Ranebo, J Shoulder Elbow Surg 2017 - Clinical and Structural Outcome 22 Years after Acromioplasty without Tendon Repair in Patients with Subacromial Pain and Cuff Tears
|
Clinical and Structural Outcome 22 Years after Acromioplasty without Tendon Repair in Patients with Subacromial Pain and Cuff Tears
Ranebo, Adolfsson, et al.·J Shoulder Elbow Surg·2017·42 citations
Ranebo and colleagues asked whether unrepaired partial- and full‑thickness cuff tears had progressed, and whether the glenohumeral joint had deteriorated, more than 20 years after arthroscopic acromioplasty alone.
Retrospective review of a consecutive series operated at Linköping University Hospital from 1989 to 1993. 69 of 111 patients were examined at a mean 22 years (range 21 to 25). Level IV.
Key Findings
Of the unrepaired full‑thickness tears, 20 progressed (87% of those scanned) and 17 developed cuff tear arthropathy, Hamada 2 or higher (74% of those with radiographs).
Of the partial‑thickness tears, 16 progressed to full thickness (42% of those scanned) and 3 of 43 with radiographs (7%) developed arthropathy. Both rates were significantly lower than with full‑thickness tears (p < 0.001).
By tear type at surgery, partial tears ended with better scores than full tears: mean WORC 77% vs 64% (p = 0.03) and relative Constant 92 vs 72 (p = 0.027).
Scores tracked arthropathy. With a full‑thickness tear at follow‑up, mean relative Constant was 88 with Hamada 1 (n = 18) vs 51 with Hamada 4b (n = 8).
With a full‑thickness tear and Hamada 2 or higher, 30% to 35% reported moderate to severe pain on the WORC pain questions.
There were no preoperative scores and no repaired comparison group, so the study cannot say whether repair would have done better. The authors suspect the 32 patients who died or were too ill would have shown high progression rates.
Authors' conclusion
After an acromioplasty, most unrepaired full-thickness tears will, in long-term, increase in size and be accompanied by cuff tear arthropathy changes. Most partial thickness tears remain unchanged; cuff tear arthropathy is rare, and clinical scores generally good.
Ranebo and colleagues asked whether unrepaired partial- and full‑thickness cuff tears had progressed, and whether the glenohumeral joint had deteriorated, more than 20 years after arthroscopic acromioplasty alone.
Retrospective review of a consecutive series operated at Linköping University Hospital from 1989 to 1993. 69 of 111 patients were examined at a mean 22 years (range 21 to 25). Level IV.
Key Findings
Of the unrepaired full‑thickness tears, 20 progressed (87% of those scanned) and 17 developed cuff tear arthropathy, Hamada 2 or higher (74% of those with radiographs).
Of the partial‑thickness tears, 16 progressed to full thickness (42% of those scanned) and 3 of 43 with radiographs (7%) developed arthropathy. Both rates were significantly lower than with full‑thickness tears (p < 0.001).
By tear type at surgery, partial tears ended with better scores than full tears: mean WORC 77% vs 64% (p = 0.03) and relative Constant 92 vs 72 (p = 0.027).
Scores tracked arthropathy. With a full‑thickness tear at follow‑up, mean relative Constant was 88 with Hamada 1 (n = 18) vs 51 with Hamada 4b (n = 8).
With a full‑thickness tear and Hamada 2 or higher, 30% to 35% reported moderate to severe pain on the WORC pain questions.
There were no preoperative scores and no repaired comparison group, so the study cannot say whether repair would have done better. The authors suspect the 32 patients who died or were too ill would have shown high progression rates.
Authors' conclusion
After an acromioplasty, most unrepaired full-thickness tears will, in long-term, increase in size and be accompanied by cuff tear arthropathy changes. Most partial thickness tears remain unchanged; cuff tear arthropathy is rare, and clinical scores generally good.