Clinical outcomes of primary repair for large and massive rotator cuff tears using an all-arthroscopic rotator cuff muscle advancement technique.

Background: The retear rate after repair of large and massive rotator cuff tears remains high. In this study, we report on the clinical outcomes of an all-arthroscopic rotator cuff muscle advancement technique, which retained the fascial continuity between the origin of the rhomboid and rotator cuff muscles at postoperative in patients with large or massive rotator cuff tears.

Methods: The all-arthroscopic technique for muscle advancement in the repair of large or massive rotator cuff tears is based on the Debeyre-Patte procedure and included dissection of the medial insertions of the supraspinatus (SSP) and infraspinatus (ISP) muscles from the superior, medial, and inferior borders of the scapula, maintaining the fascial continuity with the rhomboid muscle at the medial border of the scapula. Clinical assessment of outcomes was based on 18 patients (18 shoulders) with large or massive rotator cuff tears. The site of rotator cuff tear and the grade of fatty muscle infiltration were examined preoperatively. Postoperatively, the integrity of the repair was assessed, with the change in clinical outcomes evaluated using the Japan Orthopedic Association and Constant-Murley scores.

Results: Preoperatively, tears were identified in the SSP and ISP tendons. The distribution of stages, based on assessment of rotator cuff stumps, was as follows: I and II, none; III-1, 7 shoulders; and III-2, 11 shoulders. The distribution of fatty muscle infiltration was as follows: grade 2 of the subscapularis in 7 of 18 shoulders (38.9%); grade 3 of the SSP in 17 of 18 shoulders (94.4%); and grade 3 of the ISP in 10 of 18 shoulders (55.6%). Integrity of the repair (Sugaya classification type I) was achieved in 17 cases, with retear (Sugaya type IV) occurring in one case. The mean Japan Orthopedic Association and Constant-Murley scores improved from 40 and 39, respectively, preoperatively to 74 and 64, respectively, at 2 years postoperatively. The rate of retear was <6%.

Conclusion: All-arthroscopic rotator cuff muscle advancement is a useful primary repair technique for large or massive rotator cuff tears.