tears of less than 2 cm in size (39 cases) or between 2 to 4 cm (3 cases) of th e supra-spinatus, 22 tears of the supra-and infraspinatus measuring be tween 2 to 4 cm, and 9 massive tears. The tendon of the long head of t he biceps was pathological in 1/3 of cases. All 98 patients were opera ted on by the same surgeon using the same repair technique, and all fo llowed ambulatory rehabilitation along the same principles of self-reh abilitation applied pre operatively. In each patient function was asse ssed using Constant's scoring method, and the condition of the repaire d cuff was determined by ultrasonography at the time of clinical follo w-up. The average follow-up period was 4 years (2 to 6 years). Results Ultrasonography revealed intact cuffs in 65 per cent, thinned cuffs i n 11 per cent and recurrent full thickness tears in 24 per cent of cas es. The risk of recurrent tear increased with the extent of the tear t o be repaired (57 per cent), in older patient (25 per cent) and with a higher lever of post-surgical occupational use (18 per cent). A drop in the post-operative Constant score had a predictive value for a full thickness recurrent defect. Discussion Constant's scoring method appe ars to be a reliable, reproducible method for analysing functional res ults following surgical repair of full thickness cuff tears and to ref lect the anatomic condition of the repaired cuff. At clinical follow-u p, the anatomic condition of the cuff is more determinant of final fun ctional results than initial tear size. Conclusions Assessment of func tional results must be complemented by anatomic examination using ultr asonography in order to specify the size of any possible recurrent def ect and to detect thinning of the cuff which cannot be identified by C onstant's score. Analysis of the risk factors for recurrent tear led t he authors to question the necessity of repairing massive tears in old er patients and pointed to the valuable advantages of reinforcing frag ile cuffs during initial repair especially in very active patients.