title: Arthroscopic Repair of Massive Cuff Tears With Large Subscapularis Tendon Ruptures (Lafosse III/IV): A Prospective Magnetic Resonance Imaging-Controlled Case Series of 26 Cases With a Minimum Follow-up of 1 Year.
abstract: OBJECTIVE
  To prospectively assess arthroscopic repair of massive cuff tears (MCT) in a highly selective patient group with large subscapularis (SSC) tendon tears by means of clinical results and magnetic resonance imaging (MRI) studies.
  
  
  METHODS
  Between April 2009 and December 2010, 26 patients with MCT were treated with arthroscopic rotator cuff repair. Only lesions involving a large tear of the SSC tendon (Lafosse III or IV) in combination with a complete tear of the supraspinatus (SSP) tendon and a tear of at least the anterior third of the infraspinatus (ISP) tendon were included. Minimum follow-up was 1 year. Pre- and postoperative assessment included a standardized clinical examination, subjective patient outcome, and MRI (structural integrity, fatty muscle infiltration, and muscular mass).
  
  
  RESULTS
  Mean follow-up was 17 months (range, 12 to 34 months). MRI was performed in 25 patients. In 21 (84%) the cuff repair was intact. A partial retear of the SSC was found in 2 patients (8%). In 2 patients (8%) a full-thickness retear of the posterosuperior cuff was observed (1 SSP, 1 SSP/ISP). A significant increase of the muscle mass and decrease of fatty infiltration was observed for the SSC and SSP but not for the ISP. The mean Constant-Murley score improved from 36 to 86 points (P < .001) with all its subscores as well (P < .001). Muscular strength improved for the SSC (4.9 v 3.0, P < .001), SSP (4.6 v 2.9, P < .001), and ISP (4.8 v 3.4, P < .001). Overall patient satisfaction was high (3.6 ± 0.8).
  
  
  CONCLUSIONS
  Arthroscopic repair of MCT involving the ISP, SSP, and large tears of the SSC provides a reliable tendon healing, in particular for the SSC tendon, combined with good functional results.
  
  
  METHODS
  Level IV, therapeutic case series.
authors.affiliation: Department of Surgery, Waid Hospital Zurich, Zurich, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Grueninger
authors.affiliation: Institute for Clinical Radiology, Waid Hospital Zurich, Zurich, Switzerland.
authors.forename: Nikola
authors.initials: N
authors.lastname: Nikolic
authors.affiliation: Department of Surgery, Waid Hospital Zurich, Zurich, Switzerland; Institute for Clinical Radiology, Waid Hospital Zurich, Zurich, Switzerland.
authors.forename: Joerg
authors.initials: J
authors.lastname: Schneider
authors.affiliation: Department of Surgery, Triemli Hospital Zurich, Zurich, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lattmann
authors.affiliation: Department of Surgery, Triemli Hospital Zurich, Zurich, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Platz
authors.affiliation: Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland.
authors.forename: Corinne
authors.initials: C
authors.lastname: Chmiel
authors.affiliation: Department of Surgery, Waid Hospital Zurich, Zurich, Switzerland. Electronic address: christoph.meier@ksw.ch.
authors.forename: Christoph
authors.initials: C
authors.lastname: Meier
mesh_terms: D000368:Aged; D001182:Arthroscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011184:Postoperative Period; D011446:Prospective Studies; D017006:Rotator Cuff / Q000473:pathology / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012421:Rupture; D013708:Tendon Injuries / Q000175:diagnosis / Q000601:surgery*