title: Open repair for massive rotator cuff tear with a modified transosseous-equivalent procedure: preliminary results at short-term follow-up.
abstract: BACKGROUND
  Many surgical procedures have been reported for rotator cuff tears. We adopted the modified transosseous-equivalent procedure, also termed "surface-holding repair with transosseous sutures," and demonstrated that this procedure has a biomechanical advantage regarding the concentration of stress on the tendon stump. This study aimed to evaluate the clinical and structural outcomes of this technique, which has been demonstrated by postoperative magnetic resonance imaging (MRI) to produce high intact rates.
  
  
  METHODS
  Twenty-nine massive rotator cuff tears involving at least two tendons were treated by open repair using this procedure. Twenty-four patients were evaluated at an average of 43.2 months (range 24-71) postoperatively (the follow-up rate was 83.8%). The pre- and postoperative clinical outcomes were examined using the scoring system of the Japanese Orthopedic Association (JOA score). In an A-P radiograph, the presence of osteoarthritis (OA) of the glenohumeral joint and upward migration of the humeral head were compared pre- and postoperatively. The repair integrity of the cuff tendon was evaluated by applying Sugaya's classification to the postoperative MRIs.
  
  
  RESULTS
  The JOA score improved from 42.8 points preoperatively to 89.3 points at final follow-up. Radiographic examination showed that OA progressed in 16.7% and upward migration of the humeral head progressed in 20.8%. Postoperative MRI scans revealed 14 shoulders with type 1 repair based on Sugaya's classification, 4 shoulders with type 2, 4 shoulders with type 3, 2 shoulders with type 4, and no shoulders with a type 5 repair.
  
  
  CONCLUSIONS
  Although osteoarthritis of the glenohumeral joint and upward migration of the humeral head had both progressed postoperatively in some cases, postoperative MRI scans revealed that 91.7% of the repairs resulted in a continuous rotator cuff. Therefore, this technique produces a high healing rate.
authors.affiliation: Department of Orthopedic Surgery, University of the Ryukyus Graduate School of Medicine, 207 Uehara, Nishihara, Okinawa, Japan. hyama_shoulder@hotmail.com
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamaguchi
authors.forename: Naoki
authors.initials: N
authors.lastname: Suenaga
authors.forename: Naomi
authors.initials: N
authors.lastname: Oizumi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Hosokawa
authors.forename: Fuminori
authors.initials: F
authors.lastname: Kanaya
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D013997:Time Factors