title: Arthroscopic management of massive rotator cuff tears: an evaluation of debridement, complete, and partial repair with and without force couple restoration.
abstract: OBJECTIVE
  To evaluate the effectiveness of arthroscopic debridement (DB), partial (PR), and complete repair (CR) for massive rotator cuff tears (mRCT) in terms of functional and subjective parameters, and repair integrity.
  
  
  METHODS
  For this single-centre study, 68 consecutive shoulders with mRCT involving at least three tendons and treated with arthroscopic DB (n = 23), PR (n = 22), and CR (n = 23) were included. All patients (52-81 years) were prospectively assessed before and at a mean of 45 months after surgery using functional and subjective parameters. Preoperative tendon rupture pattern and post-operative repair integrity were assessed by MRI. A coding system describing accurately rotator cuff rupture, treatment, and integrity was established.
  
  
  RESULTS
  All treatment groups improved significantly from pre- to post-operative (P < 0.01), while preoperative parameters, except fatty degeneration, were not significantly different. However, post-operative comparisons revealed similar scores with DB (constant score, CS 65.8 ± 14.7, qDASH 24.1 ± 20.6) and PR (CS 67.5 ± 9.9, P = n.s.; qDASH 20.5 ± 14.4, P = n.s.), while CR were significantly better (CS 80.3 ± 8.9; qDASH 7.0 ± 8.7; P ≤ 0.001). Force couple restoration of PR did not significantly influence outcome. Re-tear rates with CR (29 %) were lower compared to PR (53 %). Intact CR compared to intact PR showed better CS (83.4 ± 7.3 vs. 68.5 ± 10.6, P = 0.009) and qDASH (5.4 ± 8.3 vs. 21.2 ± 9.5, P = 0.006). The vast majority of patients were satisfied with their arthroscopic procedure (DB 87 %; PR 86 %; CR 91 %).
  
  
  CONCLUSIONS
  Arthroscopic DB, PR, and CR were effective in treating mRCT involving at least three tendons. Reparability of mRCT was influenced by fatty degeneration of the muscles. However, CR showed the most favourable short-term improvements.
  
  
  METHODS
  IV.
authors.affiliation: Department of Orthopedics, St. Vincent Hospital, Stumpergasse 13, 1060, Vienna, Austria.
authors.forename: Philipp R
authors.initials: PR
authors.lastname: Heuberer
authors.affiliation: Department of Orthopedics, St. Vincent Hospital, Stumpergasse 13, 1060, Vienna, Austria.
authors.forename: Roman
authors.initials: R
authors.lastname: Kölblinger
authors.affiliation: Department of Orthopedics, St. Vincent Hospital, Stumpergasse 13, 1060, Vienna, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Buchleitner
authors.affiliation: Department of Orthopedics, St. Vincent Hospital, Stumpergasse 13, 1060, Vienna, Austria.
authors.forename: Leo
authors.initials: L
authors.lastname: Pauzenberger
authors.affiliation: Department of Orthopedics, St. Vincent Hospital, Stumpergasse 13, 1060, Vienna, Austria.
authors.forename: Brenda
authors.initials: B
authors.lastname: Laky
authors.affiliation: Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Auffarth
authors.affiliation: Department of Traumatology and Sports Injuries, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Philipp
authors.initials: P
authors.lastname: Moroder
authors.affiliation: Department of Orthopedics, St. Vincent Hospital, Stumpergasse 13, 1060, Vienna, Austria.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Salem
authors.affiliation: Department of Orthopedics, St. Vincent Hospital, Stumpergasse 13, 1060, Vienna, Austria.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kriegleder
authors.affiliation: Department of Orthopedics, St. Vincent Hospital, Stumpergasse 13, 1060, Vienna, Austria. werner.anderl@bhs.at.
authors.forename: Werner
authors.initials: W
authors.lastname: Anderl
mesh_terms: D000368:Aged; D001182:Arthroscopy / Q000379:methods*; D003646:Debridement / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D019651:Plastic Surgery Procedures / Q000379:methods; D017006:Rotator Cuff / Q000601:surgery; D000070636:Rotator Cuff Injuries / Q000601:surgery*; D053656:Tenodesis / Q000379:methods; D058971:Tenotomy / Q000379:methods; D015599:Trauma Severity Indices; D016896:Treatment Outcome
keywords: Arthroscopy; Complete repair; Debridement; Force couple; Massive rotator cuff tear; Partial repair