The Journal of Bone and Joint Surgery 83:71 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.
Surgical Repair of Chronic Rotator Cuff Tears
A Prospective Long-Term Study
Robert H. Cofield, MD,
Javad Parvizi, MD, FRCS,
Pierre J. Hoffmeyer, MD,
William L. Lanzer, MD,
Duane M. Ilstrup, MS and
Charles M. Rowland, MS
Investigation performed at the Departments of Orthopedic
Surgery and Biostatistics, Mayo Clinic and Mayo Foundation, Rochester,
Minnesota
Robert H. Cofield, MD
Javad Parvizi, MD, FRCS
Duane M. Ilstrup, MS
Charles M. Rowland, MS
Departments of Orthopedic Surgery (R.H.C. and J.P.) and Biostatistics
(D.M.I. and C.M.R.), Mayo Clinic, 200 First Street S.W., Rochester,
MN 55905
Pierre J. Hoffmeyer, MD
Hopitaux Universitaires de Geneve, Rue Micheli-du-Crest 24, CH-1211
Geneve 14, Switzerland
William L. Lanzer, MD
550 16th Avenue, Suite 300A, Seattle, WA 98122
No benefits in any form have been received or will be received
from a commercial party related directly or indirectly to the subject
of this article. No funds were received in support of this study.
Background: Rotator cuff disease or injury is
one of the most frequently seen orthopaedic conditions, and surgical
repair of rotator cuff tears is a common procedure. A prospective
analysis of the operation, with consistent assessment of patient
characteristics, variables associated with the rotator cuff tear
and repair techniques, and outcome factors, was performed.
Methods: One hundred and five shoulders with a chronic rotator
cuff tear underwent open surgical repair and acromioplasty between
1975 and 1983. The patients were followed for an average of 13.4
years (range, two to twenty-two years). There were sixteen small
tears, forty medium tears, thirty-eight large tears, and eleven
massive tears. The tears were repaired directly (seventy-two tears),
by V-Y plasty (twelve), by tendon transposition (twenty), or by
reinforcement with a fascia lata graft (one). The long head of the
biceps had been previously torn in eleven shoulders and was tenodesed
in three other shoulders. In fifty-six shoulders, the distal part
of the clavicle was excised for treatment of degenerative arthritic
changes, often associated with osteophyte formation.
Results: Satisfactory pain relief was obtained in
ninety-six shoulders (p < 0.0001). There was significant improvement
in active abduction (p < 0.001) and external rotation (p < 0.007)
as well as in strength in these directions of movement (p < 0.03
and p < 0.002, respectively). At the latest follow-up evaluation,
the result was rated as excellent for sixty-eight shoulders, satisfactory
for sixteen, and unsatisfactory for twenty-one. Tear size was the
most important determinant of outcome with regard to active motion,
strength, rating of the result, patient satisfaction, and need for
a reoperation. Older age, less preoperative active motion, preoperative
weakness, distal clavicular excision, and a transposition repair technique
were all associated with larger tear size. There were eight reoperations;
five were for rerepair of a persistent or recurrent rotator cuff
tear.
Conclusions: Standard tendon repair techniques combined
with anterior acromioplasty, postoperative limb protection, and
monitored physiotherapy can produce consistent and lasting pain
relief and improvement in range of motion. Improving the results
of this procedure will depend upon the development of new techniques
to address the active motion and strength deficiencies following
repair of massive rotator cuff tears.
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