Results of surgery after failed attempt at repair of irreparable rotator cuff tear

Twelve patients who had surgery to repair a rotator cuff tear, which could not be repaired because the residual tendon tissue was of poor quality, insufficient, or both, were followed up for a mean of 33 months. At surgery, the deltoid was detached from the acromion for 4 to 6 cm and an acromioplasty was done. Preoperatively, all patients except one had mild to severe pain. The mean active forward flexion, abduction, and external rotation were 75 degrees, 61 degrees, and 22 degrees, respectively. After surgery, of the 11 patients who had shoulder pain preoperatively, 10 reported partial relief of pain and one was pain-free. However, shoulder function deteriorated in 11 patients and remained unchanged in one patient who had a pseudoparalytic shoulder before and after surgery. The mean postoperative values of forward flexion, abduction, and external rotation were 49 degrees, 43 degrees, and 16 degrees, respectively. Only one patient was satisfied with the result of surgery because of pain relief. Two patients had repeat surgery (total shoulder replacement or latissimus dorsi transfer) 6 and 4 months after the index surgery because of unsatisfactory functional results. Attempts at open repair of an irreparable cuff tear should be avoided because functional results generally are poor. When there is a risk that an irreparable tear will be found, open surgery should not be done or alternative procedures should be planned before surgery.