title: Clinical and structural outcome 22 years after acromioplasty without tendon repair in patients with subacromial pain and cuff tears.
abstract: BACKGROUND
  Long-term results regarding tear progression, arthropathy, and clinical scores of unrepaired rotator cuff tears are largely unknown. This study investigated whether the condition of the glenohumeral joint and rotator cuff had deteriorated at a minimum of 20 years after an acromioplasty without cuff repair and assessed the clinical results.
  
  
  METHODS
  A retrospective analysis was conducted of a consecutive series of patients treated between 1989 and 1993 with acromioplasty without cuff repair due to subacromial pain and cuff tear. At follow-up results of x-ray, ultrasonography, and clinical scores were recorded.
  
  
  RESULTS
  At a mean of 22 years (range, 21-25 years), 69 patients were available for follow-up with Western Ontario Rotator Cuff Index, Constant-Murley (CM) score, x-ray, and ultrasonography. Mean age at operation was 49 years (range, 19-69 years). There were 45 partial-thickness tears (PTT) and 24 full-thickness tears (FTT). Of 23 patients with FTT, 17 (74% with x-ray) had developed cuff tear arthropathy (Hamada ≥2) and 20 (87% with ultrasonography) had progressed in tear size. Mean relative CM in patients with FTT and cuff tear arthropathy was 62 (standard deviation [SD], 27), and the mean WORC was 58% (SD, 26%). In the 43 PTT patients, 3 (7% with x-ray) had developed cuff tear arthropathy and 16 (42% with ultrasonography) had tear progression. With PTT at follow-up, the mean relative CM was 101 (SD, 22), and the mean WORC was 81% (SD, 20%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthopedics, Kalmar County Hospital, Kalmar, Sweden; The Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden. Electronic address: mats.ranebo@ltkalmar.se.
authors.forename: Mats C
authors.initials: MC
authors.lastname: Ranebo
authors.affiliation: Department of Orthopedics, Linkoping University Hospital, Linköping, Sweden.
authors.forename: Hanna C
authors.initials: HC
authors.lastname: Björnsson Hallgren
authors.affiliation: The Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: Rolf
authors.initials: R
authors.lastname: Norlin
authors.affiliation: The Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Department of Orthopedics, Linkoping University Hospital, Linköping, Sweden.
authors.forename: Lars E
authors.initials: LE
authors.lastname: Adolfsson
mesh_terms: D000174:Acromion / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D000070636:Rotator Cuff Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D000070656:Rotator Cuff Tear Arthropathy / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology*; D020069:Shoulder Pain / Q000601:surgery*; D013997:Time Factors; D014463:Ultrasonography; D055815:Young Adult
keywords: Shoulder; acromioplasty; cuff tear arthropathy; long-term; natural history; rotator cuff; tear progression