Arthroscopic repair of massive rotator cuff tears with stage 3 and 4 fatty degeneration.

PURPOSE: The purpose of this study was to assess the functional results of arthroscopic repair of massive rotator cuff tears in patients who had stage 3 and 4 fatty degeneration of the rotator cuff musculature, according to the Goutallier scale.

METHODS: From January 1997 to December 2001, 22 patients with massive rotator cuff tears and Goutallier stage 3 or 4 fatty degeneration of the infraspinatus, with a mean age of 66.5 +/- 9.26 years, underwent arthroscopic rotator cuff repair and were available for follow-up. The average tear size was 4.8 +/- 0.85 cm in medial-to-lateral width and 6.2 +/- 1.53 cm in anterior-to-posterior length, with an approximate tear size area of 30.0 +/- 10.0 sq cm, and involved 2 tendons (supraspinatus and infraspinatus) or 3 tendons (supraspinatus, infraspinatus, and subscapularis) in each case. The mean time from surgery to follow-up was 39.3 months (range, 24-60 months). In addition to comparison of preoperative and postoperative range of motion, strength and University of California, Los Angeles (UCLA) score, outcomes were also assessed with the Constant score.

RESULTS: The increase of mean active forward elevation was 53.7 degrees (preoperative: 103.2 degrees and postoperatively: 156.9 degrees ). The gain of mean active external rotation was 19.1 degrees (preoperative: 35.7 degrees and postoperative: 54.8 degrees). The gain of mean external rotation power was 1.9 (preoperative: 2.3 and postoperative: 4.2). The improvement in the UCLA score was 17.2 points (preoperative: 12.3 and postoperative: 29.5). The mean postoperative Constant score was 74.8/100, and the weighted postoperative Constant score was 88.5/100. In 5 patients with fatty degeneration greater than 75% (advanced stage 4), results were less dramatically improved than in 17 patients with fatty degeneration of 50% to 75%, all of whom exhibited clinical improvement. However, clinical improvement was achieved even in 2 of 5 patients with advanced stage 4 involvement.

CONCLUSIONS: Arthroscopic rotator cuff repair in patients with grade 3 or 4 fatty degeneration (> or =50%) can provide significant functional improvement. Those with 50% to 75% fatty degeneration showed a much greater degree of improvement (with all 17 cases exhibiting beneficial postoperative increases in their UCLA scores ranging from 12 to 26 points) than those with >75% fatty degeneration (with only 2 of 5 cases showing an increase of 10 or more points in their UCLA scores). However, clinical improvement was observed in 86.4% of cases that would have been classified as likely to fail by the Goutallier criteria.

LEVEL OF EVIDENCE: Level IV, therapeutic case series.