Prof. Lennard Funk’s Education Portal

Call: 01625 545071
Email: [email protected]
For treatment enquires visit The Arm Clinic

Arthroscopic treatment of massive and irreparable cuff tears

Authors: Peter Habermeyer

References: SECEC, Rome 2005

Definition of Massive cuff tears:
- Bateman & Cofield: Massive = greater than 5 cm
- Gerber : Massive = Two or more tendons

Irreparable Cuff tears:
- Fatty muscle degeneration > 11°
- Fixed tendon retraction more than Grade II° 
- Acromiohumeral distance less than 7 mm

Ability to mobilize a tear to the tuberosity is a better determinant of outcome than the size of the tear [Jones and Savoir III, Arthroscopy 2003]

MASSIVE LESIONS: SIDE TO SIDE OR TENDON TO BONE REPAIR:
Biomechanical rationals:
- force couple
- suspension bridge
- edge stability

Side to side repair: = creating a functional rotator cuff tear / force couple repair

Arthroscopic repair of massive cuff tears
Analysis of results by tear size and by repair technique:
- Margin convergence versus tendon to bone repair:
- Modified UCLA Score: 95% good and excellent results
- Results were independent of tear size
- No difference in repair technique
[Burkhart SS et al., Arthroscopy 2001, Nice 2004]

Arthroscopic repair of large and massive tears
- 37 large tears, 13 massive tears
- Follow-up 32 months, 88% good and excellent outcomes
-Patients with massive tears had outcomes equal to those with large tears [Jones and Savoie III, Arthroscopy 2003]

Arthroscopic complete Tendon to bone repair
- 50% healed (3/6) [Boileau AAOS 2004]
- 94% Retear rate, excellent pain relief (17/18) [Galatz et al., J Bone Surg Am 2004]
No significant differences in outcomes after complete or partial repair
[Lo and Burkhart Arthroscopy 2004; Bennett WF, Arthroscopy 2004]
-Tendon to bone repair if the tendons can be mobilised and reconstructed without tension
-Side to side repair if a tendon to bone repair is not possible without tension
-Reconstruction of the force couple is the key!

Search ShoulderDoc.co.uk

Find a Shoulder Professional

+ Add Your Clinic Advanced Search

This website is certified by Health On the Net Foundation. Click to verify. This site complies with the HONcode standard for trustworthy health information:
verify here.

ShoulderDoc.co.uk satisfies the INTUTE criteria for quality and has been awarded 'editor's choice'.

The material on this website is designed to support, not replace, the relationship that exists between ourselves and our patients. Full Disclaimer