The results of operative repairs of chronic tears of the rotator cuff in 28 patients were reviewed retrospectively. The mean follow-up time was 18 months. All the patients had failed to respond to conservative treatment and had persistent pain, weakness or loss of active motion. The average age at the time of repair was 59 years (range 42 to 73 years) . The tear of the rotator cuff was classified according to its defect size. There were small tears (2 centimeters or less) in 12 shoulders, large tears (greater than 2 centimeters) in 10 shoulders, and degenerative extensive tear in 6 shoulders.
The type of repair performed was dependent on the direction tissue was torn in and the amount of loss of tendon substance. In 12 shoulders, repair was attempted by suturing tendon to tendon. MacLaughlin's procedure was done in 10 shoulders. In the 6 degenerative extensive tears, the trapezius muscle was transferred under the acromion to the humeral head in 5 shoulders and the deltoid muscle was transferred in one shoulder. In addition, anterior acromioplasty was performed in all patients to decompress the subacromial space.
There was slight pain in 6 shoulders and moderate pain in 3 shoulders postoperatively, although all patients had persistent pain on motion preoperatively. The average range of motion improved 33 degress in flexion and 40 degrees in abduction, though the external rotation was not improved much. Muscular strength recovered to about 80% of the sound side except in the cases with a degenerative extensive tear. In them muscular strength was 33.2% of the sound side.
According to Wolfgang's rating system, the results were excellent or good in 85.6% (24 patients) and fair or poor in 14.4% (4 patients) .
Our arthroscopic research showed that elderly patients with a large and long standing tear had advaced degenerative changes in other shoulder structures. In such patients rotator cuff repair should be considered to be shoulder joint reconstruction. And further the exact shoulder pathomechanics in degenerative extensive tears should be understood so as to obtain better results. The treatment of degenerative extensive tear with respect to cuff tear arthropathy is now so difficult that it's surgical repair requires careful consideration and better surgical procedures for it should be developed.
