Massive Rotator Cuff Tear

Surgical Technique and Results in Relations with Preoperative Prognostic Factors

Dr. Fernando Barclay, Dr. Francisco Arcuri, Dr. Jorge Cavallo, Dr. Javier Leunda Buenos Aires, Argentina

Disclosure

Arthrex

Hypothesis
The results of arthroscopic repair of massive rotator cuff tears have a direct correlation with preoperative prognostic factors: Age, Chronicity, Retraction, Muscle Atrophy and Fatty Infiltration.

Materials and Methods

22 Shoulders/Arthroscopic massive rotator cuff repair Sex 11/11 Age: 51-78 years 66.5 Symptoms: 2-84 month 20.3 Follow up: 24-96 month Functional outcome: # Constant Score # Satisfaction Anatomical outcome: 16 with/ MRI

Functional Outcomes
Constant 100 50 0
Absolute Difference Constant pos-pre Pain pos-pre Activivity pos-pre ROM pos-pre Strenght pos-pre % relative difference (**) Constant pos-pre Pain pos-pre Activity pos-pre ROM pos-pre Strenght pos-pre N 22 22 22 22 22 N 22 22 22 22 22 Mean 35.9 4.9 5.0 18.4 5.9 Mean (%) 84.3 95.0 53.2 102.2 78. 8

54,5%
12 Shoulders

32%
7 Shoulders

9%
2 Shoulders

1 Shoulders

4,5%

Std. Deviation 12.15 4.13 3.23 7.00 5.41 Std. Deviation (%) 28.73 81.00 37.40 55.41 78.03

Sig. (2-tailed p) < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 Sig. (2-tailed) < 0.001 < 0.001 < 0.001 < 0.001 < 0.001

Constant/Age/Chronicity
Pearson Correlation Sig. (1-tailed) N

AGE

Constant pos-pre AGE Constant pos-pre AGE

Constant pos-pre -.321 .073 22

AGE -.321 .073 22

P= -.321 No Significant

CHRONICITY
Pearson Correlation Sig. (1-tailed) N Constant pos-pre Chronicity (month) Constant pos-pre Chronicity (month)

Constant pos-pre -.442 .020 22

Cronicity (month) -.442 .020 . 22

P= -.442 Significant

Constant/Retraction
100 80 Constant 60 40 20 0
stage 2 stage 3
Ltd. Deviation 19.8448 22.9231 17.2465 60.8307 28.7265

88%

93,5% 75,5% 57%

stage 4

stage 5

N 2 3 4 5 Total 11 6 2 3 22

Mean 88.225 93.539 75.610 57.018 84.272

95% Confidence Interval for Mean Lower Upper Bound Bound 74.893 101.557 69.483 117.596 -79.344 230.563 -94.094 208.129 71.536 97.009

Retraction p=0.308 No Significant (ANOVA) Tomazeau Classification

Constant/Atrophy
120 100 Constant 80 60 40 20 0
estadio 0 estadio 1 estadio 2 estadio 3
50% 91,5% 106,5% 84,5%

Mean

Std. Deviation

95% Confidence Interval for Mean Lower Upper Bound Bound 37.966 87.548 69.256 -8.583 71.536 145.420 125.648 99.683 109.193 97.009

Atrophy p=0.018 Significant (ANOVA) Warners Classification

0 no 1 leve 2 moderada 3 severa Total

3 5 10 4 22

91.693 106.598 84.470 50.305 84.272

21.6280 15.3423 21.2670 37.0081 28.7265

Constant/Fatty Infiltration
120 100 Constant 80 60 40 20 0
stage 0 stage 1 stage 2 stage 3 stage 4
98% 100,5% 82% 78,5% 67%

Mean

Std. Deviation

0 1 2 3 4 Total

2 7 1 6 6 22

97.956 100.408 82.222 78.469 67.031 84.272

26.4609 16.7263 . 25.2252 38.9414 28.7265

95% Confidence Interval for Mean Lower Upper Bound Bound -139.786 335.698 84.939 115.877 . . 51.997 104.941 26.164 107.897 71.536 97.009

Fatty Infiltration p=0.291 No Significant (ANOVA)

Healing
16 MRI
Re-ruptures 4 years follow-up

20.5%

Healed

Re-rupture

Constant/Healing/Re-rupture
100
Constant

67,5%
2 Shoulders

96%
10 Shoulders

80 60 40 20 0

91,5%
92 Constant
total

parcial

Healing p=0.065 No Significant

90 88 86 84

86,5%
4 Shoulders

12 Shoulders

(ANOVA)

NO Re-rupture p=0.715 No Significant

SI

Conclusions
Arthroscopic repair of Massive Rotator Cuff Tears, could achieve acceptable and predictable results, only if a judicious surgical technique is done and preoperative Prognostic Factors are taking into account in the decision making. Muscle Atrophy and Chronicity of the tear affect postoperative functional results.

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