21. DELETERIOUS EFFECT OF ACROMIOPLASTY DURING PALLIATIVE TREATMENT OF UNREPARABLE ROTATOR CUFF TEARS

Abstract

Purpose of the study: Palliative treatment for unreparable rotator cuff tears by intra-articular resection of the long head of the biceps provides demonstrated satisfactory results. We hypothesized that associated acromioplasty could be deleterious.

Material and method: We conducted a case-control study comparing 24 tenotomies or tenodeses of the long head of the biceps with 24 tenotomies or tenodeses of the long head of the biceps associated with acromioplasty. All patients had an unreparable tear of the rotator cuff. Full-thickness tear of the subscapularis or Hamada and Fukuda radiological stage 3 or 4 tear were exclusion criteria. The two groups were matched for weighted Constant score, Hamada and Fukuda stage, type of tear of the infraspinatus and subscapularis, overall fatty infiltration grade, and follow-up. After the physical examination, we compared the four items of the Constant score, the absolute and weighted score, active anterior elevation, pain score on a visual analogue scale (VAS), and the subjective shoulder score. All patients were examined by a clinician unaware of the group at last follow-up (mean 51 months).

Results: The two groups were comparable preoperatively except for the fatty infiltration index which was higher in the acromioplasty group. At 51 months follow-up, active anterior elevation was statistically lower in the acromioplasty group (145 versus 170). The absolute and weighted Constant scores were lower in the acromioplasty group (p< 0.05). There was no difference for pain and the subjective shoulder score (67 versus 71). Four patients in the acromioplasty group required revision total shoulder arthroplasty versus two in the group without acromioplasty.

Discussion: Association of acromioplasty with intra-articular resection of the long head of the biceps for palliative treatment of unreparable rotator cuff tears is deleterious for elevation and reduces overall shoulder function. Even though acromioplasty provides good short-term results for average-sized tears, outcome is less satisfactory for massive tears and deteriorates over time. In addition, as described by Wiley, acromioplasty can induce a pseudoparalytic shoulder in patients with unreparable tears.