Anatomical tendon-to-bone repair of retracted rotator cuff tear is a difficult challenge given the high rate of recurrence.
The study hypothesis was that side-to-side repair of U-shaped retracted tear allows tendon healing with satisfactory medium-term clinical results.
Materials and methods
Between 1999 and 2007, 35patients (mean age 53.5years) were operated on with this open technique. On the De Orio and Cofield classification, tendon lesions were medium in 5cases, large in 25 and massive in 5. Subacromial space was in all cases greater than 7mm. Fatty infiltration grade was less than or equal to 2 on Goutallier's classification in all cases except for 1 grade3 (supraspinatus only). At last follow-up, patients were assessed clinically (Constant score) and radiographically. Tendon healing was assessed by ultrasound (31 cases) or CT-arthrography (4cases).
Mean follow-up was 60months. Constant score improved significantly, from 64.7±10 preoperatively to 77.1±14 postoperatively (P<0.05). Recurrence rate was 17.1%. Subacromial space was<6mm postoperatively in 2cases.
Side-to-side repair, bringing the posterior cuff onto the anterior edge of the tear, allowed tension-free repair of retracted tear if the preoperative reparability criteria are met: subacromial space equal to or greater than 7mm, and absence of fatty infiltration significantly greater than grade 2 on the Goutallier classification. Under these conditions, clinical and anatomical results were satisfactory at a mean 5years’ follow-up.
Level of evidence
IV, retrospective.Le texte complet de cet article est disponible en PDF.
Keywords : Shoulder, Rotator cuff, Large and massive tear, Side-to-side repair, Fatty infiltration, Margin convergence