Arthroscopic debridement of massive irreparable rotator cuff tears.
OBJECTIVE
The purpose of this study was to evaluate clinical and radiologic results of arthroscopic debridement of massive irreparable rotator cuff tears.


METHODS
Thirty-one patients (mean age, 70.6 years) were retrospectively reviewed for a mean of 47 months (range, 24 to 69 months) after arthroscopic debridement of an irreparable rotator cuff tear. Operative treatment included biceps tenotomy in 24 cases (77.4%). No acromioplasty was performed to maintain the coracoacromial arch. Clinical outcome was assessed by use of the American Shoulder and Elbow Surgeons (ASES) and Constant scores, as well as measurement of abduction strength and elbow flexion strength compared with the contralateral side at final follow-up. Preoperative and follow-up radiographs were evaluated for acromiohumeral distance and grade of osteoarthritis according to the Samilson-Prieto classification.


RESULTS
The mean ASES score was significantly improved from 24.0 to 69.8 points at follow-up. Scores for pain were reduced from 7.8 to 2.9 points on a visual analog scale ranging from 0 to 10 points. The age- and gender-adjusted Constant score was 72.2%. Radiologic analysis showed progression of osteoarthritis in 10 cases (32.3%); this had no influence on the ASES score. Acromiohumeral distance decreased from 8.3 to 7.0 mm. Biceps strength was 6.1 kg on the operated side and 6.3 kg on the contralateral side. Abduction strength was significantly lower on the operated side at 2.6 kg versus 3.7 kg on the contralateral side. No complication related to the procedure was reported.


CONCLUSIONS
For elderly patients with low functional demands, arthroscopic debridement in combination with biceps tenotomy is a safe procedure and leads to significant functional improvement without loss of biceps strength. Progression of osteoarthritic changes cannot be prevented, but no influence on the clinical result could be shown.


METHODS
Level IV, therapeutic case series.
Liem
Dennis
D
Department of Orthopaedics, University Hospital of Münster, Münster, Germany. dennisliem@web.de
Lengers
Nina
N
Dedy
Nicolas
N
Poetzl
Wolfgang
W
Steinbeck
Jörn
J
Marquardt
Björn
B
D000368:Aged; D001182:Arthroscopy; D003646:Debridement / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006801:Humans; D022125:Lacerations / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D010003:Osteoarthritis / Q000150:complications; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery; D013710:Tendons / Q000601:surgery; D016896:Treatment Outcome