Results of surgery afetr failed attempt at repair of irreparable rotator cuff tears

Aims Numerous studies have analyzed the outcomes of surgery in massive cuff tears, but very little is known on the results of open surgery aimed at repairing a rupture which, at surgery, is found to be truly irreparable. Methods 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 or insufficient or both, were followed 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 for one, had mild to severe pain and the mean active forward flexion, abduction and external rotation were 75°, 61° and 22°, respectively. Results After surgery, of the 11 patients who had shoulder pain preoperatively, 10 reported partial relief of pain and one was painfree. However, shoulder function deteriorated in 11 patients and remained unchanged in one who had a pseudoparalytic shoulder before and after surgery. The mean postoperative values of forward flexion, abduction and external rotation were 49°, 43° and 16°, 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 an unsatisfactory functional result. Conclusions 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, no open surgery should be done or alternative procedures should be planned before surgery.