Surgical repair of chronic rotator cuff tears - A prospective long-term study

Background: Rotator cuff disease or injury is one of the most frequently se en orthopaedic conditions, and surgical repair of rotator cuff tears is a c ommon procedure. A prospective analysis of the operation, with consistent a ssessment of patient characteristics, variables associated with the rotator cuff tear and repair techniques, and outcome factors, was performed. Methods: One hundred and five shoulders with a chronic rotator cuff tear un derwent open surgical repair and acromioplasty between 1975 and 1983. The p atients were followed for an average of 13.4 years (range, two to twenty-tw o years). There were sixteen small tears, forty medium tears, thirty-eight large tears, and eleven massive tears. The tears were repaired directly (se venty-two tears), by V-Y plasty (twelve), by tendon transposition (twenty), or by reinforcement with a fascia lata graft (one). The long head of the b iceps had been previously torn in eleven shoulders and was tenodesed in thr ee other shoulders. In fifty-six shoulders, the distal part of the clavicle was excised for treatment of degenerative arthritic changes, often associa ted with osteophyte formation. Results: Satisfactory pain relief was obtained in ninety-six shoulders (p < 0.0001). There was significant improvement in active abduction (p < 0.001) and external rotation (p < 0.007) as well as in strength in these directio ns of movement (p < 0.03 and p < 0.002, respectively). At the latest follow -up evaluation, the result was rated as excellent for sixty-eight shoulders , satisfactory for sixteen, and unsatisfactory for twenty-one. Tear size wa s the most important determinant of outcome with regard to active motion, s trength, rating of the result, patient satisfaction, and need for a reopera tion. Older age, less preoperative active motion, preoperative weakness, di stal clavicular excision, and a transposition repair technique were all ass ociated with larger tear size. There were eight reoperations; five were for rerepair of a persistent or recurrent rotator cuff tear. Conclusions: Standard tendon repair techniques combined with anterior acrom ioplasty, postoperative limb protection, and monitored physiotherapy can pr oduce consistent and lasting pain relief and improvement in range of motion . Improving the results of this procedure will depend upon the development of new techniques to address the active motion and strength deficiencies fo llowing repair of massive rotator cuff tears.