Arthroscopic debridement of massive irreparable rotator cuff tears

Abstract

Purpose: The purpose of this study was to evaluate clinical and radiologic results of arthroscopic debridement of massive irreparable rotator cuff tears.

Methods: Thirty-one patients (mean age, 70.6 years) were retrospectively reviewed for a mean of 47 months (range, 24 to 69 months) after arthroscopic debridement of an irreparable rotator cuff tear. Operative treatment included biceps tenotomy in 24 cases (77.4%). No acromioplasty was performed to maintain the coracoacromial arch. Clinical outcome was assessed by use of the American Shoulder and Elbow Surgeons (ASES) and Constant scores, as well as measurement of abduction strength and elbow flexion strength compared with the contralateral side at final follow-up. Preoperative and follow-up radiographs were evaluated for acromiohumeral distance and grade of osteoarthritis according to the Samilson-Prieto classification.

Results: The mean ASES score was significantly improved from 24.0 to 69.8 points at follow-up. Scores for pain were reduced from 7.8 to 2.9 points on a visual analog scale ranging from 0 to 10 points. The age- and gender-adjusted Constant score was 72.2%. Radiologic analysis showed progression of osteoarthritis in 10 cases (32.3%); this had no influence on the ASES score. Acromiohumeral distance decreased from 8.3 to 7.0 mm. Biceps strength was 6.1 kg on the operated side and 6.3 kg on the contralateral side. Abduction strength was significantly lower on the operated side at 2.6 kg versus 3.7 kg on the contralateral side. No complication related to the procedure was reported.

Conclusions: For elderly patients with low functional demands, arthroscopic debridement in combination with biceps tenotomy is a safe procedure and leads to significant functional improvement without loss of biceps strength. Progression of osteoarthritic changes cannot be prevented, but no influence on the clinical result could be shown.

Level of evidence: Level IV, therapeutic case series.