SURGICAL TREATMENT OF THE MASSIVE ROTATOR CUFF TEARS

Abstract

Background: The purpose of this study was to evaluate the mid and long-term results of the open repair of the rotator cuff tears in patients where pain of the shoulder was the primary and function the secondary consideration.

Material – Method: the study includes 48 patients, out of a total 64, operated on during the period 1985–2001 for full-thickness massive tears of the rotator cuff. The average age was fifty-two years. In all but six the main symptom was persistent pain resulting from a chronic tear. This group had clinical evidence of a rotator cuff defect in the form of weakness and limited range of active motion. The six additional patients suffered from acute tears following trauma and were led to early surgical repair. Their characteristic sign was extensive limitation of active motion, whereas the passive movements were near normal. The operation performed was the anterior acromioplasty with cuff repair through an anterosuperior incision. Several techniques were employed to advance the retracted tendons to their insertions, in the large and massive chronic tears. No patient had transfer of the latissimus dorsi tendon to bridge the gap in the rotator cuff.

Results: The clinical evaluation according to the rating system of UCLA showed 36 excellent, 9 good and 3 fair results. There was no poor result after an average follow-up 7,4 years.

Conclusions: The present series indicates that reconstruction of a torn rotator cuff can be successful in the majority of patients. Careful preoperative evaluation and planning is of great value in arranging the surgical technique. In large and massive chronic tears the retracted infl exible muscles do not allow easy advancement of their tendons in order to be securely fixed to the greater tubercle. Therefore the surgeon should be familiar with special techniques to achieve a so-called watertight repair, which is necessary for a long-lasting good result.