Functional outcome after arthroscopic repair of massive rotator cuff tears in individuals with pseudoparalysis

Abstract

Purpose: The purpose of this study was to evaluate the functional results after arthroscopic rotator cuff repair (ARCR) for patients with preoperative pseudoparalysis.

Methods: This retrospective review examined massive rotator cuff tears treated with an ARCR over a 10-year period. Pseudoparalysis was defined as active forward flexion (FF) less than or equal to 90° with full passive FF. Primary ARCRs (group I) and revision ARCRs (group II) were included. Postoperative reversal of pseudoparalysis, functional outcome, and complications were self-assessed at a minimum of 2 years postoperatively.

Results: In group I 39 patients with a mean age of 62 years at the time of surgery were available for follow-up at a mean of 75 months. Active FF improved from 49° preoperatively to 155° postoperatively (P < .001), and pseudoparalysis was reversed in 90% of patients. In group II 14 patients with a mean age of 63 years at the time of surgery were available for follow-up at a mean of 72 months. Active FF improved from 43° to 109° (P < .001), and pseudoparalysis was reversed in 43% of patients. The mean American Shoulder and Elbow Surgeons score improved in both group I (P < .001) and group II (P = .033). Recovery of FF greater than 90° in group I was associated with a shorter interval before repair (P = .021) and a complete repair (P = .026).

Conclusions: ARCR of massive rotator cuff tears with advanced mobilization techniques can lead to reversal of preoperative pseudoparalysis in 90% of patients who have not had previous surgery. In these patients functional improvement can be obtained with a low rate of complications. However, in the setting of a revision ARCR and pseudoparalysis, only 43% of patients regained FF above 90°.

Level of evidence: Level IV, therapeutic case series.