The results of repair of massive tears of the rotator cuff

Background Massive tears of the tendons of the rotator cuff cause atrophy a nd fatty degeneration of the rotator cuff muscles and painful loss of funct ion of the shoulder, Repair of massive rotator cuff tears is often followed by retears of the tendons, additional muscular degeneration, and a poor cl inical outcome. The purposes of this study were to determine whether a new method of repair of rotator cuff tendons can yield a lower retear rate and a better clinical outcome than previously reported methods, to assess the m uscular changes following repair of massive tears of the musculotendinous u nits, and to correlate findings on magnetic resonance imaging with the clin ical results. Methods: Twenty-nine massive rotator cuff tears involving complete detachme nt of at least two tendons were repaired operatively with use of a new labo ratory-tested technique in a prospective study. At least two years (average , thirty-seven months; range, twenty-four to sixty-one months) postoperativ ely, twenty-seven patients were evaluated clinically and with magnetic reso nance imaging to determine the clinical outcome, the integrity of the repai r, and the condition of the rotator cuff muscles, Results: The age and gender-adjusted Constant score improved from an averag e of 49 percent preoperatively to an average of 85 percent postoperatively, corresponding to a subjective shoulder value of 78 percent of that of a no rmal shoulder. Pain-free flexion improved from an average of 92 degrees to an average of 142 degrees, and abduction improved from an average of 82 deg rees to an average of 137 degrees. Pain decreased and performance of activi ties of daily living improved significantly (p < 0.05), The seventeen patie nts who had a structurally successful repair all had an excellent clinical outcome, Muscle atrophy could not be reversed except in successfully repair ed supraspinatus musculotendinous units, Fatty degeneration increased in si ll muscles. Conclusions: The method of repair of massive rotator cuff tears that was us ed in this study yielded a comparatively low retear rate and good-to-excell ent clinical results; however, the repair did not result in substantial rev ersal of muscular atrophy and fatty degeneration, Retears occurred more oft en in patients who had had a shorter interval between the onset of the symp toms and the operation (p < 0.05), Patients who had a retear had improvemen t of the shoulder compared with the preoperative state, but they had less i mprovement than did those who had a successful repair.