Reversed arthroscopic subacromial decompression for symptomatic irreparable rotator cuff tears: Mid-term follow-up results in 34 shoulders

In the elderly, there is no guideline for the treatment of irreparable rotator cuff lesions. The results of open or arthroscopic repair are variable. We hypothesized that the use of a reversed arthroscopic subacromial decompression (RASD) would yield comparable results. Between January 2004 and Dece...

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Veröffentlicht in:	Journal of shoulder and elbow surgery Jg. 19; H. 4; S. 601 - 608
Hauptverfasser:	Verhelst, Luk, Vandekerckhove, Pieter-Jan, Sergeant, Gregory, Liekens, Koen, Van Hoonacker, Petrus, Berghs, Bart
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	New York, NY Mosby, Inc 01.06.2010 Elsevier
Schlagworte:	38 months follow-up Acromion Aged Arthroscopy Arthroscopy - methods Biological and medical sciences Debridement - methods Disease Progression Diseases of the osteoarticular system elderly patient Endoscopy Female Follow-Up Studies Humans Investigative techniques, diagnostic techniques (general aspects) irreparable cuff tear Joint Diseases - diagnostic imaging Joint Diseases - surgery Juxtaarticular diseases. Extraarticular rhumatism Male Medical sciences Orthopedics Radiography Range of Motion, Articular Retrospective Studies Reversed arthroscopic subacromial decompression Rotator Cuff - diagnostic imaging Rotator Cuff - surgery Rupture, Spontaneous Shoulder Joint - diagnostic imaging Shoulder Joint - physiopathology Shoulder Joint - surgery Time Factors Treatment Outcome Treatment Study elderly patient Retrospective Case Series Level IV irreparable cuff tear 38 months follow-up Reversed arthroscopic subacromial decompression Juxtaarticular disease Symptomatology Arthroscopy Rotator cuff rupture Shoulder Diseases of the osteoarticular system Rheumatology Endoscopy
ISSN:	1058-2746, 1532-6500, 1532-6500
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Abstract	In the elderly, there is no guideline for the treatment of irreparable rotator cuff lesions. The results of open or arthroscopic repair are variable. We hypothesized that the use of a reversed arthroscopic subacromial decompression (RASD) would yield comparable results. Between January 2004 and December 2006, thirty-eight patients underwent a RASD for irreparable cuff tears in 39 shoulders. The surgical procedure consisted of a tenotomy of the long head of the biceps tendon, a debridement of the torn rotator cuff and a tuberoplasty, without violation of the coracoacromial arch and the acromion. Thirty-three patients (age 69.9 ± 7.3 years) were available for clinical and radiological evaluation of 34 shoulders (male/female ratio: 11/22), at a mean follow-up of 38 months (range: 21 months–52 months). Two of 33 patients had required revision surgery, and were excluded from further statistical analysis. In the remaining 31 patients (32 shoulders), the modified Constant-Murley score (CMS) improved from 34.9% ± 11.6 to 84.0% ± 11.6 (p < 0.0001). The preoperative mobility did not correlate with the final result. Preoperative pain was found to correlate negatively to the modified CMS at follow-up (p= 0.0038). Although the acromiohumeral height decreased with 2.58 mm ± 1.68 and the severity of glenohumeral osteoarthritis increased with one grade (Samilson-Prieto classification), there was no correlation with the functional outcome. We conclude that for irreparable rotator cuff tears in the elderly, excellent mid-term results can be achieved with a RASD.
AbstractList	In the elderly, there is no guideline for the treatment of irreparable rotator cuff lesions. The results of open or arthroscopic repair are variable. We hypothesized that the use of a reversed arthroscopic subacromial decompression (RASD) would yield comparable results.BACKGROUNDIn the elderly, there is no guideline for the treatment of irreparable rotator cuff lesions. The results of open or arthroscopic repair are variable. We hypothesized that the use of a reversed arthroscopic subacromial decompression (RASD) would yield comparable results.Between January 2004 and December 2006, thirty-eight patients underwent a RASD for irreparable cuff tears in 39 shoulders. The surgical procedure consisted of a tenotomy of the long head of the biceps tendon, a debridement of the torn rotator cuff and a tuberoplasty, without violation of the coracoacromial arch and the acromion.MATERIAL AND METHODSBetween January 2004 and December 2006, thirty-eight patients underwent a RASD for irreparable cuff tears in 39 shoulders. The surgical procedure consisted of a tenotomy of the long head of the biceps tendon, a debridement of the torn rotator cuff and a tuberoplasty, without violation of the coracoacromial arch and the acromion.Thirty-three patients (age 69.9 +/- 7.3 years) were available for clinical and radiological evaluation of 34 shoulders (male/female ratio: 11/22), at a mean follow-up of 38 months (range: 21 months-52 months). Two of 33 patients had required revision surgery, and were excluded from further statistical analysis. In the remaining 31 patients (32 shoulders), the modified Constant-Murley score (CMS) improved from 34.9% +/- 11.6 to 84.0% +/- 11.6 (p < 0.0001). The preoperative mobility did not correlate with the final result. Preoperative pain was found to correlate negatively to the modified CMS at follow-up (p= 0.0038). Although the acromiohumeral height decreased with 2.58 mm +/- 1.68 and the severity of glenohumeral osteoarthritis increased with one grade (Samilson-Prieto classification), there was no correlation with the functional outcome.RESULTSThirty-three patients (age 69.9 +/- 7.3 years) were available for clinical and radiological evaluation of 34 shoulders (male/female ratio: 11/22), at a mean follow-up of 38 months (range: 21 months-52 months). Two of 33 patients had required revision surgery, and were excluded from further statistical analysis. In the remaining 31 patients (32 shoulders), the modified Constant-Murley score (CMS) improved from 34.9% +/- 11.6 to 84.0% +/- 11.6 (p < 0.0001). The preoperative mobility did not correlate with the final result. Preoperative pain was found to correlate negatively to the modified CMS at follow-up (p= 0.0038). Although the acromiohumeral height decreased with 2.58 mm +/- 1.68 and the severity of glenohumeral osteoarthritis increased with one grade (Samilson-Prieto classification), there was no correlation with the functional outcome.We conclude that for irreparable rotator cuff tears in the elderly, excellent mid-term results can be achieved with a RASD.CONCLUSIONWe conclude that for irreparable rotator cuff tears in the elderly, excellent mid-term results can be achieved with a RASD. In the elderly, there is no guideline for the treatment of irreparable rotator cuff lesions. The results of open or arthroscopic repair are variable. We hypothesized that the use of a reversed arthroscopic subacromial decompression (RASD) would yield comparable results. Between January 2004 and December 2006, thirty-eight patients underwent a RASD for irreparable cuff tears in 39 shoulders. The surgical procedure consisted of a tenotomy of the long head of the biceps tendon, a debridement of the torn rotator cuff and a tuberoplasty, without violation of the coracoacromial arch and the acromion. Thirty-three patients (age 69.9 +/- 7.3 years) were available for clinical and radiological evaluation of 34 shoulders (male/female ratio: 11/22), at a mean follow-up of 38 months (range: 21 months-52 months). Two of 33 patients had required revision surgery, and were excluded from further statistical analysis. In the remaining 31 patients (32 shoulders), the modified Constant-Murley score (CMS) improved from 34.9% +/- 11.6 to 84.0% +/- 11.6 (p < 0.0001). The preoperative mobility did not correlate with the final result. Preoperative pain was found to correlate negatively to the modified CMS at follow-up (p= 0.0038). Although the acromiohumeral height decreased with 2.58 mm +/- 1.68 and the severity of glenohumeral osteoarthritis increased with one grade (Samilson-Prieto classification), there was no correlation with the functional outcome. We conclude that for irreparable rotator cuff tears in the elderly, excellent mid-term results can be achieved with a RASD. In the elderly, there is no guideline for the treatment of irreparable rotator cuff lesions. The results of open or arthroscopic repair are variable. We hypothesized that the use of a reversed arthroscopic subacromial decompression (RASD) would yield comparable results. Between January 2004 and December 2006, thirty-eight patients underwent a RASD for irreparable cuff tears in 39 shoulders. The surgical procedure consisted of a tenotomy of the long head of the biceps tendon, a debridement of the torn rotator cuff and a tuberoplasty, without violation of the coracoacromial arch and the acromion. Thirty-three patients (age 69.9 ± 7.3 years) were available for clinical and radiological evaluation of 34 shoulders (male/female ratio: 11/22), at a mean follow-up of 38 months (range: 21 months–52 months). Two of 33 patients had required revision surgery, and were excluded from further statistical analysis. In the remaining 31 patients (32 shoulders), the modified Constant-Murley score (CMS) improved from 34.9% ± 11.6 to 84.0% ± 11.6 (p < 0.0001). The preoperative mobility did not correlate with the final result. Preoperative pain was found to correlate negatively to the modified CMS at follow-up (p= 0.0038). Although the acromiohumeral height decreased with 2.58 mm ± 1.68 and the severity of glenohumeral osteoarthritis increased with one grade (Samilson-Prieto classification), there was no correlation with the functional outcome. We conclude that for irreparable rotator cuff tears in the elderly, excellent mid-term results can be achieved with a RASD. Background In the elderly, there is no guideline for the treatment of irreparable rotator cuff lesions. The results of open or arthroscopic repair are variable. We hypothesized that the use of a reversed arthroscopic subacromial decompression (RASD) would yield comparable results. Material and methods Between January 2004 and December 2006, thirty-eight patients underwent a RASD for irreparable cuff tears in 39 shoulders. The surgical procedure consisted of a tenotomy of the long head of the biceps tendon, a debridement of the torn rotator cuff and a tuberoplasty, without violation of the coracoacromial arch and the acromion. Results Thirty-three patients (age 69.9 ± 7.3 years) were available for clinical and radiological evaluation of 34 shoulders (male/female ratio: 11/22), at a mean follow-up of 38 months (range: 21 months–52 months). Two of 33 patients had required revision surgery, and were excluded from further statistical analysis. In the remaining 31 patients (32 shoulders), the modified Constant-Murley score (CMS) improved from 34.9% ± 11.6 to 84.0% ± 11.6 (p < 0.0001). The preoperative mobility did not correlate with the final result. Preoperative pain was found to correlate negatively to the modified CMS at follow-up (p= 0.0038). Although the acromiohumeral height decreased with 2.58 mm ± 1.68 and the severity of glenohumeral osteoarthritis increased with one grade (Samilson-Prieto classification), there was no correlation with the functional outcome. Conclusion We conclude that for irreparable rotator cuff tears in the elderly, excellent mid-term results can be achieved with a RASD.
Author	Verhelst, Luk Liekens, Koen Berghs, Bart Van Hoonacker, Petrus Sergeant, Gregory Vandekerckhove, Pieter-Jan
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Keywords	Treatment Study elderly patient Retrospective Case Series Level IV irreparable cuff tear 38 months follow-up Reversed arthroscopic subacromial decompression Juxtaarticular disease Symptomatology Arthroscopy Rotator cuff rupture Shoulder Diseases of the osteoarticular system Rheumatology Endoscopy
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Snippet	In the elderly, there is no guideline for the treatment of irreparable rotator cuff lesions. The results of open or arthroscopic repair are variable. We... Background In the elderly, there is no guideline for the treatment of irreparable rotator cuff lesions. The results of open or arthroscopic repair are...
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SubjectTerms	38 months follow-up Acromion Aged Arthroscopy Arthroscopy - methods Biological and medical sciences Debridement - methods Disease Progression Diseases of the osteoarticular system elderly patient Endoscopy Female Follow-Up Studies Humans Investigative techniques, diagnostic techniques (general aspects) irreparable cuff tear Joint Diseases - diagnostic imaging Joint Diseases - surgery Juxtaarticular diseases. Extraarticular rhumatism Male Medical sciences Orthopedics Radiography Range of Motion, Articular Retrospective Studies Reversed arthroscopic subacromial decompression Rotator Cuff - diagnostic imaging Rotator Cuff - surgery Rupture, Spontaneous Shoulder Joint - diagnostic imaging Shoulder Joint - physiopathology Shoulder Joint - surgery Time Factors Treatment Outcome
Title	Reversed arthroscopic subacromial decompression for symptomatic irreparable rotator cuff tears: Mid-term follow-up results in 34 shoulders
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