IRREPARABLE CUFF TEARS
Acromioplasty
Subacromial decompression:
- “…adequate subacromial decompression is mandatory in obtaining a successful outcome” [Rockwood and Burkhead, Orthop 1988; Ellman, Arthroscopy 1993; Burkhart, Orthop Clin 1993]
- Coracoacromial arc is a passive stabilizer against antero superior translation [Lazarus, J Shoulder Elbow Surg 1996; Warren, J Shoulder Elbow Surg 1996]
- no subacromial decompression in cuff deficiency
Role of the long head of biceps tendon in a cuff deficient shoulder:
- Depressor function
- Pain generator
- Arthroscopic tenotomy
[Kido et al., J Bone Surg 2000; Kempf et al., Arthroscopy 1999; Walch et al., ICSS 1998]
Results of isolated tenotomy of the long head of the biceps tendon for massive RC-Tears:
- 83% good and excellent (adjusted Constant Score)
- 85% satisfactory rate
- LHB tenotomy is a palliative procedure that leads to relief of pain at rest [Walch et al., ICSS 1998]
Tenotomy or tenodesis of the long head of biceps tendon?
No difference in cosmetic appearance
- Grade of muscle spasm
- Anterior shoulder pain
- LHB tenotomy is an reasonable alternative to biceps tenodesis [Osbahr et al., Arthroscopy 2002]
REVERSED SUBACROMIAL DECOMPRESSION:
- Less invasive procedure for patients with “functional massive RC-tears
- Preserves the coracoacromial arc
- “…proper patient selection is mandatory for a successful outcome” [Ellman, Orthop Trans 1989; Levy, Arthroscopy 1991; Burkat, Orthop Clin 1993, Kempf, Arthroscopy 1999]
Indications:
- Old patient
- Low functional demand
- Unsuccessful conservative treatment
- Main symptoms: pain, sufficient function
- Fast rehabilitation
Contraindications:
Subscapularis tendon tear
Technique:
- Debridement
- - “…remove the aggressive agent (bursa, synovium) in order to recover the patients previous status of painlessness.” [Kelberine, The Cuff 1997]
- Tenotomy of the long head of biceps tendon
- Tuerculoplasty
NO ACROMIOPLASTY
Results:
- 100% pain relief: 68% painfree (mean follow-up 40 months)
- 86% good and excellent results in adjusted Constant Score
- No improvement of strength
- Osteoarthritic increased, but never by more than one stage (Samilson) [Scheibel et al., J Shoulder Elbow Surg 2004]
