Introduction

Massive rotator cuff tears in the patient who is too young for a reverse shoulder replacement are a challenging situation. A technique using a ‘Grammont osteotomy’ of the acromion has been developed to allow a comprehensive approach, the so called “Full Monty”.

Eighty-eight consecutive patients with symptomatic rotator cuff tears were entered in to a prospect study with a novel technique of open double row repair using a ‘Capstan’ screw technique. The medial row has standard anchors, but the lateral suture row is a 35mm × 6.5mm ‘Capstan' screw. This allows up to 28 suture bridges to be taken from the medial row to the lateral row compressing the footprint and spreading the load. This creates a very robust repair or ‘bulletproof repair’. This was used for medium to large isolated supraspinatus tears

Each patient had a pre and post operative Oxford Shoulder Score (OSS), American Shoulder and Elbow Score (ASES Score). The mean pre-operative OSS was 22 (maximum 48) and the mean post-operative OSS was 45, (p < 0.0001). Flexion improved from a mean of 117° to 172° (p < 0.0001). The clinical re-tear rate was 3.4%. 95% were satisfied with the procedure. There were no deep infections. 18% had transient stiffness, 6% stiffness at one year but none severe enough to warrant release. There were no instances of deltoid dysfunction.

This demonstrates excellent results in terms of OSS, patient satisfaction and function. Clinical re-tear rate is markedly reduced in comparison to previous literature.

Massive tears of the supraspinatus of the rotator cuff lead to painful loss of movement. The literature supports repair of these tears for young healthy individuals, however they present a surgical challenge with historically poor results from both athroscopic and standard open techniques.

Prof Bunker has developed a surgical technique for massive rotator cuff tears with a Grammont Osteotomy of the spine of the acromion, when standard surgical techniques will not allow the necessary exposure: the so called “Full Monty”.

Patients were entered in to a prospective study to obtain the functional benefit of this procedure. Each patient had a pre-operative American Shoulder Elbow Score (ASES) Oxford Shoulder score (OSS), pain score, range of movement. Post-operatively these measures were repeated along with a patient questionnaire on function and satisfaction.

The mean American Shoulder score (ASS) preoperatively was 7 (out of a possible 30) and improved postoperatively to 23(P = 0.00011). The improvement in the Oxford Shoulder Score was 22 (out of a possible 48) preoperatively to 43 postoperatively (0.0001) and 80% patients stated their treatment was “successful”.

We believe this a successful surgical option for a patient with “massive” rotator cuff tear that is not amenable to standard surgical techniques.