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Clinical and Radiographic Outcomes of Failed Repairs of Large or Massive Rotator Cuff TearsMinimum Ten-Year Follow-up
E. Scott Paxton, MD1; Sharlene A. Teefey, MD1; Nirvikar Dahiya, MD1; Jay D. Keener, MD1; Ken Yamaguchi, MD1; Leesa M. Galatz, MD1
1 Department of Orthopedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 South Euclid Avenue, St. Louis, MO 63110. E-mail address for L.M. Galatz: galatzl@wustl.edu
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Investigation performed at Washington University Orthopedics, Barnes-Jewish Hospital, St. Louis, and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Apr 03;95(7):627-632. doi: 10.2106/JBJS.L.00255
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Abstract

Introduction: 

Little information exists regarding the long-term outcome after structural failure of rotator cuff repair. We previously reported clinical improvement, despite a 94% rate of failure of healing, at two years of follow-up in a cohort of eighteen patients who had undergone arthroscopic repair of massive rotator cuff tears. The purpose of the present study was to evaluate the ten-year results for these patients with known structural failures of rotator cuff repairs.

Methods: 

Fifteen (83%) of eighteen patients were available for follow-up at ten years. Patients were evaluated with use of the American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST), a visual analog scale pain score, and the Constant score. Radiographs and sonograms were assessed.

Results: 

The average age was 74.6 years at the time of the latest follow-up. The average ASES score was 79.4 points (range, 50 to 95 points) and the average visual analog scale pain score was 2.2 points (range, 1 to 4 points); both scores were unchanged from those at two years. The average SST score was 9.2 points (range, 6 to 12 points), and the average age-adjusted Constant score was 73.2 points (range, 58.7 to 89.7 points). Of the patients with structurally failed repairs, all but one had radiographic signs of proximal humeral migration or cuff tear arthropathy: three had Hamada Grade-2 changes, five had Grade-3 changes, and three had Grade-4 changes (with two having Grade-4a changes and one having Grade-4b changes). Ultrasound confirmed the persistence of all tears that had been seen at two years.

Conclusions: 

Clinical improvements and pain relief after arthroscopic rotator cuff repair of large and massive tears are durable at the time of long-term (ten-year) follow-up, despite early structural failure of repair. Shoulders had a high rate of progression of radiographic signs associated with large rotator cuff tears. These results demonstrate that healing of large rotator cuff tears is not critical for long-term satisfactory clinical results in older patients.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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