Results of surgical repair of rotator cuff tears

Seventythree patients with a rotator cuff tear who underwent surgery for repair of the lesion were studied prospectively. Based on the degree of active elevation of the shoulder (AES) and hypotrophy of the rotator muscles, the patients were distinguished in 4 groups: A (AES>100°); B (AES between 60° and 100°); C (AES<60°); D (AES<100° and marked muscle hypotrophy). At surgery, based on the size of the cuff tear, 4 degrees of lesion were identi- fied: I (<2cm.); II (2-4 cm.); III (>4 cm., but repairable); IV (not repair- ble). The results, evaluated after a mean time of 2.3 years from surgery (range, 1- 7 years), were correlated to various factors, including the preope- rative clinical findings, the size of the tear, the type of lesion (rupture or avulsion) and the presumable etiology, traumatic or degenerative, of the tear. The overall results were satisfactory in 73% of the cases. Significant differences, however, were found depending clinical findings and the size of the lesion. The proportion of satisfactory results showed a progressive decrease from group A (88%) to group D (14%). The results were satisfactory in 88% and 89% of patients with a grade I and grade II lesion, respectively, in 56% of patients with a grade III lesion and in none of those with a grade IV lesion. The results of surgical repair of cuff tears are satisfactory in almost all patients with an active elevation of the shoulder greater than 60° and a small or medium size tear. Of the patients with an active elevation inferior to 60° and a large tear, less than two thirds obtain a satisfactory result. The results are mostly unsatisfactory when the tear is non repairable or in the presence of marked hypotrophy of the rotator muscles. In the latter patients and in those in whom a non repairable lesion is suspected, a nuscle transfer procedure should be considered and planned before surgery.