El resultado y la integridad de la repación artroscópica completa de las lesiones transversales complejas del manguito rotador.
1 Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University School of Medicine at Barnes-Jewish Hospital, One Barnes-Jewish Hospital Plaza, Suite 11300, West Pavilion, St. Louis, MO 63110. E-mail address for L.M. Galatz: galatzl@msnotes.wustl.edu
2 P.O. Box 99405, New Market, Auckland, New Zealand
3 Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kings Highway, Campus Box 8131, Ninth Floor MIR, St. Louis, MO 63110
Investigation performed at the Shoulder and Elbow Service, Department of Orthopaedic Surgery and the Mallinckrodt Institute of Radiology, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, Missouri
Background: The impact of a recurrent defect on the outcome after rotator cuff repair has been controversial. The purpose of this study was to evaluate the functional and anatomic results after arthroscopic repair of large and massive rotator cuff tears with use of ultrasound as an imaging modality to determine the postoperative integrity of the repair.
Methods: Eighteen patients who had complete arthroscopic repair of a tear measuring >2 cm in the transverse dimension were evaluated at a minimum of twelve months after surgery and again at two years after surgery. The evaluation consisted of a standardized history and physical examination as well as calculation of the preoperative and postoperative shoulder scores according to the system of the American Shoulder and Elbow Surgeons. The strength of both shoulders was quantitated postoperatively with use of a portable dynamometer. Ultrasound studies were performed with use of an established and validated protocol at a minimum of twelve months after surgery.
Results: Recurrent tears were seen in seventeen of the eighteen patients. Despite the absence of healing at twelve months after surgery, thirteen patients had an American Shoulder and Elbow Surgeons score of 90 points. Sixteen patients had an improvement in the functional outcome score, which increased from an average of 48.3 to 84.6 points. Sixteen patients had a decrease in pain, and twelve had no pain. Although eight patients had preoperative forward elevation to <95°, all eighteen regained motion above shoulder level and had an average of 152° of elevation. At the second evaluation, a minimum of twenty-four months after surgery, the average score, according to the system of the American Shoulder and Elbow Surgeons, had decreased to 79.9 points; only nine patients had a score of ³90 points, and six patients had a score of £79 points. The average forward elevation decreased to 142°.
Conclusions: Arthroscopic repair of large and massive rotator cuff tears led to a high percentage of recurrent defects. The minimum twelve-month evaluation showed excellent pain relief and improvement in the ability to perform activities of daily living despite the high rate of recurrent defects; however, at a minimum follow-up of two years, the results deteriorated with only twelve patients who had an American Shoulder and Elbow Surgeons score of ³80.
Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.
J Bone Joint Surg Am 2004 86: 219-224.
