The Journal of Bone and Joint Surgery (American). 2005;87:1278-1283.
doi:10.2106/JBJS.D.02432
© 2005 The Journal of Bone and Joint Surgery, Inc.
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 Shoulder/Elbow Test 10: Summer 2005
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Open Rotator Cuff Repair without Acromioplasty

Wren V. McCallister, MD1, I. Moby Parsons, MD2, Robert M. Titelman, MD3 and Frederick A. Matsen, III, MD1

1 Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 N.E. Pacific Street, Box 356500, Seattle, WA 98195. E-mail address for F.A. Matsen III: matsen{at}u.washington.edu
2 Seacoast Orthopaedics and Sports Medicine, 237 Route 108, Suite 205, Somersworth, NH 03878
3 Resurgens Orthopaedics, 1285 Hembree Road, Suite 200-A, Roswell, GA 30076

Investigation performed at the Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, Washington

Background: In most clinical reports on rotator cuff repair, acromioplasty was done as part of the procedure. In this prospective study, we evaluated the hypothesis that rotator cuff repair without acromioplasty would result in a substantial improvement in shoulder comfort and function.

Methods: Ninety-six consecutive primary repairs of full-thickness tears of the rotator cuff were performed through a deltoid-muscle-splitting incision that preserved the integrity of the coracoacromial arch and the deltoid insertion. All patients were invited to participate in a prospective study involving periodic self-assessment of shoulder function with the Simple Shoulder Test and general health status with the Short Form-36 (SF-36) questionnaire, both of which are validated instruments. Sixty-one patients provided follow-up information for at least two years postoperatively, and the average duration of follow-up was five years. Thirty-four of the tears involved the supraspinatus tendon alone; sixteen involved the supraspinatus and infraspinatus tendons; and eleven involved the supraspinatus, infraspinatus, and subscapularis tendons.

Results: The percentage of shoulders that could be used to perform each of the twelve functions on the Simple Shoulder Test was significantly increased postoperatively (p < 0.002). Men and women had different degrees of function preoperatively (p < 0.00000001) and postoperatively (p < 0.001), but the improvement in function was essentially identical for the two genders. The mean improvement in the number of shoulder tests that could be performed was best for the patients with one-tendon tears (4.9 tests), next best for those with two-tendon tears (3.6 tests), and worst for those with three-tendon tears (3.3 tests). SF-36 scores for physical role (p < 0.003) and comfort (p < 0.0001) were significantly improved postoperatively.

Conclusions: Significant improvement in self-assessed shoulder comfort and in each of the twelve shoulder functions was observed after rotator cuff repairs performed without acromioplasty. The technique that we used is very similar to that described by Codman almost seventy years ago.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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Letters to the Editor:

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An Apology and Clarification by Dr. Matsen
Frederick A. Matsen, MD
JBJS Online, 8 Oct 2008 [Full text]