2025 ISAKOS Congress in Munich, Germany

2025 ISAKOS Biennial Congress Paper


Clinical and Radiological Outcomes of All Arthroscopic Supraspinatus and Infraspinatus Muscle Advancement Procedure for Massive Retracted Rotator Cuff Tears Including Pseudoparalytic Patients

Ashish Gupta, MBBS, MSc, FRACS, FAORTHOA, Brisbane, QLD AUSTRALIA
Kristine R. Italia, MD, FPOA, Quezon City, Metro Manila PHILIPPINES
Mohammad Jomaa LEBANON
Andrew Ker, MBChB, BSc (Hons), FRCSed (T+O), Brisbane, QLD UNITED KINGDOM
Roberto Pareyon MEXICO
Jashint Maharaj, MBBS, FRSPH, Brisbane, QLD AUSTRALIA
Sarah L Whitehouse, PhD, Brisbane, Queensland AUSTRALIA
Kenneth Cutbush, MBBS, FRACS, FAOrthA, Spring Hill, QLD AUSTRALIA

Queensland Unit for Advanced Shoulder Research, Brisbane, QLD, AUSTRALIA

FDA Status Not Applicable

Summary

This study aims to present the clinical and radiological outcomes of all-arthroscopic muscle slide and advancement rotator cuff repair procedure.

Abstract

Introduction

Massive retracted cuff tears (mRCTs) are associated with high re-tear rate. Repair of such tears is challenging due to retraction, muscular fatty infiltration, and poor tissue quality resulting in “irreparability”. These challenges make primary repair a less favourable option, hence other salvage procedures are often suggested, such as superior capsular reconstruction and tendon transfers. An all-arthroscopic technique of releasing cuff muscles off the scapular body allowing advancement of whole muscle-tendon unit laterally to achieve a tension-free footprint repair is described. This study aims to present the clinical and radiological outcomes of all-arthroscopic muscle slide and advancement.

Methods

This was a retrospective case series of patients who underwent arthroscopic rotator cuff repair with muscle advancement for large to mRCTs. This technique involves releasing the rotator cuff muscles intraarticularly and off their fossae to facilitate lateral excursion of the whole muscle-tendon unit, then repairing the tendons in a tension-free manner using double layer lasso loop (DLLL) technique. Preoperative and postoperative visual analogue scale (VAS), ASES, Constant score, UCLA score, active range of motion, and strength were assessed. Preoperative radiological assessment with a magnetic resonance imaging (MRI) included tendon retraction (Patte Classification) and Goutallier classification of fatty degeneration. Post-surgery cuff healing and integrity of repair were assessed on MRI 6 months after the procedure using the Sugaya classification, wherein, Sugaya 4 and 5 were considered as re-tears.

Results

A total of 43 shoulders in 38 patients were included. About half of the cohort (51.2%) had 3-tendon tears. Goutallier 3 and 4 fatty degeneration were present in 37% of supraspinatus and 23% of infraspinatus. 93% of tears were retracted around the glenoid or beyond (Patte 3). Four showed repair failure resulting to a 9.3% retear rate. At a mean follow-up of 18.8 months, VAS, ASES, Constant, and UCLA scores significantly improved in patients who had healed cuff repairs (p<.001). The patients in the healed group also showed significantly better ASES, Constant, and UCLA scores than the retear group. Active range of motion improved significantly in all planes for patients with healed repairs. The abduction strength, supraspinatus, and infraspinatus strengths were at least 90% of the contralateral side. All patients who had preoperative pseudoparalysis recovered postoperatively.

Conclusion

The goal of this technique is to allow mRCTs, which often may be deemed irreparable by some surgeons, to be primarily repaired completely onto the footprint in a tension-free manner. This study showed a healing rate of 90.7%, which is relatively higher than those reported in literature for repair of massive cuff tears. Primary repair of massive, retracted posterosuperior cuff tears using the muscle advancement technique coupled with DLLL repair leads to restoration of range of motion, strength, and excellent functional outcomes, even in patients with pseudoparalysis and advanced fatty infiltration.