SURGICAL REPAIR OF CHRONIC ROTATOR CUFF TEAR. A PROSPECTIVE LONG-TERM STUDY WITH AVERAGE ELEVEN YEAR FOLLOW-UP

Abstract

Surgical repair of rotator cuff tendon is one of the most common orthopaedic procedures performed in the United States. This prospective single-surgeon study reports the long-term results of chronic rotator cuff repair. Vigorous statistical analysis was carried out to detect any association of various outcome parameters with the exact surgical pathology.

105 consecutive shoulders (97 patients) undergoing open repair of chronic (> 3 months) rotator cuff tear between 1975 to 1983 by the senior author were recruited to the study. Pain unresponsive to nonoperative treatment was the indication for surgery. The details of patient’s medical records, radiographic data, and the operative findings were prospectively reviewed. There were 67 males and 30 females with a mean age of 58 years (range, 38 to 75). Follow-up averaged 11 years with no patients lost to follow-up. There were 16 small, 40 medium, 38 large and 11 massive tears.

Surgical repair relieved pain in 92% of patients (p< 0.0001). There was also a significant improvement in range of motion (p< 0.0001) and strength of abduction and external rotation following surgery (p< 0.0001). Return of movement and strength decreased with increasing tear size. At the latest follow-up results were rated as excellent in 68 shoulders, satisfactory in 12, and unsatisfactory in 25. 8 out of the 11 massive tears had unsatisfactory outcome. There were eight reoperations for traumatic retears.

Standard tendon repair techniques combined with adequate postoperative protection and monitored physical therapy produced consistently satisfactory results. Introduction of experimental repair methods should be confined to those patients with massive tendon tears and only then with the hope of increasing function, as pain relief is satisfactory with usual treatment methods.