Outcome of Rotator Cuff Repair in Large-to-Massive Tear With Pseudoparalysis - A Comparative Study With Propensity Score Matching

References: Am J Sports Med July 2011 vol. 39 no. 7 1413-1420

Background: Active range of motion deficit is one of the alleged negative influencing factors of rotator cuff repair. Recently, with the popularity of reverse total shoulder arthroplasty (RTSA), there is a tendency toward performing RTSA in cases of nonarthritic large-to-massive tears with pseudoparalysis.

Hypothesis: Rotator cuff repair in patients with active motion deficit may yield inferior outcome.

Study Design: Cohort study; Level of evidence, 3.

Methods: Among 195 complete repairs of large-to-massive rotator cuff tears, 35 patients experienced painful pseudoparalysis preoperatively. Propensity score matching (1-to-1) was performed between pseudoparalytic and nonpseudoparalytic groups. Finally, 29 patients in each group were matched using the following variables: age, gender, dominance, onset period, aggravation period, number of tendons involved, retraction, operation method (arthroscopic or mini-open), rows of repair (single or double), number of anchors, and fatty degeneration of the supraspinatus, infraspinatus, and subscapularis. At least 1 year after surgery (mean, 30.5 months), range of motion, visual analog scale for pain and satisfaction, Constant score, Simple Shoulder Test, American Shoulder and Elbow Surgeons (ASES) score, and University of California, Los Angeles shoulder rating scale (UCLA score) were evaluated. Healing of repaired cuffs was evaluated by computed tomography arthrography.

Results: Range of motion was improved in both groups after rotator cuff repair. Active forward elevation had significantly improved postoperatively in the pseudoparalytic group (P < .001). All functional outcome scores improved at the final follow-up visit compared with preoperative values (all P < .05). Preoperative Constant, ASES, and UCLA scores were significantly inferior in the pseudoparalytic group, but all except the Constant score showed no differences between the 2 groups at the final follow-up (P = .04). Postoperatively, 7 patients (24.1%) in the pseudoparalytic and 1 (3.4%) in the nonpseudoparalytic group showed pseudoparalysis (P = .03). Among 37 patients who underwent postoperative computed tomography arthrography, cuff healing was achieved in 6 of 18 (33.3%) in the pseudoparalytic and 9 of 19 (47.4%) in the nonpseudoparalytic group (P = .385).

Conclusion: Recovery from pseudoparalysis after rotator cuff repair was evident in a large portion of the study group, and postoperative function and cuff healing were not different according to the presence of pseudoparalysis. Considering possible complications and longevity of RTSA, rotator cuff repair should be the first-line treatment option for large-to-massive tears.