The Results of Surgical Treatment for Rotatoe Cuff Tear

Abstract

We have treated the patients with rotator cuff tear by McLaughlin' s procedure along with a partial lateral acromionectomy and resection of the coraco-acromial ligament. The purpose of this study is to investigate the influecing factors on the postoperative results of rotator cuff tear treated by this method.
122 shoulders were followed up for 6 months to 12 years (average 47 months). There were 10 5 males and 13 females with an average age of 54 years. McLaughlin's procedure was performed in 118 shoulders and patch graft procedures were done in rest 4 patients. We evaluated the pre and post-operative results according to the shoulder evaluation sheet of the Japanese Orthopaedic Asociation (JOA score). In all the patients size of the tear, age at operation, time between the onset and operation, preoperative JOA score ane presence of shoulder contracture before operation were investigated. There were partial or small tear in 25 shoulders,55 medium tears and rest 42 shoulders had large tears.
The average postoperative JOA score for partial or small tear, medium and la rge tears were 92.5,92.1 and 88.0 points respectively. There were statistically significant differrences between the large tear with the rest 2 types. Postoperative JOA score showed no correlation with the age at operation, preoperative JOA score, time betwen the onset and operation, follow-up period and presence of shoulder contracture before operation.6 patients had poor results with postoperative JOA score lower than 80points.5 of them had large tears and rest one had small tear.4 out of these 5 large tear cases showed rerupture of the rotator cuff by MRI or arthrographic examination. Therefore, in large tears due to degenerative changes and the large gap, forceful pulling of the rotator cuff during operation may cause rerupture. Postoperatively 3 cases with large tear and 2 cases of medium tear had transient brachial plexus palsy. The cause of this transient brachial palsy was thought to be due to horizontal abduction position of the arm or compression of the plexas by the casting material. Therefore, to avoid this complication, care must be taken while casting the patient in zero position postoperatively.