TUBEROPLASTY: ADVANTAGES OF REVERSED DECOMPRESSION – THREE YEAR FOLLOW-UP RESULTS IN 34 PATIENTS

Abstract

Study design: Retrospective study of 34 patients with a massive rotator cuff tear, who were treated with an arthroscopic tuberoplasty, debridement of the degenerate cuff and biceps tenotomy.

Objectives: To evaluate the clinical outcome of a reversed decompression at the medium term follow up.

Summary of background data: Rotator cuff repair can become impossible for massive tears in the elderly. If conservative management fails, a reverse total shoulder arthroplasty (RSA) is commonly used. However, Fenlin described in 2002 a tuberoplasty for this pathology and reported good to excellent results. This procedure appears to be well tolerated as it is arthroscopic, not time consuming and not depending on intensive physiotherapy. In case of failure, a primary RSA is still possible.

Methods: 36 patients treated with a tuberoplasty between February 2002 and September 2006 were identified.

One patient deceased, one patient developed Alzheimer dementia, leaving 34 patients available for follow-up. They completed the SF-36 questionnaire and the Simple shoulder test. They were clinically reviewed and scored with the Constant-Murley score. All 34 had complete radiographic work-up (x-ray; ultrasound) preoperatively and at final follow up.

Results: Median age at operation was 71 years (range: 52,5 – 82,16). Mean follow-up was 3,1 years (SD: +/− 0,75).

Mean operating time was 35 minutes (SD: +/− 12.33). There were no surgical complications. Postoperatively, there was an uneventful recovery in all patients.

At final follow-up, two patients were revised to a RSA. One patient was revised after 9 months because of continuous pain and loss of function. The second patient developed a complete osteonecrosis and was revised after one year.

The 32 remaining patients had a preoperative Constant-Murley score adjusted for age and gender of 34,8. This improved to an average of 84 at final follow up.

The simple shoulder test improved from an average of 1,8 to 8,4.

The average decrease of subacromial space was 2,34 mm and the loss of glenohumeral joint space was 0,57. Finally, the preoperative grade of arthrosis was 0,46 compared to a postoperative average of 1,1.

At final follow-up, 85% (27/32) were either satisfied or very satisfied with the result. 12,5% (4/32) appreciated the result as only fair. 2,5% (1/32) was dissatisfied, but didn’t consider revision surgery.

Conclusion: We conclude that a tuberoplasty with rotator cuff debridement and biceps tenotomy is a reliable treatment for massive rotator cuff tears in the elderly at medium follow up. In case of failure, revision to RSA is still a valuable option.