Summary

The most patients having the failed ARMRCT can be treated conservatively according to the result of this long-term followup study.

Abstract

Background

Arthroscopic repair of massive rotator cuff tear (ARMRCT) had still high failure rates despite several surgical technique or augmentation methods having been proposed. The failed ARMRCT was difficult situation for the surgeon to do revision. Despite published literature indicating that those having retorn cuff still achieved relative better outcome before the surgery, it does not specify which patients might not require further or revision surgery. The purpose of the study is to present long-term follow-up of shoulder function of ARMRCT and risk factors for further or revision surgery.

Material And Methods

In this retrospective cohort study from Jan 2012 to Jan 2016, the patients who had received ARMRCT confirmed by pre-operative magnetic resonance imaging (MRI) and intra-operative arthroscopic photos were included. The failed ARMRCT was defined as Sugaya’s classification type IV and V based on 6-month MRI follow-up. The latest American Shoulder and Elbow Surgeons (ASES) score and UCLA (University of California, Los Angeles) score were compared to pre-operative parameters. The risk factors for further or revision surgery were identified from patient, clinical, and radiologic factor by multivariate regression analysis.

Results

There were 367 patients received ARMRCT and 132 patients (35.9%) were regarded as failed ARMRCT. 10 patients lost to follow-up and 8 patients demised were excluded. The average age of index surgery was 63.2 ±8.3 (range, 51.2-73.2) years with 61(53.5%) females and 53 (46.5%) males. There were 68 (59.6%) patients classified in Sugaya’s classification type IV and 46 (39.4%) in type V. There were 2 patients in Sugaya’s type IV and 19 patients in Sugaya’s type V (18.4%) received reoperation (1 debridement for infection, 4 revision repairs, 4 superior capsule reconstructions, 12 reverse shoulder arthroplasty). The rest of 93 patient’s latest ASES score was 73.6±10.3 vs. 37.2±4.83, preoperatively (p<0.001) and the latest UCLA score was 24.6 ±3.72 vs. 9.02 ± 4.83, preoperatively (p<0.001) in 9.8 years (range 8.2-10.6 years) follow-up. Using multivariate analysis, the risk factors for further or revision surgery of ARMRCT were only Sugaya’s classification type V. (aOR: 14.2, 95% CI: 2.95-68.8).

Discussion

The major finding of this study was most of the patients (81.5%) who had failed ARMRCT may be treated conservatively without revision or further surgery at minimal 8 years follow-up. Moreover, the functional score had improvement and achieved the minimal clinically important difference. However, the retear pattern classified as Sugaya’s classification type V had much more risk to have the further or revision surgery.

Conclusion

The functional results of failed ARMRCT mostly can achieve minimal clinically important difference and keep observation follow-up. Sugaya’s classification type V had higher risk to have further or revision surgery.