ABSTRACT
Conservative therapy has been recommended for the treatment of a chronic cuff lesion with relatively good results. However, recent reports about operative treatment of cuff lesions have yielded more favorable results. Although the current literature seems to favor early treatment, there is an ongoing debate about the timing of the operation. During a 16-year period, 415 chronic full-thickness rotator cuff tears were operated on at our institution. The indication for operative treatment was persistent, severe or moderate pain at rest and impairment of shoulder function after initial conservative treatment. At follow-up, the symptoms were assessed by an interview, and all patients were clinically examined. Pain, function, range of active forward flexion, active abduction, strength (manual muscle testing), and patient satisfaction were recorded, and the results were evaluated by the University of California, Los Angeles shoulder rating scale. On the basis of our results, we recommend operative treatment of the rotator cuff for all cases in which the tear is full thickness, regardless of tear size, if patients have any symptoms, especially pain.
Subject(s)
Arthroscopy/methods , Range of Motion, Articular/physiology , Rotator Cuff Injuries , Rotator Cuff/surgery , Adult , Age Factors , Aged , Analysis of Variance , Arthroscopy/adverse effects , Female , Humans , Male , Middle Aged , Pain Measurement , Patient Satisfaction , Postoperative Complications/physiopathology , Probability , Prognosis , Retrospective Studies , Risk Assessment , Shoulder Joint/physiopathology , Shoulder Joint/surgery , Shoulder Pain/physiopathology , Statistics, Nonparametric , Treatment OutcomeABSTRACT
The distinction among an acute tear, acute symptoms of a chronic tear, or the acute extension of an existing chronic tear is very difficult, if not impossible, to make. In general, operative treatment of lesions with a sudden onset has yielded favorable results in many studies. However, the timing of the operation for tears with an acute onset of symptoms is still a very controversial issue, as are the treatment options for chronic tears with acute symptoms. This study analyzes the follow-up results of early operative treatment of rotator cuff tears with an acute onset of symptoms, regardless of tear type. Twenty-nine patients with a sudden onset of symptoms and significant impairment of shoulder function had a full-thickness rotator cuff tear. The patients were operated on within 3 weeks from the beginning of the symptoms. Twenty-six patients underwent follow-up. The results were evaluated by use of the UCLA shoulder rating scale. At follow-up, 22 patients (85%) had no pain and 21 (81%) had returned to normal activities and had normal shoulder function. Active forward flexion averaged 51 degrees preoperatively and 167 degrees at follow-up. After repair of the tear, shoulder strength was normal in 22 of 26 shoulders (85%); 3 patients had fair strength, all after repair of a massive tear. Of the patients, 25 (96%) were satisfied with the result. The overall result was excellent in 20 patients (77%), good in 4 (15%), fair in 1 (4%), and poor in 1 (4%). Early operative treatment appears to be better for rotator cuff tears with a sudden onset of symptoms and poor function to achieve maximal return of shoulder function. With time, the tear may enlarge, and the cuff may lose its elasticity, thus making the late surgical repair more difficult or even impossible.
