Summary

The outcome of arthroscopic Coffield modification for primary unrepairable rotator cuff upper rupture was good and effective.

Abstract

Aim

The aim of this study was to evaluate the clinical results of arthroscopic partial subscapular muscle transfer (Coffield's modified method) for the superior irreparable rotator cuff tear.

Background

Cofield reported the transfer of all subscapularis (SSC) tendon in patients with irreparable massive rotator cuff tear in 1982. Bigliani reported the transfer of the upper one third of the SSC tendon and Suenaga reported the transfer of the half to two thirds of the SSC tendon to the defect of the supraspinatus (SSP) tendon and infraspinatus (ISP) tendons. Since 2016, we used arthroscopy to subscapular partial muscle transfer (Coffield's modified method) for the superior irreparable rotator cuff tear.

Methods

We treated 10 cases of superior irreparable rotator cuff tear by arthroscopic partial subscapular muscle transfer. There was male 4, female 6, with average age of 66.2 years (63-75). The postoperative period was 24-36 months, and there were 3 shoulders in the reoperation case, 4 shoulders in the SSP tendon tear, 6 shoulders in the SSP and ISP tendon tear. Surgery is like this. 1) Fix LHB 2) Detach the upper 1/2 of the subscapularis muscle under the periosteum and make an inward U-shaped incision 3) Transfer the subscapular muscle to the large nodule, fix 4) Remain The infraspinatus, the supraspinatus and suture were performed in this order. Clinical results were evaluated according to constant score and

Results

The constant score improved from 63.8 (48-78) points before surgery to 91.3 (77-100) points after surgery. The pain and range of motion all improved in all cases, but 2 shoulders required improvement for 10 months after the operation, and 3 shoulders left the discomfort at the time of front elevation. There was no re-tear on MRI 2 years after surgery. The outcome of Arthroscopic partial subscapular muscle transfer was good, but there are cases where improvement of range of motion took a long time and cases where sense of incongruity at the time of forward elevation remained

Conclusion

Arthroscopic partial subscapular muscle transfer for the superior irreparable rotator cuff tear is an effective method.