Abstract
The aim of this study was to assess the outcome of subacromial decompression alone for small and medium size rotator cuff tears.
Between January 1996 and Mach 1999, one hundred and fourteen patients had a subacromial decompression for small and medium cuff tears. They were sixty men (63 shoulders) and fifty women (51 shoulders) with a mean age of 61 years (range, 37 to 87 years). The mean duration of symptoms was 25 months (range, 3 to 225 months). There were 31 manual workers, 28 sedentary workers 55 were retired.
There were 26 small and 88 medium size tears. The mean follow-up was 40 months (range, 24 to 62 months). Patients were assessed using the constant score and a patient satisfaction scale. The mean (SD) Constant score was 70 (+/−16.8). The procedure was considered a failure, if the patient had subsequent surgery or was dissatisfied with the result. There were 29 (25.4%) unsatisfactory results. Twenty-five patients (21.9%) had revision surgery.
An unsatisfactory outcome was related to manual work (p< 0.001) and symptoms of more than 12 months (p< 0.05). Results were unsatisfactory in 40.4% of patients under the age of 60 years and 12.9% over the age of 60 years (p< 0.001). Unsatisfactory results were not related to arm dominance, sex, history of trauma, tear size, biceps pathology or presence of acromio-clavicular osteophytes (p> 0.5 for all).
The mean duration between subacromial decompression and subsequent surgery in 25 patients was 13 months (range: three to 35 months). At revision surgery, three (42.8%) of seven small tears had progressed to medium size tears and three (16.6%) of eighteen medium tears had progressed to large size tears.
Subacromial decompression for small and medium sized tears has an unsatisfactory outcome in patients under the age of sixty years and manual workers but may be a suitable alternative to cuff repair in patients above the age of sixty years. Some small and medium sized cuff tears progress in spite of adequate subacromial decompression.
The abstracts were prepared by Mr Roger Emery. Correspondence should be addressed to him at the British Orthopaedic Association, Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London WC2A 3PN
