Gerber and colleagues tested whether a new laboratory‑tested technique for massive cuff tears lowers the retear rate and improves function compared with earlier methods, and tracked what happens to the cuff muscles and how MRI relates to clinical results.
Prospective series of 29 massive tears with at least two tendons fully detached. 27 patients were reviewed clinically and on MRI at a mean of 37 months (range 24 to 61).
Methods
Design
Prospective cohort
Data source
Single center, University of Zurich
Patients
29 massive tears repaired
At least two tendons completely detached
Acromiohumeral distance ≥ 6 mm
27 evaluated at follow‑up
Exposure
Transosseous repair
Braided polyester sutures
Mason‑Allen stitch
Titanium plate augmentation
Follow-up
Minimum 2 years (mean 37 months, range 24 to 61)
Outcomes
Age- and gender‑adjusted Constant score
Subjective shoulder value
Repair integrity on MRI
Muscle atrophy and fatty degeneration on MRI
Key Findings
Retears occurred in 34% of repairs (10 of 29).
The mean age- and gender‑adjusted Constant score rose from 49% before surgery to 85% after, with pain‑free flexion improving from 92° to 142° and abduction from 82° to 137°.
All 17 patients whose repair healed structurally had an excellent clinical result.
Patients who retore had a shorter history of shoulder symptoms before surgery (11 vs 28 months, p = 0.021).
Six small retears did no better clinically than four retears as large as the original tear, so the presence of a retear mattered more than its size.
Atrophy was not reversed: supraspinatus area rose after successful repair (364 to 434 mm²) and fell after failed repair (408 to 247 mm²), and postoperative areas differed between the two groups (p = 0.0088).
Board pearl
Gerber required an acromiohumeral distance of at least 6 mm on a standing AP radiograph and excluded shoulders with static superior subluxation of the humeral head.
Authors' conclusion
The method of repair of massive rotator cuff tears that was used in this study yielded a comparatively low retear rate and good-to-excellent clinical results; however, the repair did not result in substantial reversal of muscular atrophy and fatty degeneration. Retears occurred more often in patients who had had a shorter interval between the onset of the symptoms and the operation (p < 0.05). Patients who had a retear had improvement of the shoulder compared with the preoperative state, but they had less improvement than did those who had a successful repair.
Gerber and colleagues tested whether a new laboratory‑tested technique for massive cuff tears lowers the retear rate and improves function compared with earlier methods, and tracked what happens to the cuff muscles and how MRI relates to clinical results.
Prospective series of 29 massive tears with at least two tendons fully detached. 27 patients were reviewed clinically and on MRI at a mean of 37 months (range 24 to 61).
Methods
Design
Prospective cohort
Data source
Single center, University of Zurich
Patients
29 massive tears repaired
At least two tendons completely detached
Acromiohumeral distance ≥ 6 mm
27 evaluated at follow‑up
Exposure
Transosseous repair
Braided polyester sutures
Mason‑Allen stitch
Titanium plate augmentation
Follow-up
Minimum 2 years (mean 37 months, range 24 to 61)
Outcomes
Age- and gender‑adjusted Constant score
Subjective shoulder value
Repair integrity on MRI
Muscle atrophy and fatty degeneration on MRI
Key Findings
Retears occurred in 34% of repairs (10 of 29).
The mean age- and gender‑adjusted Constant score rose from 49% before surgery to 85% after, with pain‑free flexion improving from 92° to 142° and abduction from 82° to 137°.
All 17 patients whose repair healed structurally had an excellent clinical result.
Patients who retore had a shorter history of shoulder symptoms before surgery (11 vs 28 months, p = 0.021).
Six small retears did no better clinically than four retears as large as the original tear, so the presence of a retear mattered more than its size.
Atrophy was not reversed: supraspinatus area rose after successful repair (364 to 434 mm²) and fell after failed repair (408 to 247 mm²), and postoperative areas differed between the two groups (p = 0.0088).
Board pearl
Gerber required an acromiohumeral distance of at least 6 mm on a standing AP radiograph and excluded shoulders with static superior subluxation of the humeral head.
Authors' conclusion
The method of repair of massive rotator cuff tears that was used in this study yielded a comparatively low retear rate and good-to-excellent clinical results; however, the repair did not result in substantial reversal of muscular atrophy and fatty degeneration. Retears occurred more often in patients who had had a shorter interval between the onset of the symptoms and the operation (p < 0.05). Patients who had a retear had improvement of the shoulder compared with the preoperative state, but they had less improvement than did those who had a successful repair.