Background: In most clinical reports on rotator cuff repair,
acromioplasty was done as part of the procedure. In this prospective study, we
evaluated the hypothesis that rotator cuff repair without acromioplasty would
result in a substantial improvement in shoulder comfort and function.
Methods: Ninety-six consecutive primary repairs of full-thickness
tears of the rotator cuff were performed through a deltoid-muscle-splitting
incision that preserved the integrity of the coracoacromial arch and the
deltoid insertion. All patients were invited to participate in a prospective
study involving periodic self-assessment of shoulder function with the Simple
Shoulder Test and general health status with the Short Form-36 (SF-36)
questionnaire, both of which are validated instruments. Sixty-one patients
provided follow-up information for at least two years postoperatively, and the
average duration of follow-up was five years. Thirty-four of the tears
involved the supraspinatus tendon alone; sixteen involved the supraspinatus
and infraspinatus tendons; and eleven involved the supraspinatus,
infraspinatus, and subscapularis tendons.
Results: The percentage of shoulders that could be used to perform
each of the twelve functions on the Simple Shoulder Test was significantly
increased postoperatively (p < 0.002). Men and women had different degrees
of function preoperatively (p < 0.00000001) and postoperatively (p <
0.001), but the improvement in function was essentially identical for the two
genders. The mean improvement in the number of shoulder tests that could be
performed was best for the patients with one-tendon tears (4.9 tests), next
best for those with two-tendon tears (3.6 tests), and worst for those with
three-tendon tears (3.3 tests). SF-36 scores for physical role (p < 0.003)
and comfort (p < 0.0001) were significantly improved postoperatively.
Conclusions: Significant improvement in self-assessed shoulder
comfort and in each of the twelve shoulder functions was observed after
rotator cuff repairs performed without acromioplasty. The technique that we
used is very similar to that described by Codman almost seventy years ago.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.