FUNCTIONAL EVALUATION OF PATIENTS WHO HAVE UNDERGONE ARTHROSCOPIC DEBRIDEMENT TO TREAT MASSIVE AND IRREPARABLE TEARS OF THE ROTATOR CUFF

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Abstract

To evaluate the results from patients who underwent arthroscopic debridement of extensive irreparable rotator cuff injuries. Methods: 27 patients were operated between 2003 and 2007, and 22 of them were evaluated. The surgical procedure consisted of arthroscopic debridement of the stumps of the tendons involved, bursectomy, removal of acromial osteophytes and, possibly, biceps tenotomy and tuberoplasty. Results: All the patients showed involvement of the supraspinatus and infraspinatus tendons at the preoperative stage. In the postoperative evaluation, 14 patients had a complete teres minor muscle, and three had partial tears of the subscapularis tendon. There was an improvement in the UCLA criteria, from 15 preoperatively to 31 postoperatively. There was no improvement in muscle strength, but there was a reduction in the pain. Conclusion: Arthroscopic debridement is a recommended procedure for elderly patients with irreparable rotator cuff tears, good range of motion and low functional demand, when the main objective is to diminish pain.

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Most cited references 25

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Results of a second attempt at surgical repair of a failed initial rotator-cuff repair.

J DeOrio, R Cofield (1984)

Twenty-seven patients with twenty-seven involved shoulders underwent a second attempt at repair of an initial rotator-cuff repair that had failed. Factors associated with the failure of the initial repair included a massive or large tendon tear, damage to the deltoid origin at the original surgery, and possibly inadequate postoperative external support. Seven patients required a third operation because of continuing pain or weakness. The remaining twenty patients were followed for a minimum of two years (average, forty-eight months) and seventeen of them were examined at an average of forty-six months (range, twenty-six to 118 months) after surgery. Postoperatively, although seventeen patients (63 per cent) still had moderate or severe pain, sixteen (76 per cent) of the twenty-one patients who were operated on to relieve pain reported that the pain was substantially diminished. Active abduction increased an average of 8 degrees, but only seven shoulders gained more than 30 degrees of active abduction. Nineteen shoulders remained moderately or markedly weak in abduction. Over-all, four patients (17 per cent) had a good result; six (25 per cent), a fair result; and fourteen (58 per cent), a poor result. These results suggest that the surgeon should be quite hesitant to propose a second attempt at rotator cuff repair to a patient, as although pain may be diminished, active movement is unlikely to improve.

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Reverse total shoulder arthroplasty: a review of results according to etiology.

Bryan Wall, Laurent Nové-Josserand, Daniel P O'Connor … (2007)

Reverse total shoulder arthroplasty provides a surgical alternative to standard total shoulder arthroplasty for the treatment of selected complex shoulder problems. The purpose of the present study was to evaluate the effects of etiology on the results of reverse total shoulder arthroplasty. Between May 1995 and June 2003, 240 consecutive reverse total shoulder arthroplasties were performed in 232 patients with an average age of 72.7 years. Patients were grouped according to etiology, and the clinical and radiographic outcomes for each group were measured and compared. One hundred and eighty-six patients with 191 retained reverse total shoulder arthroplasty prostheses were followed for an average of 39.9 months. Overall, the average Constant score improved from 23 points before surgery to 60 points at the time of follow-up and 173 of the 186 patients were satisfied or very satisfied with the result. Although substantial clinical and functional improvement was observed in all etiology groups, patients with primary rotator cuff tear arthropathy, primary osteoarthritis with a rotator cuff tear, and a massive rotator cuff tear had better outcomes, on average, than patients who had posttraumatic arthritis and those managed with revision arthroplasty. Dislocation (fifteen cases) and infection (eight cases) were the most common complications among the 199 shoulders that were followed for two years or were revised prior to the minimum two-year follow-up. Patients who received the reverse prosthesis at the time of a revision arthroplasty had a higher complication rate than did those who received the reverse prosthesis at the time of a primary arthroplasty. The reverse total shoulder arthroplasty prosthesis can produce good results when used for the treatment of a number of other complex shoulder problems in addition to cuff tear arthropathy. Patients with posttraumatic arthritis and those undergoing revision arthroplasty may have less improvement and higher complication rates in comparison with patients with other etiologies. The advanced age of the patients in the present series and the relatively short duration of follow-up suggest that the prosthesis should continue to be used judiciously.

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Classification of rotator cuff lesions.

D Patte (1990)

Among various studies reporting the outcome of surgical repairs of rotator cuff tears, comparisons are very difficult because of the absence of a classification system. A proposed classification system takes into account the extent of the tear, its topography in the sagittal and frontal planes, the trophic quality of the muscle, and the integrity of the long head of the biceps. The new classification system exploits the advances in diagnostic imaging and is useful in the assessment of nonoperatively treated patients.

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Author and article information

Contributors

Marco Antônio de Castro Veado: Role: Professor

Alessandro Ulhôa Rodrigues: Role: Surgeon

Journal

Journal ID (nlm-ta): Rev Bras Ortop

Journal ID (iso-abbrev): Rev Bras Ortop

Title: Revista Brasileira de Ortopedia

Publisher: Elsevier

ISSN (Electronic): 2255-4971

Publication date PMC-release: 12 December 2015

Publication date Collection: Sep-Oct 2010

Publication date (Electronic): 12 December 2015

Volume: 45

Issue: 5

Pages: 426-431

Affiliations

[1 ]Professor in the School of Medical Sciences of Minas Gerais; Surgeon in the Shoulder and Elbow Group of Hospital Mater Dei and Hospital Israel Pinheiro de Minas Gerais (IPSEMG)

[2 ]Surgeon in the Shoulder and Elbow Group of Hospital Mater Dei, Belo Horizonte, MG

Author notes

[* ]Correspondence: Avenida Barbacena 1018/806, Santo Agostinho, 30190-131 Belo Horizonte, MGCorrespondence: Avenida Barbacena 1018/806Santo AgostinhoBelo HorizonteMG30190-131 alessandroulhoa@ 123456superig.com.br

Article

Publisher ID: S2255-4971(15)30431-6

DOI: 10.1016/S2255-4971(15)30431-6

PMC ID: 4799142

PubMed ID: 27022590

SO-VID: 60681f3e-4e54-4054-b336-02860500f049

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

FUNCTIONAL EVALUATION OF PATIENTS WHO HAVE UNDERGONE ARTHROSCOPIC DEBRIDEMENT TO TREAT MASSIVE AND IRREPARABLE TEARS OF THE ROTATOR CUFF

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Abstract

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Most cited references 25

Results of a second attempt at surgical repair of a failed initial rotator-cuff repair.

Reverse total shoulder arthroplasty: a review of results according to etiology.

Classification of rotator cuff lesions.

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