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Open Repair Successful for Massive Tear in Rotator Cuff

Rotator cuff injuries are not uncommon and they don't happen in only athletes. Anyone can tear their rotator cuff, which is a group of four muscles and several tendons around the top of the humerus, the bone that connects the arm to the shoulder. Although some people with torn rotator cuffs have a lot of pain, researchers estimate that as many as 50 percent of people over the age of 60 who have this injury are asymptomatic, they don't feel it.

In younger people, a torn cuff is usually caused by heaving lifting or manual labor and it causes quite a bit of pain, making it difficult to use the affected arm. As a result, the person who is injured may find it hard to work, resulting in cost for medical care and lost work time. A massive rotator cuff tear is defined as there being two or more tendons that are injured. These are particularly hard to treat and can often be retorn after repair, more so than after smaller tears are repaired.

The authors of this study followed 27 patients who had massive rotator cuff repairs to see what their outcome was. The researchers assessed how well they were doing a few years after the study and checked in again about nine to ten years after. Since four patients were lost to follow-up, the final results included 23 patients. All the patients had undergone an open rotator cuff repair and then wore a sling and splint. They were given passive exercises under the supervision of a physiotherapist. The patients were only allowed to do active exercises after six weeks, followed by strengthening exercises six week later.

The 23 patients, who were on average 54 years old, were examined using the same types of x-rays, magnetic resonance imaging, as well as other tests that were done earlier at three years follow up. The researchers found that there were no complications or repeat surgeries in the period between the 3-year and the 9-year follow up. At the final follow up, 74 percent of the patients said that they were very satisfied with the surgery and its results, 22 percent said they were satisfied, and one patient was disappointed in the results. This was a bit of a change from the 3-year follow up because two patients had rated themselves as satisfied then but very satisfied at nine years, three changed from disappointed to very satisfied at nine years, and one patient said they were satisfied first but this changed to unsatisfied.

One of the issues that the researchers wanted to examine was the retear rate, how many patients had retorn their rotator cuff. After almost 10 years, the retear rate was an average 57 percent. It was higher if the patient had torn three tendons, at 86 percent, and lower if there were two tears, at 44 percent. The researchers noted that none of the retears was bigger than the original tears. While it may seem that the number is high, especially when compared with studies that found there was an average 13 percent rate of retears in tears of only one tendon, this study's finding is in line with others that examined the same problem. The authors pointed out that their findings differed from other studies in some ways. For example, in this study, there didn't seem to be a relationship between the age of the patient and the likelihood of retears.

As with all studies, there were some limitations. The researchers in this study weren't able to determine exactly when the retear occurred. The authors also pointed out that their study was relatively small and the patients were relatively young, which may have made an impact on the results.

The authors concluded that the open rotator cuff repair offered good results for at least 10 years following surgery although the chances of retears did increase over time.

References: Matthias A. Zumstein, MD et al. The Clinical and Structural Long-Term Results of Open Repair of Massive Tears of the Rotator Cuff. In The Journal of Bone & Joint Surgery. November 2008. Vol. 90. No. 11.

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