The acromion-splitting approach for large and massive rotator cuff tears.

A retrospective review of 42 patients in whom a rotator cuff injury was diagnosed and who subsequently underwent surgery with the superior acromion-spitting approach technique was conducted. The average size of the tear was 4.2 cm with an average tear retraction of 4.1 cm. Thirty-seven (38 shoulders) of the 42 patients underwent a physical examination, interview, and radiographs at an average followup of 33.4 months (range, 15 to 66). Using the University of California, Los Angeles Shoulder Rating Scale, 27 shoulders were graded as excellent or good, and 11 shoulders were graded as fair or poor. Radiographic examination demonstrated bony union in 29 shoulders. The remaining 9 shoulders had evidence of fibrous union that could be characterized as clinically asymptomatic. Twenty patients had computed tomography scans that demonstrated decompression where the bony or fibrous union had occurred. In addition, some increased decompression in several patients with fibrous union indicated that the anterior acromion sought its appropriate level. Based on the results of this study, the acromion-splitting approach, used as an extension of the miniapproach for rotator cuff tears, can be successfully used when a large or massive rotator cuff tear is identified.