Early Rotator Cuff Surgery Yields Good Long-Term Outcomes
Early surgery to repair isolated supraspinatus tears provides lasting improvement in strength, function, and other outcomes by preventing later rotator cuff muscle degeneration, according to study from a French orthopedic surgery research group. The study was recently published in The Journal of Bone & Joint Surgery.
The researchers identified 511 patients at 15 French hospitals who underwent surgery in 2003 to repair isolated, full-thickness supraspinatus tears. At least 10 years later, 288 patients returned for follow-up evaluation, including magnetic resonance imaging (MRI) scans in 210 patients. Average age at the time of surgery was 56.5 years, with nearly equal numbers of women and men.
The results suggested substantial improvement in most patients. The average Constant score – a standard assessment accounting for shoulder motion, strength, daily activities, and pain – improved from approximately 52 (out of a possible 100) before surgery to 78 at 10 years of follow-up. Key patient-rated outcomes also showed meaningful improvement.
The MRI scans showed healing in more than 80% of tendons, although most had at least a minor residual tear. The MRI evidence of tendon healing was closely related to the Constant score, especially in terms of strength.
Healing and recovery were not as good in patients who had MRI evidence of fat accumulation within the repaired supraspinatus muscle, a sign of muscle degeneration. Outcomes were similar for patients who had open versus arthroscopic surgery. The degree of preoperative retraction of the torn muscle was not a major factor affecting the 10-year outcomes.
Most rotator cuff tears start within the supraspinatus tendon, and previous studies have shown improved outcomes after supraspinatus repair. “However, there is no consensus on the management of such tears because of a lack of long-term outcome studies,” the authors write.
They note some limitations of their study, especially the fact that many patients were not available for follow-up. But long-term data on this still-large number of patients enables “reliable analysis of repair integrity and longevity” after isolated supraspinatus repair.
Collin P, Kempf JF, Mole D, et al. Ten-year multicenter clinical and MRI evaluation of isolated supraspinatus repairs. J Bone Joint Surg Am. 2017 Aug 16;99(16):1355-1364. doi: 10.2106/JBJS.16.01267.