Jost, J Bone Joint Surg Am 2000 - Clinical Outcome after Structural Failure of Rotator Cuff Repairs

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Clinical Outcome after Structural Failure of Rotator Cuff Repairs

Jost, Gerber, et al.·J Bone Joint Surg Am·2000·526 citations·Prospective cohort

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Background

The clinical outcome for patients with documented rerupture after open repair of one or more rotator cuff tendons is not well known. The purpose of this study was to evaluate the clinical outcomes of a consecutive series of rotator cuff reruptures after repair and to provide information concerning the advisability of rotator cuff repair in situations in which there may be a high probability of rerupture.

Methods

During prospective follow-up after rotator cuff repairs, we detected, with magnetic resonance imaging, structural failure of the repair in 20 patients, who had a mean age of 59 years at the time of the rotator cuff repair. All patients were clinically examined for the purpose of this report at a mean of 38 months.

Results

The reruptures invariably involved the originally torn tendon but were smaller than the original tear in 16 of the 20 patients.
Fatty degeneration of the supraspinatus and infraspinatus muscles, atrophy of the supraspinatus muscle, and glenohumeral osteoarthritis progressed significantly from the preoperative state (p < 0.05).
At the time of the most recent follow-up, the subjective shoulder value averaged 75 percent of the value for a normal shoulder.
11 patients were very satisfied with the result, 6 were satisfied, 2 were disappointed, and one was dissatisfied.
The mean relative score according to the system of Constant and Murley had increased from 49 percent of the score for a normal shoulder preoperatively to 83 percent postoperatively (p = 0.0001).
Pain had decreased significantly, and the ranges of active, pain-free forward elevation and abduction as well as the abduction strength had improved significantly (p < 0.05).
The clinical outcome was significantly correlated with the size of the postoperative tear, the stage of postoperative fatty muscle degeneration of the infraspinatus and subscapularis, the postoperative acromiohumeral distance, and the degree of postoperative glenohumeral osteoarthritis (p < 0.05).

Conclusions

This study documents that an attempt at rotator cuff repair significantly decreases pain (p = 0.0026) and significantly improves function (p = 0.0005) and strength (p = 0.0137) even if magnetic resonance imaging documents that the repair has failed. This finding suggests that the potential for rerupture should not be considered a formal contraindication to an attempt at repair if optimal functional recovery is the goal of treatment.

Copyright remains with the authors and publisher.

Clinical Outcome after Structural Failure of Rotator Cuff Repairs

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Clinical Outcome after Structural Failure of Rotator Cuff Repairs

Jost, Gerber, et al.·J Bone Joint Surg Am·2000·526 citations·Prospective cohort

|

Background

The clinical outcome for patients with documented rerupture after open repair of one or more rotator cuff tendons is not well known. The purpose of this study was to evaluate the clinical outcomes of a consecutive series of rotator cuff reruptures after repair and to provide information concerning the advisability of rotator cuff repair in situations in which there may be a high probability of rerupture.

Methods

During prospective follow-up after rotator cuff repairs, we detected, with magnetic resonance imaging, structural failure of the repair in 20 patients, who had a mean age of 59 years at the time of the rotator cuff repair. All patients were clinically examined for the purpose of this report at a mean of 38 months.

Results

The reruptures invariably involved the originally torn tendon but were smaller than the original tear in 16 of the 20 patients.
Fatty degeneration of the supraspinatus and infraspinatus muscles, atrophy of the supraspinatus muscle, and glenohumeral osteoarthritis progressed significantly from the preoperative state (p < 0.05).
At the time of the most recent follow-up, the subjective shoulder value averaged 75 percent of the value for a normal shoulder.
11 patients were very satisfied with the result, 6 were satisfied, 2 were disappointed, and one was dissatisfied.
The mean relative score according to the system of Constant and Murley had increased from 49 percent of the score for a normal shoulder preoperatively to 83 percent postoperatively (p = 0.0001).
Pain had decreased significantly, and the ranges of active, pain-free forward elevation and abduction as well as the abduction strength had improved significantly (p < 0.05).
The clinical outcome was significantly correlated with the size of the postoperative tear, the stage of postoperative fatty muscle degeneration of the infraspinatus and subscapularis, the postoperative acromiohumeral distance, and the degree of postoperative glenohumeral osteoarthritis (p < 0.05).

Conclusions

This study documents that an attempt at rotator cuff repair significantly decreases pain (p = 0.0026) and significantly improves function (p = 0.0005) and strength (p = 0.0137) even if magnetic resonance imaging documents that the repair has failed. This finding suggests that the potential for rerupture should not be considered a formal contraindication to an attempt at repair if optimal functional recovery is the goal of treatment.

Copyright remains with the authors and publisher.

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