Partial and complete repairs of massive rotator cuff tears maintain similar long-term improvements in clinical scores
Purpose The authors have previously published early outcomes of arthroscopic repairs of 86 massive rotator cuff tears (mRCTs) and aimed to determine whether their clinical scores are maintained or deteriorate after 5 more years. Methods Of the initial series of 86 shoulders, 2 had deceased, 16 lost...
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| Veröffentlicht in: | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2021, Vol.29 (1), p.181-191 |
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| container_title | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA |
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| creator | Besnard, Marion Freychet, Benjamin Clechet, Julien Hannink, Gerjon Saffarini, Mo Carrillon, Yannick Godenèche, Arnaud |
| description | Purpose
The authors have previously published early outcomes of arthroscopic repairs of 86 massive rotator cuff tears (mRCTs) and aimed to determine whether their clinical scores are maintained or deteriorate after 5 more years.
Methods
Of the initial series of 86 shoulders, 2 had deceased, 16 lost to follow-up and 4 reoperated, leaving 64 for assessment. The repairs were complete in 44 and partial in 20, and 17 shoulders had pseudoparalysis. Preoperative assessment included absolute Constant score, shoulder strength, tear pattern, tendon retraction, and fatty infiltration. Patients were evaluated at 8.1 ± 0.6 years (range 7.1–9.3) using absolute and age-/sex-adjusted Constant score, subjective shoulder value (SSV), and simple shoulder test (SST).
Results
Absolute Constant score was 80.0 ± 11.7 at first follow-up (at 2–5 years) but diminished to 76.7 ± 10.2 at second follow-up (at 7–10 years) (
p
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| doi_str_mv | 10.1007/s00167-020-05907-8 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2369408196</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2486292831</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-17c42cbd21f67fbdac77f194c874f3cf1153762f064c65a0be2bcc3b3d3e8fa43</originalsourceid><addsrcrecordid>eNp9kU9rFjEQh4Mo9m31C3iQgBcv0cmfTXaPUqoVCnrQc8hmk5Ky2bxmsgW_vdG3KnjwEBIyz_xm4CHkBYc3HMC8RQCuDQMBDIYJDBsfkQNXUjIjlXlMDjApwQQM-oycI94B9KeanpIzKTiMQsOB7J9dbcmt1G0L9SUf19ACreHoUkVaIs0OMd33r9JcK5X6PUbaguvV7NLW-qGYclpdpWvZblkLNdOUj7Xchxy2hrQTfk1b8n0M-lIDPiNPolsxPH-4L8jX91dfLq_ZzacPHy_f3TAvzdAYN14JPy-CR23ivDhvTOST8qNRUfrI-SCNFhG08npwMAcxey9nucgwRqfkBXl9yu3bfNsDNpsT-rCubgtlRyuknhSMfNIdffUPelf2uvXtrFCjFpMYJe-UOFG-FsQaoj3WlF39bjnYn1LsSYrtUuwvKXbsTS8fovc5h-VPy28LHZAnAHtpuw317-z_xP4AsISZbg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2486292831</pqid></control><display><type>article</type><title>Partial and complete repairs of massive rotator cuff tears maintain similar long-term improvements in clinical scores</title><source>MEDLINE</source><source>Wiley Online Library All Journals</source><source>SpringerLink Journals - AutoHoldings</source><creator>Besnard, Marion ; Freychet, Benjamin ; Clechet, Julien ; Hannink, Gerjon ; Saffarini, Mo ; Carrillon, Yannick ; Godenèche, Arnaud</creator><creatorcontrib>Besnard, Marion ; Freychet, Benjamin ; Clechet, Julien ; Hannink, Gerjon ; Saffarini, Mo ; Carrillon, Yannick ; Godenèche, Arnaud</creatorcontrib><description>Purpose
The authors have previously published early outcomes of arthroscopic repairs of 86 massive rotator cuff tears (mRCTs) and aimed to determine whether their clinical scores are maintained or deteriorate after 5 more years.
Methods
Of the initial series of 86 shoulders, 2 had deceased, 16 lost to follow-up and 4 reoperated, leaving 64 for assessment. The repairs were complete in 44 and partial in 20, and 17 shoulders had pseudoparalysis. Preoperative assessment included absolute Constant score, shoulder strength, tear pattern, tendon retraction, and fatty infiltration. Patients were evaluated at 8.1 ± 0.6 years (range 7.1–9.3) using absolute and age-/sex-adjusted Constant score, subjective shoulder value (SSV), and simple shoulder test (SST).
Results
Absolute Constant score was 80.0 ± 11.7 at first follow-up (at 2–5 years) but diminished to 76.7 ± 10.2 at second follow-up (at 7–10 years) (
p
< 0.001). Adjusted Constant score was 99.7 ± 15.9 at first follow-up and remained 98.8 ± 15.9 at second follow-up (ns). Comparing other outcomes revealed a decrease in strength over time (
p
< 0.001) but no change in pain, SSV or SST. Partially-repaired shoulders had lower strength at both follow-ups (
p
< 0.05). Pseudoparalytic shoulders had lower absolute and adjusted Constant score at second follow-up (
p
< 0.05), but their net improvements in absolute Constant score were higher (
p
= 0.014).
Conclusions
Both partial and complete arthroscopic repairs grant satisfactory long-term outcomes for patients with mRCTs, regardless of their tear pattern, fatty infiltration and presence of pseudoparalysis. Absolute Constant score decreased over time for both repair types, but adjusted Constant score remained stable, suggesting that decline is due to aging rather than tissue degeneration. The clinical relevance of this study is that arthroscopic repair should be considered for mRCTs, even if not completely repairable, rather than more invasive and/or risky treatments, such as reverse shoulder arthroplasty.
Level of evidence
IV.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-020-05907-8</identifier><identifier>PMID: 32108260</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Aged ; Aging ; Arthroscopy ; Degeneration ; Female ; Follow-Up Studies ; Humans ; Infiltration ; Injuries ; Medicine ; Medicine & Public Health ; Middle Aged ; Muscle Weakness - physiopathology ; Orthopedics ; Pain ; Reoperation ; Repair ; Rotator cuff ; Rotator Cuff - surgery ; Rotator Cuff Injuries - physiopathology ; Rotator Cuff Injuries - surgery ; Shoulder ; Treatment Outcome</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2021, Vol.29 (1), p.181-191</ispartof><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020</rights><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-17c42cbd21f67fbdac77f194c874f3cf1153762f064c65a0be2bcc3b3d3e8fa43</citedby><cites>FETCH-LOGICAL-c375t-17c42cbd21f67fbdac77f194c874f3cf1153762f064c65a0be2bcc3b3d3e8fa43</cites><orcidid>0000-0002-9656-987X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00167-020-05907-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00167-020-05907-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32108260$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Besnard, Marion</creatorcontrib><creatorcontrib>Freychet, Benjamin</creatorcontrib><creatorcontrib>Clechet, Julien</creatorcontrib><creatorcontrib>Hannink, Gerjon</creatorcontrib><creatorcontrib>Saffarini, Mo</creatorcontrib><creatorcontrib>Carrillon, Yannick</creatorcontrib><creatorcontrib>Godenèche, Arnaud</creatorcontrib><title>Partial and complete repairs of massive rotator cuff tears maintain similar long-term improvements in clinical scores</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose
The authors have previously published early outcomes of arthroscopic repairs of 86 massive rotator cuff tears (mRCTs) and aimed to determine whether their clinical scores are maintained or deteriorate after 5 more years.
Methods
Of the initial series of 86 shoulders, 2 had deceased, 16 lost to follow-up and 4 reoperated, leaving 64 for assessment. The repairs were complete in 44 and partial in 20, and 17 shoulders had pseudoparalysis. Preoperative assessment included absolute Constant score, shoulder strength, tear pattern, tendon retraction, and fatty infiltration. Patients were evaluated at 8.1 ± 0.6 years (range 7.1–9.3) using absolute and age-/sex-adjusted Constant score, subjective shoulder value (SSV), and simple shoulder test (SST).
Results
Absolute Constant score was 80.0 ± 11.7 at first follow-up (at 2–5 years) but diminished to 76.7 ± 10.2 at second follow-up (at 7–10 years) (
p
< 0.001). Adjusted Constant score was 99.7 ± 15.9 at first follow-up and remained 98.8 ± 15.9 at second follow-up (ns). Comparing other outcomes revealed a decrease in strength over time (
p
< 0.001) but no change in pain, SSV or SST. Partially-repaired shoulders had lower strength at both follow-ups (
p
< 0.05). Pseudoparalytic shoulders had lower absolute and adjusted Constant score at second follow-up (
p
< 0.05), but their net improvements in absolute Constant score were higher (
p
= 0.014).
Conclusions
Both partial and complete arthroscopic repairs grant satisfactory long-term outcomes for patients with mRCTs, regardless of their tear pattern, fatty infiltration and presence of pseudoparalysis. Absolute Constant score decreased over time for both repair types, but adjusted Constant score remained stable, suggesting that decline is due to aging rather than tissue degeneration. The clinical relevance of this study is that arthroscopic repair should be considered for mRCTs, even if not completely repairable, rather than more invasive and/or risky treatments, such as reverse shoulder arthroplasty.
Level of evidence
IV.</description><subject>Adult</subject><subject>Aged</subject><subject>Aging</subject><subject>Arthroscopy</subject><subject>Degeneration</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Infiltration</subject><subject>Injuries</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Muscle Weakness - physiopathology</subject><subject>Orthopedics</subject><subject>Pain</subject><subject>Reoperation</subject><subject>Repair</subject><subject>Rotator cuff</subject><subject>Rotator Cuff - surgery</subject><subject>Rotator Cuff Injuries - physiopathology</subject><subject>Rotator Cuff Injuries - surgery</subject><subject>Shoulder</subject><subject>Treatment Outcome</subject><issn>0942-2056</issn><issn>1433-7347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kU9rFjEQh4Mo9m31C3iQgBcv0cmfTXaPUqoVCnrQc8hmk5Ky2bxmsgW_vdG3KnjwEBIyz_xm4CHkBYc3HMC8RQCuDQMBDIYJDBsfkQNXUjIjlXlMDjApwQQM-oycI94B9KeanpIzKTiMQsOB7J9dbcmt1G0L9SUf19ACreHoUkVaIs0OMd33r9JcK5X6PUbaguvV7NLW-qGYclpdpWvZblkLNdOUj7Xchxy2hrQTfk1b8n0M-lIDPiNPolsxPH-4L8jX91dfLq_ZzacPHy_f3TAvzdAYN14JPy-CR23ivDhvTOST8qNRUfrI-SCNFhG08npwMAcxey9nucgwRqfkBXl9yu3bfNsDNpsT-rCubgtlRyuknhSMfNIdffUPelf2uvXtrFCjFpMYJe-UOFG-FsQaoj3WlF39bjnYn1LsSYrtUuwvKXbsTS8fovc5h-VPy28LHZAnAHtpuw317-z_xP4AsISZbg</recordid><startdate>2021</startdate><enddate>2021</enddate><creator>Besnard, Marion</creator><creator>Freychet, Benjamin</creator><creator>Clechet, Julien</creator><creator>Hannink, Gerjon</creator><creator>Saffarini, Mo</creator><creator>Carrillon, Yannick</creator><creator>Godenèche, Arnaud</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9656-987X</orcidid></search><sort><creationdate>2021</creationdate><title>Partial and complete repairs of massive rotator cuff tears maintain similar long-term improvements in clinical scores</title><author>Besnard, Marion ; Freychet, Benjamin ; Clechet, Julien ; Hannink, Gerjon ; Saffarini, Mo ; Carrillon, Yannick ; Godenèche, Arnaud</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-17c42cbd21f67fbdac77f194c874f3cf1153762f064c65a0be2bcc3b3d3e8fa43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aging</topic><topic>Arthroscopy</topic><topic>Degeneration</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Infiltration</topic><topic>Injuries</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Muscle Weakness - physiopathology</topic><topic>Orthopedics</topic><topic>Pain</topic><topic>Reoperation</topic><topic>Repair</topic><topic>Rotator cuff</topic><topic>Rotator Cuff - surgery</topic><topic>Rotator Cuff Injuries - physiopathology</topic><topic>Rotator Cuff Injuries - surgery</topic><topic>Shoulder</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Besnard, Marion</creatorcontrib><creatorcontrib>Freychet, Benjamin</creatorcontrib><creatorcontrib>Clechet, Julien</creatorcontrib><creatorcontrib>Hannink, Gerjon</creatorcontrib><creatorcontrib>Saffarini, Mo</creatorcontrib><creatorcontrib>Carrillon, Yannick</creatorcontrib><creatorcontrib>Godenèche, Arnaud</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Besnard, Marion</au><au>Freychet, Benjamin</au><au>Clechet, Julien</au><au>Hannink, Gerjon</au><au>Saffarini, Mo</au><au>Carrillon, Yannick</au><au>Godenèche, Arnaud</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Partial and complete repairs of massive rotator cuff tears maintain similar long-term improvements in clinical scores</atitle><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle><stitle>Knee Surg Sports Traumatol Arthrosc</stitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><date>2021</date><risdate>2021</risdate><volume>29</volume><issue>1</issue><spage>181</spage><epage>191</epage><pages>181-191</pages><issn>0942-2056</issn><eissn>1433-7347</eissn><abstract>Purpose
The authors have previously published early outcomes of arthroscopic repairs of 86 massive rotator cuff tears (mRCTs) and aimed to determine whether their clinical scores are maintained or deteriorate after 5 more years.
Methods
Of the initial series of 86 shoulders, 2 had deceased, 16 lost to follow-up and 4 reoperated, leaving 64 for assessment. The repairs were complete in 44 and partial in 20, and 17 shoulders had pseudoparalysis. Preoperative assessment included absolute Constant score, shoulder strength, tear pattern, tendon retraction, and fatty infiltration. Patients were evaluated at 8.1 ± 0.6 years (range 7.1–9.3) using absolute and age-/sex-adjusted Constant score, subjective shoulder value (SSV), and simple shoulder test (SST).
Results
Absolute Constant score was 80.0 ± 11.7 at first follow-up (at 2–5 years) but diminished to 76.7 ± 10.2 at second follow-up (at 7–10 years) (
p
< 0.001). Adjusted Constant score was 99.7 ± 15.9 at first follow-up and remained 98.8 ± 15.9 at second follow-up (ns). Comparing other outcomes revealed a decrease in strength over time (
p
< 0.001) but no change in pain, SSV or SST. Partially-repaired shoulders had lower strength at both follow-ups (
p
< 0.05). Pseudoparalytic shoulders had lower absolute and adjusted Constant score at second follow-up (
p
< 0.05), but their net improvements in absolute Constant score were higher (
p
= 0.014).
Conclusions
Both partial and complete arthroscopic repairs grant satisfactory long-term outcomes for patients with mRCTs, regardless of their tear pattern, fatty infiltration and presence of pseudoparalysis. Absolute Constant score decreased over time for both repair types, but adjusted Constant score remained stable, suggesting that decline is due to aging rather than tissue degeneration. The clinical relevance of this study is that arthroscopic repair should be considered for mRCTs, even if not completely repairable, rather than more invasive and/or risky treatments, such as reverse shoulder arthroplasty.
Level of evidence
IV.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>32108260</pmid><doi>10.1007/s00167-020-05907-8</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-9656-987X</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0942-2056 |
| ispartof | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2021, Vol.29 (1), p.181-191 |
| issn | 0942-2056 1433-7347 |
| language | eng |
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| source | MEDLINE; Wiley Online Library All Journals; SpringerLink Journals - AutoHoldings |
| subjects | Adult Aged Aging Arthroscopy Degeneration Female Follow-Up Studies Humans Infiltration Injuries Medicine Medicine & Public Health Middle Aged Muscle Weakness - physiopathology Orthopedics Pain Reoperation Repair Rotator cuff Rotator Cuff - surgery Rotator Cuff Injuries - physiopathology Rotator Cuff Injuries - surgery Shoulder Treatment Outcome |
| title | Partial and complete repairs of massive rotator cuff tears maintain similar long-term improvements in clinical scores |
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