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. 2019 Dec 1;22(4):203-209.
doi: 10.5397/cise.2019.22.4.203. eCollection 2019 Dec.

Treatment of Large and Massive Rotator Cuff Tears: Does Infraspinatus Muscle Tear Affect Repair Integrity?

Sungwook Choi  1 , Hyunchul Yang  1 , Hyunseong Kang  1 , Gyeong Min Kim  1
Affiliations

Treatment of Large and Massive Rotator Cuff Tears: Does Infraspinatus Muscle Tear Affect Repair Integrity?

Sungwook Choi et al. Clin Shoulder Elb. .

Abstract

Background: Clinical outcomes and prognosis of large and massive rotator cuff tears are known to be unpredictable not only in degeneration of the rotator cuff, but also due to a high rate of retear.

Methods: Totally, 81 patients who had undergone arthroscopic rotator cuff repair from May 2008 to February 2016 were evaluated in our study. Clinical and functional evaluations were performed with the Constant score and the University of California, Los Angeles (UCLA) score, as well as full physical examination of the shoulder. All patients were confirmed to have magnetic resonance imaging (MRI) of tendon healing at least 1 year postoperatively.

Results: The average age at the time of surgery was 65 years (range, 47-78 years). The average duration of postoperative time in which a follow-up MRI was performed was 36.1 months (range, 12-110 months). Large tears were present in 48 cases (59.3%) and massive tears in 33 cases (40.7%). Overall, there were 33 retear cases (40.7%). All the average clinical outcome scores were significantly improved at the last follow-up (p<0.001), although repair integrity was not maintained. Compared to type A, types C, and D of the Collin's classification showed significantly higher retear rates (p=0.036).

Conclusions: Arthroscopic rotator cuff repair yields improved clinical outcomes and a relatively high degree of patient satisfaction, despite the repair integrity not being maintained. Involvement of the subscapularis muscle or infraspinatus muscle had no effect on the retear rate.

Keywords: Arthroscopy; Rotator cuff; Shoulder.

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Conflict of interest statement

Conflict of interest None.

Figures

Fig. 1.
Fig. 1.
(A) Five muscles that constitute the rotator cuff. (B) Collin’s classification [11] classifies rotator cuff tear into five groups: type A, supraspinatus and superior subscapularis tears; type B, supraspinatus and entire subscapularis tears; type C, supraspinatus, superior subscapularis, and infraspinatus tears; type D, supraspinatus and infraspinatus tears; and type E, supraspinatus, infraspinatus, and teres minor tears.
Fig. 2.
Fig. 2.
(A) Preoperative coronal T2-weighted image showing a full-thickness rotator cuff tear with substantial muscle retraction. (B) The arthroscopic view showing massive rotator cuff tear. Degeneration of rotator cuff is severe and glenoid is exposed. (C) Suture anchors were placed to repair the rotator cuff on the footprint. (D) A repair configuration after arthroscopic rotator cuff repair. Due to the extensive rupture of the rotator cuff, the footprint was not completely covered.
Fig. 3.
Fig. 3.
Correlation between preoperative tear size and repair integrity (p<0.001).
Fig. 4.
Fig. 4.
Correlation between global fatty degeneration index (GFDI) and repair integrity (p<0.001).
Fig. 5.
Fig. 5.
Correlation between Collin’s classification and repair integrity (p=0.036).
See this image and copyright information in PMC

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