Functional outcomes after non-operative treatment of irreparable massive rotator cuff tears: Prospective multicenter study in 68 patients - 18/08/18

Doi : 10.1016/j.otsr.2018.08.003

Charles Agout ^a,^⁎ , Julien Berhouet ^a, Clément Spiry ^a, Nicolas Bonnevialle ^b, Thierry Joudet ^c, Luc Favard ^a
the
French Arthroscopic Society^d
^a Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France
^b Département d’orthopédie traumatologie, hôpital Riquet, CHU de Toulouse, 31059 Toulouse, France
^c Clinique chirurgicale du Libournais, 119, rue de la Marne, 33500 Libourne, France
^d 15, rue Ampère, 92500 Rueil-Malmaison, France

^⁎Corresponding author.

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Abstract

Background

Massive rotator cuff tears (RCTs) account for 10% to 40% of all RCTs and over 80% of re-tears. The objectives of this prospective study were to assess functional outcomes 6 and 12 months after starting non-operative therapy for an irreparable massive RCT and to identify predictors of good outcomes of non-operative treatment.

Hypothesis

Non-operative treatment deserves to be tried because it can produce improvements in patients with irreparable massive RCTs.

Material and methods

A prospective multicenter (12 centres) study was conducted between March 2015 and March 2016. Consecutive patients managed non-operatively for RCTs involving two or more tendons including one with a fatty infiltration score greater than 2 were included. Non-operative treatment consisted in rehabilitation and sub-acromial corticosteroid injections. Functional outcomes were assessed based on the Constant score and Subjective Shoulder Value (SSV) after 3, 6, and 12 months.

Results

Of 71 included patients, 3 underwent surgery during the study year, leaving 68 patients for the analysis of 12-month outcomes. Significant improvements were noted after 12 months in the Constant score (from 40.7 at baseline to 57.7 after 6 months and 57.1 after 12 months), in each of its items except force, and in the SSV. Constant score values after 6 and 12 months were not significantly different. No significant differences in functional outcomes were found across initial tear type.

Conclusion

Non-operative treatment produces significant functional gains in patients with irreparable massive RCTs. These gains are obtained after 6 months. Surgery can therefore be considered if the outcome is unsatisfactory after 6 months.