Open Access, Peer-reviewed
pISSN 1226-2102
eISSN 2005-8918
    J Korean Orthop Assoc. 2013 Feb;48(1):61-69. Korean.
    Published online Feb 26, 2013.
    https://doi.org/10.4055/jkoa.2013.48.1.61
    Copyright © 2013 by The Korean Orthopaedic Association
    Review

    Treatment of Massive Rotator Cuff Tears: Focusing on Arthroscopic Approach

    Seung Won Lee, M.D., Min Soo Shon, M.D.,* and Jae Chul Yoo, M.D.
      • Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
      • *Department of Orthopedic Surgery, National Medical Center, Seoul, Korea.
    • Correspondence to: Jae Chul Yoo, M.D. Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. TEL: +82-2-3410-3501, FAX: +82-2-3410-0061, Email: shoulderyoo@gmail.com
    Received January 31, 2013; Revised February 13, 2013; Accepted February 14, 2013.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    There are no standard guidelines for treatment of massive rotator cuff tears. In this article, we reviewed the various modalities for treatment of massive rotator cuff tears, especially focusing on arthroscopic treatment. Selection of one of a variety of treatment modalities is essential for understanding pathogenesis, biomechanics and reparability of massive rotator cuff tears. The best clinical results have been reported with arthroscopic complete repair of massive rotator cuff tear. Satisfactory results have also been reported with other various arthroscopic treatment methods, including simple debridement, partial repair, biceps tenotomy or tendesis, and augmentation using a tissue substitution. However few long-term follow up results are available with these salvage options. Treatment of massive rotator cuff tears is difficult due to high incidence of irreparable tears and re-tear rate. Thus, understanding the advantages and disadvantages of various treatment modalities is thought to be helpful to improving the outcome of treatment of massive rotator cuff tears.

    Keywords
    rotator cuff; massive tear; arthroscopy

    Figures

    Figure 1
    (A) Pre-operative magnetic resonance imaging shows a massive rotator cuff tear with severe tendon retraction and (B) fatty degeneration. (C) Arthroscopic finding of the same patient shows severe retraction of tendons. (D) Rotator cuff tendons could not be restored to the original footprint, despite of mobilization; therefore partial repair was performed. H, humeral head; G, Glenoid; SS, supraspinatus; SC, subscapularis; IS, infraspinatus; TM, teres minor.

    References

      1. Denard PJ, Lädermann A, Jiwani AZ, Burkhart SS. Functional outcome after arthroscopic repair of massive rotator cuff tears in individuals with pseudoparalysis. Arthroscopy 2012;28:1214–1219.
      1. Shin SJ. Massive rotator cuff tear repair. J Korean Shoulder Elbow Soc 2010;13:167–174.
      1. Post M, Silver R, Singh M. Rotator cuff tear. Diagnosis and treatment. Clin Orthop Relat Res 1983;173:78–91.
      1. Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am 2000;82:505–515.
      1. Burkhart SS. Arthroscopic treatment of massive rotator cuff tears. Clinical results and biomechanical rationale. Clin Orthop Relat Res 1991;267:45–56.
      1. Nobuhara K, Hata Y, Komai M. Surgical procedure and results of repair of massive tears of the rotator cuff. Clin Orthop Relat Res 1994;304:54–59.
      1. Tauro JC. Arthroscopic rotator cuff repair: analysis of technique and results at 2- and 3-year follow-up. Arthroscopy 1998;14:45–51.
      1. Inman VT, Saunders JB, Abbott LC. Observations of the function of the shoulder joint. 1944. Clin Orthop Relat Res 1996;330:3–12.
      1. Lo IK, Burkhart SS. Arthroscopic repair of massive, contracted, immobile rotator cuff tears using single and double interval slides: technique and preliminary results. Arthroscopy 2004;20:22–33.
      1. Albritton MJ, Graham RD, Richards RS 2nd, Basamania CJ. An anatomic study of the effects on the suprascapular nerve due to retraction of the supraspinatus muscle after a rotator cuff tear. J Shoulder Elbow Surg 2003;12:497–500.
      1. Abrams JS. Arthroscopic approach to massive rotator cuff tears. Instr Course Lect 2006;55:59–66.
      1. Gerber C, Meyer DC, Schneeberger AG, Hoppeler H, von Rechenberg B. Effect of tendon release and delayed repair on the structure of the muscles of the rotator cuff: an experimental study in sheep. J Bone Joint Surg Am 2004;86:1973–1982.
      1. Gerber C, Galantay RV, Hersche O. The pattern of pain produced by irritation of the acromioclavicular joint and the subacromial space. J Shoulder Elbow Surg 1998;7:352–355.
      1. MacDonald PB, Altamimi S. Principles of arthroscopic repair of large and massive rotator cuff tears. Instr Course Lect 2010;59:269–280.
      1. Walch G, Boulahia A, Calderone S, Robinson AH. The 'dropping' and 'hornblower's' signs in evaluation of rotator-cuff tears. J Bone Joint Surg Br 1998;80:624–628.
      1. Alqunaee M, Galvin R, Fahey T. Diagnostic accuracy of clinical tests for subacromial impingement syndrome: a systematic review and meta-analysis. Arch Phys Med Rehabil 2012;93:229–236.
      1. Rockwood CA Jr, Williams GR Jr, Burkhead WZ Jr. Débridement of degenerative, irreparable lesions of the rotator cuff. J Bone Joint Surg Am 1995;77:857–866.
      1. Warner JJ, Parsons IM 4th. Latissimus dorsi tendon transfer: a comparative analysis of primary and salvage reconstruction of massive, irreparable rotator cuff tears. J Shoulder Elbow Surg 2001;10:514–521.
      1. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 1994;304:78–83.
      1. Thomazeau H, Boukobza E, Morcet N, Chaperon J, Langlais F. Prediction of rotator cuff repair results by magnetic resonance imaging. Clin Orthop Relat Res 1997;344:275–283.
      1. Davidson JF, Burkhart SS, Richards DP, Campbell SE. Use of preoperative magnetic resonance imaging to predict rotator cuff tear pattern and method of repair. Arthroscopy 2005;21:1428.
      1. Sugihara T, Nakagawa T, Tsuchiya M, Ishizuki M. Prediction of primary reparability of massive tears of the rotator cuff on preoperative magnetic resonance imaging. J Shoulder Elbow Surg 2003;12:222–225.
      1. Zanetti M, Gerber C, Hodler J. Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging. Invest Radiol 1998;33:163–170.
      1. Yoo JC, Ahn JH, Yang JH, Koh KH, Choi SH, Yoon YC. Correlation of arthroscopic repairability of large to massive rotator cuff tears with preoperative magnetic resonance imaging scans. Arthroscopy 2009;25:573–582.
      1. Burkhead WZ Jr, Scheinberg RR, Box G. Surgical anatomy of the axillary nerve. J Shoulder Elbow Surg 1992;1:31–36.
      1. Nicholson GP. Mini-open rotator-cuff repair. Oper Tech Orthop 2002;12:162–166.
      1. Bigliani LU, Cordasco FA, McLlveen SJ, Musso ES. Operative repair of massive rotator cuff tears: long-term results. J Shoulder Elbow Surg 1992;1:120–130.
      1. Cofield RH, Parvizi J, Hoffmeyer PJ, Lanzer WL, Ilstrup DM, Rowland CM. Surgical repair of chronic rotator cuff tears. A prospective long-term study. J Bone Joint Surg Am 2001;83:71–77.
      1. Musil D, Sadovský P, Stehlík J. Massive tears of rotator cuff - comparison of mini-open and arthroscopic techniques. Part 1. Mini-open technique. Acta Chir Orthop Traumatol Cech 2006;73:387–393.
      1. Bartl C, Kouloumentas P, Holzapfel K, et al. Long-term outcome and structural integrity following open repair of massive rotator cuff tears. Int J Shoulder Surg 2012;6:1–8.
      1. Zumstein MA, Jost B, Hempel J, Hodler J, Gerber C. The clinical and structural long-term results of open repair of massive tears of the rotator cuff. J Bone Joint Surg Am 2008;90:2423–2431.
      1. Vastamäki M, Lohman M, Borgmästars N. Rotator cuff integrity correlates with clinical and functional results at a minimum 16 years after open repair. Clin Orthop Relat Res 2013;471:554–561.
      1. Kim DH, Elattrache NS, Tibone JE, et al. Biomechanical comparison of a single-row versus double-row suture anchor technique for rotator cuff repair. Am J Sports Med 2006;34:407–414.
      1. Mazzocca AD, Millett PJ, Guanche CA, Santangelo SA, Arciero RA. Arthroscopic single-row versus double-row suture anchor rotator cuff repair. Am J Sports Med 2005;33:1861–1868.
      1. Charousset C, Grimberg J, Duranthon LD, Bellaiche L, Petrover D. Can a double-row anchorage technique improve tendon healing in arthroscopic rotator cuff repair?: a prospective, nonrandomized, comparative study of double-row and single-row anchorage techniques with computed tomographic arthrography tendon healing assessment. Am J Sports Med 2007;35:1247–1253.
      1. Sugaya H, Maeda K, Matsuki K, Moriishi J. Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation. Arthroscopy 2005;21:1307–1316.
      1. Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am 2004;86:219–224.
      1. Tauro JC. Arthroscopic repair of large rotator cuff tears using the interval slide technique. Arthroscopy 2004;20:13–21.
      1. Debeyre J, Patie D, Elmelik E. Repair of ruptures of the rotator cuff of the shoulder. J Bone Joint Surg Br 1965;47:36–42.
      1. Warner JJ. Management of massive irreparable rotator cuff tears: the role of tendon transfer. Instr Course Lect 2001;50:63–71.
      1. Zanotti RM, Carpenter JE, Blasier RB, Greenfield ML, Adler RS, Bromberg MB. The low incidence of suprascapular nerve injury after primary repair of massive rotator cuff tears. J Shoulder Elbow Surg 1997;6:258–264.
      1. Cho NS, Yi JW, Rhee YG. Arthroscopic biceps augmentation for avoiding undue tension in repair of massive rotator cuff tears. Arthroscopy 2009;25:183–191.
      1. Bond JL, Dopirak RM, Higgins J, Burns J, Snyder SJ. Arthroscopic replacement of massive, irreparable rotator cuff tears using a GraftJacket allograft: technique and preliminary results. Arthroscopy 2008;24:403–409.e1.
      1. Berth A, Neumann W, Awiszus F, Pap G. Massive rotator cuff tears: functional outcome after debridement or arthroscopic partial repair. J Orthop Traumatol 2010;11:13–20.
      1. Burkhart SS, Nottage WM, Ogilvie-Harris DJ, Kohn HS, Pachelli A. Partial repair of irreparable rotator cuff tears. Arthroscopy 1994;10:363–370.
      1. Burkhart SS, Barth JR, Richards DP, Zlatkin MB, Larsen M. Arthroscopic repair of massive rotator cuff tears with stage 3 and 4 fatty degeneration. Arthroscopy 2007;23:347–354.
      1. Duralde XA, Bair B. Massive rotator cuff tears: the result of partial rotator cuff repair. J Shoulder Elbow Surg 2005;14:121–127.
      1. Moser M, Jablonski MV, Horodyski M, Wright TW. Functional outcome of surgically treated massive rotator cuff tears: a comparison of complete repair, partial repair, and debridement. Orthopedics 2007;30:479–482.
      1. Porcellini G, Castagna A, Cesari E, Merolla G, Pellegrini A, Paladini P. Partial repair of irreparable supraspinatus tendon tears: clinical and radiographic evaluations at long-term follow-up. J Shoulder Elbow Surg 2011;20:1170–1177.
      1. Gartsman GM. Massive, irreparable tears of the rotator cuff. Results of operative debridement and subacromial decompression. J Bone Joint Surg Am 1997;79:715–721.
      1. Liem D, Lengers N, Dedy N, Poetzl W, Steinbeck J, Marquardt B. Arthroscopic debridement of massive irreparable rotator cuff tears. Arthroscopy 2008;24:743–748.
      1. Fenlin JM Jr, Chase JM, Rushton SA, Frieman BG. Tuberoplasty: creation of an acromiohumeral articulation-a treatment option for massive, irreparable rotator cuff tears. J Shoulder Elbow Surg 2002;11:136–142.
      1. Scheibel M, Lichtenberg S, Habermeyer P. Reversed arthroscopic subacromial decompression for massive rotator cuff tears. J Shoulder Elbow Surg 2004;13:272–278.
      1. Lee BG, Cho NS, Rhee YG. Results of arthroscopic decompression and tuberoplasty for irreparable massive rotator cuff tears. Arthroscopy 2011;27:1341–1350.
      1. Verhelst L, Vandekerckhove PJ, Sergeant G, Liekens K, Van Hoonacker P, Berghs B. Reversed arthroscopic subacromial decompression for symptomatic irreparable rotator cuff tears: mid-term follow-up results in 34 shoulders. J Shoulder Elbow Surg 2010;19:601–608.
      1. Rodosky MW, Harner CD, Fu FH. The role of the long head of the biceps muscle and superior glenoid labrum in anterior stability of the shoulder. Am J Sports Med 1994;22:121–130.
      1. Warner JJ, McMahon PJ. The role of the long head of the biceps brachii in superior stability of the glenohumeral joint. J Bone Joint Surg Am 1995;77:366–372.
      1. Yamaguchi K, Riew KD, Galatz LM, Syme JA, Neviaser RJ. Biceps activity during shoulder motion: an electromyographic analysis. Clin Orthop Relat Res 1997;336:122–129.
      1. Walch G, Edwards TB, Boulahia A, Nové-Josserand L, Neyton L, Szabo I. Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: clinical and radiographic results of 307 cases. J Shoulder Elbow Surg 2005;14:238–246.
      1. Boileau P, Baqué F, Valerio L, Ahrens P, Chuinard C, Trojani C. Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg Am 2007;89:747–757.
      1. Kempf JF, Gleyze P, Bonnomet F, et al. A multicenter study of 210 rotator cuff tears treated by arthroscopic acromioplasty. Arthroscopy 1999;15:56–66.
    Cited by
    Crossref 2
    Google Scholar 
    MeSH Terms
    Arthroscopy
    Biomechanics
    Debridement
    Follow-Up Studies
    Incidence
    Rotator Cuff
    Tenotomy
    Metrics
    Share
    Figures
    slide

    1 / 1

    PERMALINK