PURPOSE OF THE STUDYThe aim of this study is to present a simple rotator cuff lesion classification that provides guidelines as to their treatment, and to evaluate the results of palliative arthroscopic resection of rotator cuff residues known as unreconstructible lesions. In addition, our therapeutic approaches were ascertained in view of their applicability to the types of lesions studied.
MATERIALIn a five-year period (January 1, 2000 to December 31, 2004), a total of 181 arthroscopic procedures were performed on the shoulder joints of patients diagnosed with impingement or rotator cuff syndromes. In 130 cases, a tear or irritation of the rotator cuff was recorded. Rotator cuff lesions were categorized on the basis of our modification of the Gschwend classification. In 15 of the patients, in whom unreconstructible lesions were detected, arthroscopic palliative resection of rotator cuff residues was performed. The average age of these patients was 65 years, and they were followed up for 6 to 60 months.
METHODSAll surgery was carried out in a "beach-chair" position, either under general anesthesia or with an interscalene brachial plexus block. The arthroscope was inserted through the "soft-spot". Continuous irrigation was provided with an arthroscopic pump. In the first place, the glenohumeral joint was explored, and resection of rotator cuff residues was performed via ventral and lateral ports. The procedure was completed by subacromial decompression and partial resection of the acromion. The results were evaluated by the Constant Functional Score, as modified by us. Clinical examination was supplemented with subjective information from questionnaires provided by the patients.
RESULTSIn a total of 130 shoulder joints with rotator cuff tears examined by arthroscopy, type I lesions were found in 90, and these were treated by arthroscopic subacromial decompression. Twenty-five type II and type III lesions underwent open rotator cuff repair and 15 type IV and type V lesions were treated by palliative arthroscopic resection of residual rotator cuff lesions, using the Apoil method. These fifteen patients were followed up for 6 to 60 months and their outcomes were evaluated. No excellent results were achieved (Constant Score, 80-100 points), but this is implicit in the nature of a palliative operation. Good (65-79 points) and satisfactory (51-64 points) results were recorded in 11 (73.3 %) and four (26.7 %) patients, respectively. No poor results were found. The average improvement in Constant scores was 21 points.
DISCUSSIONA total of 130 rotator cuff lesions diagnosed arthroscopically were categorized on the basis of a modified classification system. We will continue to treat type I lesions by arthroscopic subacromial decompression, which has provided good results, as reported in our previous study. We consider the arthroscopic repair of rotator cuff tears to be an optimal procedure for type II lesions; for type III lesions we will keep using open repair surgery. The most complex problem is presented by type IV lesi...
