Bryan R Butler1, Abigail N Byrne2, Laurence D Higgins2, Anup Shah3, Rachel L Fowler2
1 Department of Orthopedics, Shoulder and Elbow Service, Ohio State University, Columbus, OH, USA 2 The Harvard Shoulder Service, Brigham and Women's Hospital, Boston, MA 02155, USA 3 Atlanta Sports Medicine and Orthopedic Center, Suite 500, Atlanta, GA, USA
Correspondence Address:
Laurence D Higgins The Harvard Shoulder Service, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02155 USA
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DOI: 10.4103/0973-6042.118906
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Purpose : This study evaluated retraction in the setting of acute rotator cuff tears and determined its effects on patient outcomes and tendon repair integrity.
Materials and Methods : A total of 22 patients had surgery within 6 weeks or less from the time of injury. Fifteen of these patients were prospectively followed at a minimum of 2 years; average 40.5 months (range 24-69). Pre-operative objective and subjective outcomes were compared. Tendon repair integrity was assessed with ultrasound at a minimum of 1 year from surgery. The population was stratified into Group 1 (8 patients) with minimal intra-operative medial tendon retraction to the mid-line level of the humeral head and Group 2 (7 patients) with a large medial tendon retraction to the glenohumeral joint or greater.
Results : The average time to surgery from the onset of symptoms was 27 days (range, 6-42). Post-operative motion increased significantly for external rotation and forward elevation, 77% of patients were pain free, 80% were completely satisfied, and 100% would have the surgery again. Group 1 (small retraction) versus Group 2 (large retraction) showed that post-operative pain levels, satisfaction, range of motion, strength, subjective shoulder value (95.4% vs. 92.3%), Constant Score (80.8 vs. 78.1), and American Society of Shoulder and Elbow Surgeons (96.2 vs. 93.5) scores were not statistically different. Ultrasound showed a tendon repair integrity rate of 87%. 2 patients who did have a re-tear were in Group 2, yet had comparative outcomes.
Conclusion: In acute rotator cuff tears, equal patient satisfaction, pain scores, range of motion, strength, and outcome measures should be expected with surgical repair despite the level of retraction.
Level of Evidence : Therapeutic level IV
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