Partial Rotator Cuff Repair for Massive Tears Rarely Require Revision Surgery

Abstract

Purpose: To determine the significance of initial and residual rotator cuff tear defect size on the need for revision surgery or additional nonsurgical therapy, in a consecutive group of patients undergoing partial repair of massive rotator cuff tears.

Methods: A retrospective chart review was carried out for all arthroscopic rotator cuff repairs performed by a single surgeon between January of 2013 and December of 2016. All patients with massive rotator cuff tears (>30 cm²) who underwent partial repair were included in the study. Outcomes for the surgical procedure were measured based on the necessity for revision surgery or adjunct therapy, including steroid injections or additional physical therapy after initial release from care.

Results: In total, 1954 patients who underwent arthroscopic rotator cuff repair were identified. Thirty-eight of these met the inclusion criteria. Those patients undergoing revision surgery represented 5.2% (2/38) of the series and had an average initial/residual tear defect area of 45.0/7.0 cm². Patients requiring adjunct therapy represented 7.9% (3/38) of the series and possessed an average initial/residual tear defect size of 40.0/16.0 cm². The remaining 33 (86.9%) patients did not require revision surgery or adjunct therapy at a minimum follow-up of 2 years. There was no significance between initial and/or residual rotator cuff tear defect size and the need for revision surgery. However, there was a significant difference in the mean residual defect size in the patients requiring additional nonoperative treatment after initial release from care (P = .012).

Conclusions: There was no relationship between residual defect size after partial repair and the need for revision surgery. Patients who returned for additional nonoperative treatment after being released from care were noted to have a statistically larger residual defect size at the time of index surgical intervention. Only 5% of patients underwent subsequent surgery at an average of more than 4 years' follow-up, suggesting that partial repair of massive rotator cuff tears can provide a durable, joint-preserving intervention.

Level of evidence: Level IV, Therapeutic Case Series.

Fig 1

The right shoulder rotator cuff tear is measured before repair in the anterior/posterior (A) and medial/lateral (B) orientation using a calibrated probe, as viewed arthroscopically from the lateral portal with the patient in the beach chair position.

Fig 2

The right shoulder anterior/posterior (A) and medial/lateral (B) measurements of the residual cuff defect after partial repair is shown as viewed arthroscopically from the lateral portal with the patient in the beach chair position (same patient as in Fig 1).