Charles Agout1, Julien Berhouet2, Clément Spiry2, Nicolas Bonnevialle3, Thierry Joudet4, Luc Favard2. 1. Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France. Electronic address: agout_c@hotmail.fr. 2. Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France. 3. Département d'orthopédie traumatologie, hôpital Riquet, CHU de Toulouse, 31059 Toulouse, France. 4. Clinique chirurgicale du Libournais, 119, rue de la Marne, 33500 Libourne, France.
Abstract
BACKGROUND: Massive rotator cuff tears (RCTs) account for 10% to 40% of all RCTs and over 80% of re-tears. The objectives of this prospective study were to assess functional outcomes 6 and 12 months after starting non-operative therapy for an irreparable massive RCT and to identify predictors of good outcomes of non-operative treatment. HYPOTHESIS: Non-operative treatment deserves to be tried because it can produce improvements in patients with irreparable massive RCTs. MATERIAL AND METHODS: A prospective multicenter (12 centres) study was conducted between March 2015 and March 2016. Consecutive patients managed non-operatively for RCTs involving two or more tendons including one with a fatty infiltration score greater than 2 were included. Non-operative treatment consisted in rehabilitation and sub-acromial corticosteroid injections. Functional outcomes were assessed based on the Constant score and Subjective Shoulder Value (SSV) after 3, 6, and 12 months. RESULTS: Of 71 included patients, 3 underwent surgery during the study year, leaving 68 patients for the analysis of 12-month outcomes. Significant improvements were noted after 12 months in the Constant score (from 40.7 at baseline to 57.7 after 6 months and 57.1 after 12 months), in each of its items except force, and in the SSV. Constant score values after 6 and 12 months were not significantly different. No significant differences in functional outcomes were found across initial tear type. CONCLUSION: Non-operative treatment produces significant functional gains in patients with irreparable massive RCTs. These gains are obtained after 6 months. Surgery can therefore be considered if the outcome is unsatisfactory after 6 months. LEVEL OF EVIDENCE: III, prospective study.
BACKGROUND: Massive rotator cuff tears (RCTs) account for 10% to 40% of all RCTs and over 80% of re-tears. The objectives of this prospective study were to assess functional outcomes 6 and 12 months after starting non-operative therapy for an irreparable massive RCT and to identify predictors of good outcomes of non-operative treatment. HYPOTHESIS: Non-operative treatment deserves to be tried because it can produce improvements in patients with irreparable massive RCTs. MATERIAL AND METHODS: A prospective multicenter (12 centres) study was conducted between March 2015 and March 2016. Consecutive patients managed non-operatively for RCTs involving two or more tendons including one with a fatty infiltration score greater than 2 were included. Non-operative treatment consisted in rehabilitation and sub-acromial corticosteroid injections. Functional outcomes were assessed based on the Constant score and Subjective Shoulder Value (SSV) after 3, 6, and 12 months. RESULTS: Of 71 included patients, 3 underwent surgery during the study year, leaving 68 patients for the analysis of 12-month outcomes. Significant improvements were noted after 12 months in the Constant score (from 40.7 at baseline to 57.7 after 6 months and 57.1 after 12 months), in each of its items except force, and in the SSV. Constant score values after 6 and 12 months were not significantly different. No significant differences in functional outcomes were found across initial tear type. CONCLUSION: Non-operative treatment produces significant functional gains in patients with irreparable massive RCTs. These gains are obtained after 6 months. Surgery can therefore be considered if the outcome is unsatisfactory after 6 months. LEVEL OF EVIDENCE: III, prospective study.