Treatment of non‐arthritic pseudoparetic shoulders with irreparable massive rotator cuff tears: arthroscopic procedures yield comparable midterm results to reverse arthroplasty

Abstract

Background Irreparable massive rotator cuff tears (IMRCTs) are a well-known cause for functional limitation and difficult to treat. Although several joint-preserving as well as joint-replacing procedures were found to provide pain relief and gain of function, midterm results are scarce, particularly in pseudoparetic shoulder joints unaccompanied by severe osteoarthritis. The purpose of this study was to compare the midterm functional outcomes of arthroscopic procedures to those of reverse total shoulder arthroplasty (RTSA) in pseudoparetic shoulders with IMRCTs unaccompanied by severe osteoarthritis. Methods All patients who underwent either joint-preserving (group A) or joint-replacing (group B) procedures for IMRCT unaccompanied by severe osteoarthritis with a pseudoparetic shoulder function were retrospectively included. Clinical assessment included the Constant Score (CS), the Subjective Shoulder Value (SSV) and the Visual Analog Score (VAS) at baseline and at latest follow-up. Furthermore, the complication and revision rates were assessed. Results Overall, a total 56 patients were included of whom each 28 patients formed group A (male, 36%) and B (male, 53%) with a mean patient age at time of surgery of 70 ± 7 years and 72 ± 7 years, respectively. The mean follow-up period was 56 ± 17 months. At final follow-up, the total CS (group A: 66 ± 14 points; group B 54 ± 15 points) was significantly increased after arthroscopic treatment when compared to RTSA (p=0.011). However, no significant differences were detected with SSV (p=0.583) and VAS (p=0.536). Although complication rate (11% versus 18%) was not significantly different (p=0.705), number of revision surgeries was significantly higher in group B when compared to group A (p=0.041). Conclusions In non-arthritic pseudoparetic shoulders, both joint-preserving and joint-replacing procedures yielded good clinical midterm outcomes for the treatment of degenerative IMRCTs. Despite of comparable functional and satisfactory functional improvement, increased complication rates and surgical invasiveness outweigh the benefits of primary RTSA and therefore reserve this procedure to a second-line treatment in pseudoparetic patients without any signs of severe cuff arthropathy.

Comparison of Outcomes After Arthroscopic Superior Capsule Reconstruction Versus Arthroscopic Partial Repair or Arthroscopic Debridement for Irreparable Rotator Cuff Tears

“…Furthermore, as component loosing after RTSA is the main cause of failure over time, primary RTSA in patients <65 years of age must be carefully weighed. 52,53 The management of irreparable posterosuperior RC tears is still a challenge, as treatment strategies should be individually tailored to demands and expectations of the patient. Joint-preserving procedures such as the SCR succeed in restoring glenohumeral biomechanics and function.…”

“…Furthermore, as component loosing after RTSA is the main cause of failure over time, primary RTSA in patients <65 years of age must be carefully weighed. 52 , 53 …”

Latissimus Dorsi Transfer Combined with Subacromial Balloon Spacer for Bidirectional Rotator Cuff Deficiency

“… 8 However, RSA is associated with consistently high rates of complications in patients under 60 years of age. 9 , 10 In addition, research focused on the results of RSA in young patients is scarce, as are existing data on surgical options for MIRCT in patients without severe osteoarthritis. 9 …”

“… 9 , 10 In addition, research focused on the results of RSA in young patients is scarce, as are existing data on surgical options for MIRCT in patients without severe osteoarthritis. 9 …”

“…The optimal treatment for patients with forward elevation pseudoparesis and loss of external rotation is unknown, 2 , 6 , 8 , 9 and the options that include RSA appear to be reserved for patients with arthropathy. 9 Among the various joint preservation surgical approaches described for MIRCTs, 4 , 6 many studies have demonstrated the clinical reliability of LDTT, 4 particularly as a primary procedure. 11 , 12 In a long-term follow-up cohort of 108 patients, the rate of clinical failure of LDTT was 10%, and the conversion to RSA was 4%.…”